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Pogoda TK, Adams RS, Carlson KF, Dismuke-Greer CE, Amuan M, Pugh MJ. Risk of Adverse Outcomes Among Veterans Who Screen Positive for Traumatic Brain Injury in the Veterans Health Administration But Do Not Complete a Comprehensive Evaluation: A LIMBIC-CENC Study. J Head Trauma Rehabil 2024; 39:171-182. [PMID: 37335204 PMCID: PMC10728337 DOI: 10.1097/htr.0000000000000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To examine whether post-9/11 veterans who screened positive for mild traumatic brain injury (mTBI) but did not complete a Comprehensive TBI Evaluation (CTBIE) were at higher risk of subsequent adverse events compared with veterans who screened positive and completed a CTBIE. Upon CTBIE completion, information assessed by a trained TBI clinician indicates whether there is mTBI history (mTBI+) or not (mTBI-). SETTING Veterans Health Administration (VHA) outpatient services. PARTICIPANTS A total of 52 700 post-9/11 veterans who screened positive for TBI were included. The follow-up review period was between fiscal years 2008 and 2019. The 3 groups studied based on CTBIE completion and mTBI status were: (1) mTBI+ (48.6%), (2) mTBI- (17.8%), and (3) no CTBIE (33.7%). DESIGN This was a retrospective cohort study. Log binomial and Poisson regression models adjusting for demographic, military, pre-TBI screening health, and VHA covariates examined risk ratios of incident outcomes based on CTBIE completion and mTBI status. MAIN MEASURES Incident substance use disorders (SUDs), alcohol use disorder (AUD), opioid use disorder (OUD), overdose, and homelessness documented in VHA administrative records, and mortality as documented in the National Death Index, 3 years post-TBI screen. VHA outpatient utilization was also examined. RESULTS Compared with the no CTBIE group, the mTBI+ group had 1.28 to 1.31 times the risk of incident SUD, AUD, and overdose, but 0.73 times the risk of death 3 years following TBI screening. The mTBI- group had 0.70 times the risk of OUD compared with the no CTBIE group within the same period. The no CTBIE group also had the lowest VHA utilization. CONCLUSIONS There were mixed findings on risk of adverse events for the no CTBIE group relative to the mTBI+ and mTBI- groups. Future research is needed to explore the observed differences, including health conditions and healthcare utilization, documented outside VHA among veterans who screen positive for TBI.
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Affiliation(s)
- Terri K Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts (Dr Pogoda); Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts (Drs Pogoda and Adams); VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado (Dr Adams); Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, and Epidemiology, Oregon Health and Science University-Portland State University School of Public Health, Oregon Health and Science University, Portland (Dr Carlson); Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California (Dr Dismuke-Greer); Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah (Ms Amuan and Dr Pugh); and Department of Internal Medicine, Division of Epidemiology, University of Utah Spence Fox Eccles School of Medicine, Salt Lake City (Dr Pugh)
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Tower S, Banaag A, Adams RS, Janvrin ML, Koehlmoos TP. Analysis of Alcohol Use and Alcohol Use Disorder Trends in U.S. Active-Duty Service Women. J Womens Health (Larchmt) 2024. [PMID: 38682265 DOI: 10.1089/jwh.2023.0497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
Introduction: Alcohol use (AU) and disorders (AUDs) have been increasing among women over the past decade, with the largest increases among women of child-bearing age. Unprecedented stressors during the COVID-19 pandemic may have impacted AU for women with and without children. Little is known about how these trends are impacting women in the military. Methods: Cross-sectional study of active-duty service women (ADSW) in the U.S. Army, Air Force, Navy, and Marine Corps during fiscal years (FY) 2016-2021. We report the prevalence of AU and AUD diagnoses by FY, before/during the COVID-19 pandemic (2016-2019; 2020-2021, respectively), and by parental status. Log-binomial and logistic regressions examined associations of demographics, military, and family structure characteristics, with AU and AUD, during pre-COVID-19 and COVID-19 timeframes. Results: We identified 281,567 ADSW in the pre-COVID-19 period and 237,327 ADSW in the during COVID-19 period. The prevalence of AU was lower during the COVID-19 period (47.9%) than during the pre-COVID-19 period (63.0%); similarly, the prevalence of AUD was lower during the COVID-19 period (2.7%) than during the pre-COVID period (4.0%). ADSW with children had larger percentage decreases during the COVID-19 period. ADSW with children had a consistently lower prevalence and odds of AUD compared with ADSW without children in the pre- and during COVID-19 periods. Conclusion: Decreasing trends in AU and AUD among ADSW were unexpected. However, the prevalence of AU and AUD may not have been accurately captured during the COVID-19 period due to reductions in access to care. Continued postpandemic comparison of AU/AUD among women by parental status and demographic factors may guide targeted health efforts.
