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Feature Article

For Veterans with PTSD, substance abuse increases mortality risk

Posttraumatic stress disorder (PTSD) has been linked to an increased risk of death in those who have developed the condition. A new VA study has found that Veterans with PTSD who also have problems with drugs or alcohol abuse face an even higher risk of death, providing important information for VA and other physicians who treat patients with both issues.

The study, published Sept. 10, 2012, in the journal Drug and Alcohol Dependence, looked at nearly 275,000 Veterans who received health care from VA during fiscal year 2004.i The study team reviewed these Veterans' follow up care from Fiscal Year 2005 through 2007 to determine the main reasons 19,000 of them died during that two-year period.

"We found that for Veterans with PTSD, having a substance-use disorder significantly increased the risk of mortality [death] from all causes," says Kipling Bohnert, PhD, a researcher with the VA Ann Arbor Healthcare System and the University of Michigan, and the study's lead author.

Previous research on Veterans has linked PTSD with higher risk of death. Other studies of Veterans have found that developing PTSD increases the risk of developing a substance-use disorder. Finally, substance-use disorders have been associated with an excess risk of death among those with psychiatric disorders in general. Few studies, though, have focused directly on the three-way link among substance-use disorders, PTSD, and mortality.

While the researchers found a significant link between substance-use disorders and death in Veterans with PTSD of all ages, they found that the association was most pronounced for younger Veterans (those aged 45 and under), including those who had served in Iraq and Afghanistan. Younger Veterans showed a particularly strong link between substance-use disorders and both injury and non-injury related death.

According to the paper's senior author, Frederic C. Blow, PhD, "In theory, a treatment program that addresses both issues—substance use and PTSD—should reduce the risk of death from all causes, and this may be true especially for the nation's youngest Veterans."

Blow is the director of the Serious Mental Illness Treatment Research and Evaluation Center at the Ann Arbor VA and a professor at the University of Michigan.

Currently, VA treatments for PTSD include cognitive behavioral therapy; exposure therapy; group and family therapy, eye movement desensitization; and medication. VA currently supports a wide range of PTSD studies, including biological investigations, clinical research, small interventional trials, and large multisite cooperative studies. VA researchers are also focusing on substance use disorders, looking at various potential approaches to understand, treat and prevent such disorders.

i KM Bohnert, MA Ilgen, CS Rosen, RA Desai, K Austin, FC Blow, "The association between substance use disorders and mortality among a cohort of Veterans with posttraumatic stress disorder: Variation by age cohort and mortality type. Drug Alcohol Depend. (2012), http:/

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