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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3142 — Rates of Alcohol Misuse and Follow-Up Care among OEF/OIF Veterans in VA: Associations with Substance Use Disorders and PTSD

Grossbard JRHawkins EJ, and Williams EC, VA Puget Sound HSR&D, University of Washington; Rubinsky ADLapham GT, and Chavez LJ, VA Puget Sound HSR&D; Bradley KA, VA Puget Sound HSR&D, Group Health Research Institute;

Objectives:
VA is seeking to improve access to care for alcohol misuse among Operations Enduring and Iraqi Freedom (OEF/OIF) Veterans, who are at risk for alcohol use disorders (AUD), drug use disorders (DUDs), and post traumatic stress disorder (PTSD). However, little is known about the management of alcohol misuse among OEF/OIF Veterans with and without these disorders. This study evaluated management of alcohol misuse among OEF/OIF VA outpatients with and without AUD, co-occurring AUD/DUDs, and PTSD.

Methods:
This study used VA Office of Quality and Performance medical record review data from a national sample of VA outpatients (<= 55 years old) with documented alcohol screening (AUDIT-C) from 2006-2010. Among OEF/OIF patients with alcohol misuse (AUDIT-C >5), we used logistic regression to compare the prevalence of documented brief intervention (BI, advice to abstain or drink within recommended limits and/or feedback linking drinking to health) and/or referral, (to alcohol treatment or discussion of referral) for those with and without diagnoses for AUD, DUD, and PTSD. Models were adjusted for gender, age, marital status, alcohol misuse severity, and addictions treatment utilization.

Results:
We identified 6,618 OEF/OIF Veterans (n = 932 women) with AUDIT-C screens. Among 1,243 (18.8%) who screened positive for alcohol misuse, 61.1% (n = 759) had BI (n = 482) or referral (n = 54) only, or both BI and referral (n = 223). Rates of AUD, DUD, and PTSD were 39.6 %, 14.5%, and 61.9%, respectively. Adjusted prevalences of BI or referral were significantly higher for screen positive Veterans with AUD (71.8%, 95% CI: 66.5 – 77.2) compared to those without (52.6%, 48.1 – 57.2), and Veterans with co-occurring AUD/DUD (75.9%: 95% CI: 67.8 – 84.1) compared to those without a substance use disorder (SUD) (51.7%, 46.9 – 56.5). PTSD was not significantly associated with BI or referral.

Implications:
Results indicate AUD, DUD, and PTSD are common among OEF/OIF Veterans with alcohol misuse. Rates of BI or referral were higher for Veterans with co-occurring AUD/DUD than for those without, although even in these high-risk groups, approximately 25% with alcohol misuse did not receive BI or referral.

Impacts:
Results highlight the need for systems to ensure returning Veterans with alcohol misuse and diagnosed SUDs receive follow-up care.


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