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Affiliation(s)
- Stephanie Tower
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Amanda Banaag
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, USA
| | - Rachel Sayko Adams
- Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, Massachusetts, USA
| | - Miranda Lynn Janvrin
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, USA
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Adams RS, Forster JE, Gradus JL, Hoffmire CA, Hostetter TA, Larson MJ, Smith AA, Walsh CG, Brenner LA. Divergent trends in accidental deaths since return from an Afghanistan/Iraq deployment among army soldiers. Ann Epidemiol 2024; 91:23-29. [PMID: 38185289 DOI: 10.1016/j.annepidem.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 01/09/2024]
Abstract
PURPOSE Accidental death is a leading cause of mortality among military members and Veterans; however, knowledge is limited regarding time-dependent risk following deployment and if there are differences by type of accidental death. METHODS Longitudinal cohort study (N = 860,930) of soldiers returning from Afghanistan/Iraq deployments in fiscal years 2008-2014. Accidental deaths (i.e., motor vehicle accidents [MVA], accidental overdose, other accidental deaths), were identified through 2018. Crude and age-adjusted mortality rates, rate ratios, time-dependent hazard rates and trends postdeployment were compared across demographic and military characteristics. RESULTS During the postdeployment observation period, over one-third of deaths were accidental; most were MVA (46.0 %) or overdoses (37.9 %). Across accidental mortality categories (all, MVA, overdose), younger soldiers (18-24, 25-29) were at higher risk compared to older soldiers (40+), and females at lower risk than males. MVA death rates were highest immediately postdeployment, with a significant decreasing hazard rate over time (annual percent change [APC]: -6.5 %). Conversely, accidental overdose death rates were lowest immediately following deployment, with a significant increasing hazard rate over time (APC: 9.9 %). CONCLUSIONS Observed divergent trends in risk for the most common types of accidental deaths provide essential information to inform prevention and intervention planning for the immediate postdeployment transition and long-term.
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Affiliation(s)
- Rachel Sayko Adams
- Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, MA, USA; Brandeis University, The Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA, USA; Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA.
| | - Jeri E Forster
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA; University of Colorado, Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, Aurora, CO, USA
| | - Jaimie L Gradus
- Boston University School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - Claire A Hoffmire
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA; University of Colorado, Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, Aurora, CO, USA
| | - Trisha A Hostetter
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA
| | - Mary Jo Larson
- Brandeis University, The Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA, USA
| | - Alexandra A Smith
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA
| | - Colin G Walsh
- Vanderbilt University Medical Center, Departments of Biomedical Informatics, Medicine, and Psychiatry, Nashville, TN, USA
| | - Lisa A Brenner
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA; University of Colorado, Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, Aurora, CO, USA; University of Colorado, Departments of Psychiatry and Neurology, Anschutz Medical Campus, Aurora, CO, USA
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Gray JC, Larson MJ, Moresco N, Dufour S, Ritter GA, DeLeon PD, Milliken CS, Vest N, Adams RS. Healthcare utilization and readiness outcomes among soldiers with post-deployment at-risk drinking, by multimorbidity class. Alcohol 2024; 114:31-39. [PMID: 37619959 PMCID: PMC10881892 DOI: 10.1016/j.alcohol.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/08/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023]
Abstract
Although alcohol use disorder (AUD) regularly co-occurs with other conditions, there has not been investigation of specific multimorbidity classes among military members with at-risk alcohol use. We used latent class analysis (LCA) to cluster 138,929 soldiers with post-deployment at-risk drinking based on their co-occurring psychological and physical health conditions and indicators of alcohol severity. We examined the association of these multimorbidity classes with healthcare utilization and military readiness outcomes. Latent class analysis was conducted on 31 dichotomous indicators capturing alcohol use severity, mental health screens, psychological and physical health diagnoses, and tobacco use. Longitudinal survival analysis was used to examine the relative hazards of class membership regarding