Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001–2010: Implications for screening, diagnosis and treatment

Abstract

Post-deployment AUD and DUD diagnoses were more prevalent in subgroups of Iraq and Afghanistan veterans and were highly comorbid with PTSD and depression. Stigma and lack of universal screening may have reduced the number of DUD diagnoses reported. There is a need for improved screening and diagnosis of substance use disorders and increased availability of integrated treatments that simultaneously address AUD and DUD in the context of PTSD and other deployment-related mental health disorders.

Retrospective Analysis of Long-Term Outcomes After Combat Injury

“…An alternate hypothesis is that PTSD, which is common in combat casualties, 5 modulates this effect either directly via an inflammatory response 27 or indirectly via weight gain 28 and substance abuse. 6 However, work examining the correlation between ISS and PTSD is conflicting, 29,30 which suggests that this alone cannot account for the differences observed. It is also possible that more severely injured patients have more severe functional limitations resulting in poor outcomes.…”

“…Injuries may be associated with posttraumatic stress disorder (PTSD), 5 substance abuse, 6 functional limitations, and profound changes in the immune system and inflammatory cascade, 7 all of which might predispose veterans to the development of a wide variety of chronic medical conditions. We hypothesized that markers of injury severity would be associated with the subsequent development of HTN, CAD, DM and CKD.…”

An Interprofessional Education Project to Address Veterans’ Healthcare Needs

“…Approximately 71% of female US veterans report military sexual trauma (Murdoch, Polusny, Hodges, & O'Brien, 2004), which is associated with higher rates of PTSD in military women as compared to military men. Substance use disorders are also higher among veterans; 22-40% of veterans from the most recent wars report alcohol misuse, with 10% receiving care at a US-VHA facility and are diagnosed with an alcohol use disorder (Seal, et al, 2011). Accurately identifying and managing behavioral and physical problems among military personnel and veterans is crucial in providing competent patient-centered care.…”

Review: Managing posttraumatic stress disorder in combat veterans with comorbid traumatic brain injury

“…Data from the National Comorbidity Survey demonstrated a higher rate of cannabis use among persons with either current or lifetime diagnosis of PTSD [120]. The diagnosis of an alcohol use disorder and/or a drug use disorder was associated with PTSD in OIF/OEF veterans; 63 percent of these veterans with either alcohol or drug use disorders were diagnosed with PTSD, and 76 percent of veterans with both alcohol and drug use disorder diagnoses were found to have PTSD [121]. A community survey of nearly 10,000 veterans from the 1991 Gulf war revealed that problem alcohol use patterns were 2.7 times more likely to occur among veterans with PTSD than among veterans not diagnosed with PTSD [122].…”

“…Complicating this clinical picture is the common association of PTSD with use of substances known to interfere with sleep and behaviors that interfere with sleep. Persons with PTSD have high rates of excessive alcohol [121,134] and tobacco use [135], and for patients whose trauma occurred at night, the idea of going to sleep at night can be an intimidating experience.…”