Study tracks drug, alcohol use in OEF/OIF Veterans using VA

Stormy seas—A VA study found that some 11 percent of OEF/OIF Veterans enrolled in VA care had an alcohol or drug use diagnosis, and that these diagnoses were strongly linked to PTSD and depression. Here, a sailor stands watch on the USS Carl Vinson in the Arabian Sea in November 2010. (Photo by MC2 James R. Evans/U.S. Navy)

Reviewing data on more than 456,000 Iraq and Afghanistan Veterans who enrolled in VA health care between 2002 and 2009, a team with VA and the University of California, San Francisco, found that around 11 percent of the patients had received a diagnosis of an alcohol or drug use disorder.

About 1 in 10 Veterans had an alcohol use disorder and 1 in 20 had a drug use disorder. Male sex, age under 25, never-married or divorced status, and greater combat exposure were linked with higher rates of drug and alcohol disorders.

Of those with an alcohol or drug use disorder, up to three-quarters also received a diagnosis of PTSD or depression. In other terms, those with PTSD or depression were around four times more likely to have a drug or alcohol problem.

The rates found in the study were close to those seen in earlier studies of Vietnam Veterans.

Karen Seal, MD, MPH, and her colleagues say their findings support the need for "increased availability of integrated treatments that simultaneously address [alcohol and drug use disorders] in the context of PTSD and other deployment-related mental health disorders."

In a related study, published online in June in the Journal of General Internal Medicine, Seal's group tested whether an integrated primary care clinic—one that combines mental health and social services with primary care under the same roof—increased the use of those services among Iraq and Afghanistan Veterans. The study, which included 526 Veterans, compared an initial three-part visit to the integrated clinic with usual care, in which patients saw a primary care provider and received referrals for the other services as needed. Seal's team found that while the integrated clinic improved the likelihood of an initial mental health and social services evaluation for Veterans, it did not boost long-term retention in psychotherapy or other mental health care.

(Drug and Alcohol Dependence, July 2011; Journal of General Internal Medicine, online June 7, 2011)