healthcare utilization (e.g., emergency department visit, inpatient stay) and readiness outcomes (e.g., early separation for misconduct). Latent class analysis identified five classes: Class 1 -Relatively Healthy (51.6 %); Class 2 - Pain/Tobacco (17.3 %); Class 3 - Heavy Drinking/Pain/Tobacco (13.1 %); Class 4 - Mental Health/Pain/Tobacco (12.7 %); and Class 5 - Heavy Drinking/Mental Health/Pain/Tobacco (5.4 %). Musculoskeletal pain and tobacco use were prevalent in all classes, though highest in Classes 2, 4, and 5. Classes 4 and 5 had the highest hazards of all outcomes. Class 5 generally exhibited slightly higher hazards of all outcomes than Class 4, demonstrating the exacerbation of risk among those with heavy drinking/AUD in combination with mental health conditions and other multimorbidity. This study provides new information about the most common multimorbidity presentations of at-risk drinkers in the military so that targeted, individualized care may be employed. Future research is needed to determine whether tailored prevention and treatment approaches for soldiers in different multimorbidity classes is associated with improved outcomes.
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Affiliation(s)
- Joshua C Gray
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, Bethesda, MD 20814, United States.
| | - Mary Jo Larson
- Brandeis University, Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA 02453, United States
| | - Natalie Moresco
- Brandeis University, Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA 02453, United States
| | - Steven Dufour
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, Bethesda, MD 20814, United States; Naval Medical Center Portsmouth, Portsmouth, VA 23708, United States
| | - Grant A Ritter
- Brandeis University, Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA 02453, United States
| | - Patrick D DeLeon
- Walter Reed National Military Medical Center, Bethesda, MD 20814, United States
| | - Charles S Milliken
- Army's Substance Use Disorder Clinical Care, Office of the Army Surgeon General, Defense Health Headquarters, 7700 Arlington Blvd., Falls Church, VA 22042, United States
| | - Noel Vest
- Boston University School of Public Health, Department of Community Health Sciences, Boston, MA 02118, United States
| | - Rachel Sayko Adams
- Brandeis University, Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA 02453, United States; Boston University School of Public Health, Department of Health Law, Policy & Management, Boston, MA 02118, United States; Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO 80045, United States
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Koehlmoos TP, Lee E, Wisdahl J, Donaldson T. Fetal alcohol spectrum disorders prevention and clinical guidelines research-workshop report. BMC Proc 2023; 17:19. [PMID: 37580722 PMCID: PMC10426045 DOI: 10.1186/s12919-023-00272-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
It is estimated that up to 1 in 20 people in the United States are affected by fetal alcohol spectrum disorders (FASD), an array of cognitive, emotional, physical and social disorders caused by exposure to alcohol during prenatal development. Common diagnoses encompassed within FASD include mood and behavioral disorders, memory and central nervous system deficits, attention-deficit/hyperactivity disorder (ADHD), slow growth and low body weight. While this condition affects a broad range of individuals and families, it is of particular concern in the military community, where cultural factors including an increased prevalence of alcohol misuse pose a unique set of challenges. To shed light on these issues and provide an overview of the existing research, programs, and clinical practice guidelines surrounding FASD, the Uniformed Services University of the Health Sciences (USUHS), in conjunction with FASD United, hosted the Workshop on Fetal Alcohol Spectrum Disorders Prevention and Clinical Guidelines Research on 21 September 2022 in Washington, DC. More than 50 attendees from academia, healthcare, federal agencies, and consumer advocacy organizations gathered to share research findings, lived experiences, and strategies for improving FASD prevention, diagnosis, interventions, and support.The workshop began with a series of presentations on FASD risk factors and causes, strategies for diagnosis and interventions, and impacts and lived experiences. Individuals and families affected by FASD spoke about the ways FASD, its symptoms, and the social stigma associated with it influences their daily lives, experiences at school and work, and access to healthcare. Several speakers highlighted the work of non-profit organizations and advocacy groups in supporting families affected by FASD and other challenges faced by military families more broadly. The workshop closed with a discussion of federal agency perspectives highlighting initiatives aimed at advancing research and access to care for women and families at-risk and those currently affected by FASD.
