Course of drug use from early adulthood to mid-life among Vietnam-era veterans

Substance Use in U.S. Vietnam War Era Veterans and Nonveterans: Results from the Vietnam Era Health Retrospective Observational Study

Background: Substance use (SU) is associated with physical injury and mental health disorders in older persons, but recent research has scarcely examined SU in U.S. Vietnam-era veterans who are mostly in or near their eighth decade of life. Objectives: We compared the prevalence of self-reported lifetime and current SU and modeled current usage patterns in a nationally representative sample of veterans versus a matched nonveteran cohort. Methods: Cross-sectional, self-reported survey data were analyzed from the 2016-2017 Vietnam Era Health Retrospective Observational Study (VE-HEROeS) (n = 18,866 veterans, n = 4,530 nonveterans). We assessed lifetime and current alcohol and drug use disorders; lifetime and current use of cannabis, opioids, stimulants, sedatives, "other drugs" (psychedelics, prescription or over-the-counter drugs not prescribed/used as intended); and current SU patterns (alcohol-use-only, drug-use-only, dual-SU, no SU). Weighted descriptive, bivariable, and multivariable statistics were calculated. Covariates in multinomial modeling included sociodemographic characteristics, lifetime cigarette smoking, depression, potentially traumatic events (PTEs), and current pain (SF-8^TM). Results: Prevalence of lifetime opioid and sedative use (p ≤ .01), drug and alcohol use disorders (p < .001), and current "other drug" use (p < .001) were higher in veterans versus nonveterans. Current use of alcohol and cannabis was high in both cohorts. In veterans, very severe/severe pain, depression, and PTEs were highly associated with drug-use-only (p < .001) and dual-SU (p < .01), but these associations were fewer for nonveterans. Conclusion: This research confirmed existing concerns over substance misuse in older individuals. Vietnam-era veterans may be at particular risk due to service-related experiences and later-life tribulations. Era veterans' unique perceptions toward healthcare assistance for SU may need greater provider focus to maximize self-efficacy and treatment.

Heterogeneity in the Development of Drug Use Versatility: Risk Factors for Polydrug Use throughout the Life-Course

BACKGROUND

Polydrug use is a major public health issue associated with numerous undesirable physical and mental health outcomes. While past research has identified risk factors for polydrug use and elevated drug use variety, there has yet to be any research which seeks to examine this phenomenon from a developmental perspective. There also has yet to be any research which examines the impact of risk factors for predicting differential development.

OBJECTIVES

Identify developmental subgroups of polydrug use. Identify risk factors predicting heterogeneity in development.

METHODS

The Pathways to Desistance data were used in this research. The present study used group-based trajectory modeling to elucidate general developmental patterns of drug use variety and sought to identify risk factors predicting the heterogeneity in the development of this outcome using multinomial logistic regression among a sample of juvenile offenders.

RESULTS

A six group model best fit the drug use variety count data. Several risk factors were identified which predicted assignment to the most problematic developmental subgroup, including: low self-control, low religiosity, and history of victimization at baseline. White participants were more likely to engage in any level of drug use. Conclusions/Importance: These results indicate that juvenile offenders are at-risk for chronic issues with polydrug use and more general engagement in polydrug use. Public health and criminal justice professionals should work together to develop and implement psychosocial interventions for targeting risk factors associated with accelerating and chronic polydrug use.

Illicit Stimulant Use Development in Adolescence and Early Adulthood Among Juvenile Offenders: Risk Factors Predicting Heterogeneity

The objectives of this article are to identify groups of trajectories of stimulant use across adolescence and early adulthood among juvenile offenders and to identify risk factors predicting development. Group-based trajectory modeling was used to identify developmental subgroups of stimulant users during the study period. Multinomial logistic regression was used to examine baseline covariates’ relevance for predicting assignment to identified trajectory groups. A six-group model of stimulant use was found to best fit the data. Race, history of direct victimization at baseline, gender, low school commitment at baseline, low religiosity at baseline, and other substance use at baseline were all identified as predictors of trajectory group assignment. Juvenile offenders, particularly White and female offenders, are at elevated risk of illicit stimulant use during adolescence and early adulthood. Despite this, the vast majority of juvenile offenders in the sample had desisted by age 23, differing from research on other substances using this same sample.

"It's Not Much of a Life": The Benefits and Ethics of Using Life History Methods With People Who Inject Drugs in Qualitative Harm Reduction Research

A life history approach enables study of how risk or health protection is shaped by critical transitions and turning points in a life trajectory and in the context of social environment and time. We employed visual and narrative life history methods with people who inject drugs to explore how hepatitis C protection was enabled and maintained over the life course. We overview our methodological approach, with a focus on the ethics in practice of using life history timelines and life-grids with 37 participants. The life-grid evoked mixed emotions for participants: pleasure in receiving a personalized visual history and pain elicited by its contents. A minority managed this pain with additional heroin use. The methodological benefits of using life history methods and visual aids have been extensively reported. Crucial to consider are the ethical implications of this process, particularly for people who lack socially ascribed markers of a "successful life."