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Affiliation(s)
- Tracey Pérez Koehlmoos
- Center for Health Services Research, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA
| | - Elizabeth Lee
- Department of Pediatrics, Division of Pediatric Health Systems Research and Clinical Epidemiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Building 61 Room E225, Bethesda, MD 20814 USA
| | - Jennifer Wisdahl
- FASD United, 1200 Eton Ct NW, 3rd Floor, Washington, DC 20007 USA
| | - Tom Donaldson
- FASD United, 1200 Eton Ct NW, 3rd Floor, Washington, DC 20007 USA
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Duffy FF, Sudom K, Jones M, Fear NT, Greenberg N, Adler AB, Hoge CW, Wilk JE, Riviere LA. Calibrating the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) for detecting alcohol-related problems among Canadian, UK and US soldiers: cross-sectional pre-deployment and post-deployment survey results. BMJ Open 2023; 13:e068619. [PMID: 37130676 PMCID: PMC10163557 DOI: 10.1136/bmjopen-2022-068619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Excessive alcohol use can bring about adverse health and work-related consequences in civilian and military populations. Screening for excessive drinking can help identify individuals at risk for alcohol-related problems who may require clinical interventions. The brief validated measures of alcohol use such as the Alcohol Use Disorders Identification Test (AUDIT), or abbreviated AUDIT-Consumption (AUDIT-C), are often included in military deployment screening and epidemiologic surveys, but appropriate cut-points must be used to effectively identify individuals at risk. Although the conventional AUDIT-C cut-points ≥4 for men and ≥3 for women are commonly used, recent validation studies of veterans and civilians recommend higher cut-points to minimise misclassification and overestimation of alcohol-related problems. This study aims to ascertain optimal AUDIT-C cut-points for detecting alcohol-related problems among serving Canadian, UK and US soldiers. DESIGN Cross-sectional pre/post-deployment survey data were used. SETTINGS Comprised Army locations in Canada and UK, and selected US Army units. PARTICIPANTS Included soldiers in each of the above-mentioned settings. OUTCOME MEASURES Soldiers' AUDIT scores for hazardous and harmful alcohol use or high levels of alcohol problems served as a benchmark against which optimal sex-specific AUDIT-C cut-points were assessed. RESULTS Across the three-nation samples, AUDIT-C cut-points of ≥6/7 for men and ≥5/6 for women performed well in detecting hazardous and harmful alcohol use and provided comparable prevalence estimates to AUDIT scores ≥8 for men and ≥7 for women. The AUDIT-C cut-point ≥8/9 for both men and women performed fair-to-good when benchmarked against AUDIT ≥16, although inflated AUDIT-C-derived prevalence estimates and low positive predictive values were observed. CONCLUSION This multi-national study provides valuable information regarding appropriate AUDIT-C cut-points for detecting hazardous and harmful alcohol use, and high levels of alcohol problems among soldiers. Such information can be useful for population surveillance, pre-deployment/post-deployment screening of military personnel, and clinical practice.
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Affiliation(s)
- Farifteh Firoozmand Duffy
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- TechWerks LLC, Arlington Heights, Illinois, USA
| | - Kerry Sudom
- Director General Military Personnel Research and Analysis, Department of National Defence, Ottawa, Ontario, Canada
| | - Margaret Jones
- King's Centre for Military Health Research, King's College London, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, King's College London, London, UK
- ADMMH, King's College London, London, UK
| | - Neil Greenberg
- King's Centre for Military Health Research, King's College London, London, UK
| | - Amy B Adler
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Charles W Hoge
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Joshua E Wilk
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Lyndon A Riviere
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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Alcover KC, Poltavskiy EA, Howard JT, Watrous JR, Janak JC, Walker LE, Stewart IJ. Post-Combat-Injury Opioid Prescription and Alcohol Use Disorder in the Military. Am J Prev Med 2022; 63:904-914. [PMID: 36127194 DOI: 10.1016/j.amepre.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/29/2022] [Accepted: 07/14/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Previous studies have identified combat exposure and combat traumatic experience as problematic drinking risk factors. Increasing evidence suggests that opioid use increases the risk of alcohol use disorder. This study investigated the association between opioid prescription use after injury and (1) alcohol use disorder and (2) severity of alcohol use disorder among deployed military servicemembers. METHODS Deidentified health records data of 9,029 deployed servicemembers from a retrospective cohort study were analyzed. Data were randomly selected from the Department of Defense Trauma Registry and included servicemembers with combat injuries during deployment in Iraq or Afghanistan (2002-2016). Pharmacy records and International Classification of Diseases, Ninth and Tenth Revision diagnosis codes were used. Three groups were identified (no opioid prescription use, nonpersistent opioid prescription use, and persistent opioid prescription use) and were compared on the basis of alcohol use disorder risk using Cox proportional hazard models. Data analyses were performed in 2021. RESULTS Of the 9,029 servicemembers with combat injury, 2,262 developed alcohol use disorder (1,322 developed severe alcohol use disorder). Compared with no opioid prescription use, increased alcohol use disorder risk was associated with persistent opioid prescription use, with a hazard ratio of 1.13 (95% CI=1.02, 1.26). After covariate adjustment, increased risk remained statistically significant (hazards ratio=1.24; 95% CI=1.10, 1.39). There was no significant difference in alcohol use disorder risk between no opioid prescription use and nonpersistent opioid prescription use. The risk of severe alcohol use disorder did not vary by opioid use among servicemembers with alcohol use disorder diagnosis. CONCLUSIONS The findings of the study suggest that the incidence of alcohol use disorder was higher among injured servicemembers with persistent opioid prescription use than among those without opioid use. If replicated in prospective studies, the findings highlight the need for clinicians to consider the current and history of alcohol use of patients in initiating treatment involving opioids.
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Affiliation(s)
- Karl C Alcover
- Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland.
| | - Eduard A Poltavskiy
- Clinical Investigation Facility, David Grant U.S. Air Force Medical Center, Travis AFB, Fairfield, California
| | - Jeffrey T Howard
- Department of Public Health, The University of Texas San Antonio, San Antonio, Texas
| | - Jessica R Watrous
- Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland
| | | | - Lauren E Walker
- Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Ian J Stewart
- Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland
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Gray JC, Larson MJ, Moresco N, Ritter GA, Dufour S, Milliken CS, Adams RS. The association of engagement in substance use treatment with negative separation from the military among soldiers with post-deployment alcohol use disorder. Drug Alcohol Depend 2021; 221:108647. [PMID: 33647586 PMCID: PMC8136466 DOI: 10.1016/j.drugalcdep.2021.108647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) reduces the health of soldiers and the readiness of the Armed Forces. It remains unknown if engagement in substance use treatment in the Military Health System improves retention in the military. METHODS The sample consisted of active duty soldiers returning from an Afghanistan/Iraq deployment in fiscal years 2008-2010 who received an AUD diagnosis within 150 days of completing a post-deployment health re-assessment survey (n = 4,726). A Heckman probit procedure was used to examine predictors of substance use treatment initiation and engagement in accordance with Healthcare Effectiveness Data and Information Set (HEDIS) criteria. Cox proportional hazard modeling was used to examine the association between treatment engagement and retention, defined as a negative separation for a non-routine cause (e.g., separation due to misconduct, poor performance, disability) from the military in the two years following the index AUD diagnosis. RESULTS 40 % of soldiers meeting HEDIS AUD criteria initiated and 24 % engaged in substance use treatment. Among soldiers diagnosed with AUD, meeting criteria for treatment engagement was associated with a significantly higher hazard of having a negative separation compared to soldiers who did not engage in treatment. CONCLUSIONS Rates of initiation and engagement in substance use treatment for post-deployment AUD were relatively low. Soldiers with AUD who engaged in substance use treatment were more likely to have a negative separation from the military than soldiers with AUD who did not engage. Our findings imply that in the study cohort, treatment did not mitigate negative career consequences of AUD.
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Affiliation(s)
- Joshua C Gray
- Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA.
| | - Mary Jo Larson
- Heller School, Institute for Behavioral Health, Brandeis University, 415 South Street MS 035, Waltham, MA, 02453, USA
| | - Natalie Moresco
- Heller School, Institute for Behavioral Health, Brandeis University, 415 South Street MS 035, Waltham, MA, 02453, USA
| | - Grant A Ritter
- Heller School, Institute for Behavioral Health, Brandeis University, 415 South Street MS 035, Waltham, MA, 02453, USA
| | - Steven Dufour
- Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Charles S Milliken
- Army's Substance Use Disorder Clinical Care, Office of the Army Surgeon General, Defense Health Headquarters, 7700 Arlington Blvd, Falls Church, VA, 22042, USA
| | - Rachel Sayko Adams
- Heller School, Institute for Behavioral Health, Brandeis University, 415 South Street MS 035, Waltham, MA, 02453, USA; Rocky Mountain Mental Illness Research Education and Clinical Center, Veterans Health Administration, 1700 N. Wheeling Street, Aurora, CO, 80045, USA
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Peters ZJ, Kincaid MW, Greenberg JG, Quah RF, Curry JC. Rates of prescription orders for United States active duty service members diagnosed with alcohol use disorder. Subst Abus 2020; 42:638-645. [PMID: 32870103 DOI: 10.1080/08897077.2020.1809604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Alcohol-use disorders (AUD) pose a significant challenge for the United States (US) military. The US Department of Defense has strongly recommended several medications for use in the treatment of patients with diagnosed AUD. This study assessed the prescription of medications for active duty service members (ADSMs) diagnosed with AUD in the US Military Health System (MHS). Methods: Rates of prescription orders were retrospectively examined from 2010 to 2017 among ADSMs with an incident diagnosis of moderate-to-severe AUD. The rate of prescription orders was defined as the proportion of ADSMs with an ICD-9 or ICD-10 diagnosis code of alcohol dependence who received an order for acamprosate, disulfiram, naltrexone, and/or topiramate at a military treatment facility in the year following their incident diagnosis. Results: ADSMs receiving an order for at least one medication in the year following their incident AUD diagnosis increased from 8.8% in 2010 to 16.2% in 2017 (RR = 1.84, 95% CI, 1.76, 1.93). Oral naltrexone was ordered most frequently among this patient population, while injectable naltrexone, a medication option meant to ease and improve adherence, was ordered for a smaller proportion of patients. Conclusions: Most ADSMs who might benefit from prescriptions for AUD are not receiving them as part of their treatment despite strong clinical evidence and Department of Defense policy support for their use among this cohort.
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Affiliation(s)
- Zachary J Peters
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA.,Salient CRGT, Inc., Fairfax, Virginia, USA
| | - Melissa W Kincaid
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA.,Salient CRGT, Inc., Fairfax, Virginia, USA
| | - Jennifer G Greenberg
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA.,Salient CRGT, Inc., Fairfax, Virginia, USA
| | - Ruth F Quah
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA.,Salient CRGT, Inc., Fairfax, Virginia, USA
| | - Justin C Curry
- Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA
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Adams RS, Garnick DW, Harris AHS, Merrick EL, Hofmann K, Funk W, Williams TV, Larson MJ. Assessing the postdeployment quality of treatment for substance use disorders among Army enlisted soldiers in the Military Health System. J Subst Abuse Treat 2020; 114:108026. [PMID: 32527513 DOI: 10.1016/j.jsat.2020.108026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/07/2020] [Accepted: 05/01/2020] [Indexed: 01/23/2023]
Abstract
Little is known about the rates and predictors of substance use treatment received in the Military Health System among Army soldiers diagnosed with a postdeployment substance use disorder (SUD). We used data from the Substance Use and Psychological Injury Combat study to determine the proportion of active duty (n = 338,708) and National Guard/Reserve (n = 178,801) enlisted soldiers returning from an Afghanistan/Iraq deployment in fiscal years 2008 to 2011 who had an SUD diagnosis in the first 150 days postdeployment. Among soldiers diagnosed with an SUD, we examined the rates and predictors of substance use treatment initiation and engagement according to the Healthcare Effectiveness Data and Information Set criteria. In the first 150 days postdeployment 3.3% of active duty soldiers and 1.0% of National Guard/Reserve soldiers were diagnosed with an SUD. Active duty soldiers were more likely to initiate and engage in substance use treatment than National Guard/Reserve soldiers, yet overall, engagement rates were low (25.0% and 15.7%, respectively). Soldiers were more likely to engage in treatment if they received their index diagnosis in a specialty behavioral health setting. Efforts to improve substance use treatment in the Military Health System should include initiatives to more accurately identify soldiers with undiagnosed SUD. Suggestions to improve substance use treatment engagement in the Military Health System will be discussed.
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Affiliation(s)
- Rachel Sayko Adams
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, USA; Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center, 1700 N. Wheeling Street, Aurora, CO 80045, USA.
| | - Deborah W Garnick
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, USA.
| | - Alex H S Harris
- VA Health Services Research & Development, Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA; Department of Surgery, Stanford University, 291 Campus Drive, Stanford, CA 94305, USA.
| | - Elizabeth L Merrick
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, USA.
| | - Keith Hofmann
- Kennell and Associates, Inc., 3130 Fairview Park Drive, Suite 450, Falls Church, VA 22042, USA.
| | - Wendy Funk
- Kennell and Associates, Inc., 3130 Fairview Park Drive, Suite 450, Falls Church, VA 22042, USA.
| | - Thomas V Williams
- NORC at the University of Chicago, 4350 E W Highway, Bethesda, MD 20814, USA.
| | - Mary Jo Larson
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, USA.
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Luk JW, LaCroix JM, Thompson MF, Darmour C, Perera KU, Goldston D, Soumoff A, Weaver J, Ghahramanlou-Holloway M. Hazardous drinking and clinical correlates among suicidal patients receiving psychiatric inpatient care at military medical settings. Addict Behav 2020; 102:106178. [PMID: 31783246 DOI: 10.1016/j.addbeh.2019.106178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/19/2019] [Accepted: 10/11/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND To describe prevalence and identify clinical correlates of hazardous drinking among suicidal inpatients at military medical settings. METHOD Data were drawn from the baseline assessment of a multisite randomized controlled trial of Post-Admission Cognitive Therapy (PACT). Participants were military Service members or adult beneficiaries (N = 218) who were admitted to inpatient care following a suicide-related crisis. Hazardous alcohol use in the past year was assessed using the Alcohol Use Disorder Identification Test (AUDIT). RESULTS The average AUDIT score was 6.78 (SD = 7.87), with 28.9% reporting hazardous drinking (scored ≥8 on the AUDIT). Hazardous drinkers were more likely than nonhazardous drinkers to meet diagnosis of Substance Use Disorder (SUD; Odds Ratio [OR] = 5.96, 95% confidence intervals [CI] = 2.13, 16.71). Hazardous drinking was neither associated with measures of suicide ideation nor aborted or interrupted suicide attempt. However, hazardous drinkers had greater risk of having both single (RRR [Relative Risk Ratio] = 2.55, 95% CI = 1.18, 5.50) and multiple actual suicide attempts (RRR = 2.38, 95% CI = 1.06, 5.32) than nonhazardous drinkers. The association between hazardous drinking and single (but not multiple) actual suicide attempt remained significant after controlling for gender, depressive symptoms, hopelessness, Post-Traumatic Stress Disorder, and SUD (adjusted RRR = 2.48, 95% CI = 1.09, 5.65). CONCLUSIONS A history of actual suicide attempt is associated with hazardous alcohol use among suicidal psychiatric inpatients. Assessment of drinking and drug use may inform case conceptualization and treatment of suicide-related behaviors in psychiatric inpatient settings.
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