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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3057 — Patterns of Specialty Care Utilization by Veterans with PTSD and Substance Use Disorders

Kulkarni MROliva ETrafton J, and Timko C, Center for Healthcare Evaluation, HSR&D Center of Excellence; Kimerling R, National Center for PTSD, Center for Healthcare Evaluation;

Objectives:
Previous research among returning service members serving in Afghanistan and Iraq (OEF/OIF) has documented concerning rates of both Posttraumatic Stress Disorder (PTSD) and substance use disorders (SUDs). This study examined if comorbid PTSD and SUD diagnoses present a barrier to patient utilization of specialty PTSD and/or SUD treatment services among returning OEF/OIF Veterans in the VA healthcare system. Historically, SUD treatment providers have been concerned that trauma-focused therapies may trigger a relapse, while PTSD treatment providers have felt that individuals actively misusing substances are not appropriate for trauma-focused therapies. Because PTSD and SUD treatment utilization vary by gender, male and female Veterans were examined separately.

Methods:
This was a cross-sectional study that used national VA administrative data from Fiscal Years 2008 and 2009. The sample is composed of OEF/OIF Veterans who had at least one face-to-face outpatient mental health or primary care clinic encounter at a VHA facility and had a PTSD and/or SUD diagnosis (N = 80,228 patients). Logistic regression was used to compare three groups (SUD only, PTSD only, comorbid) on PTSD and SUD treatment utilization adjusting for demographic and military service characteristics.

Results:
Male and female comorbid patients were more likely to utilize outpatient and inpatient PTSD treatment than patients with PTSD only. Male comorbid patients were significantly more likely to utilize outpatient and inpatient SUD treatment than those with SUD only, and female comorbid patients were more likely to utilize inpatient SUD treatment than those with SUD only. Only 9% of female and 14% of male comorbid patients utilized concurrent PTSD-SUD treatment.

Implications:
Comorbid patients appear to utilize and engage in equal or more specialty PTSD and SUD treatment relative to those with a single condition, contrary to our hypothesis. However, relatively few comorbid patients receive concurrent PTSD-SUD treatment.

Impacts:
Among patients with comorbid conditions, a comorbid diagnosis of PTSD does not appear to present a barrier to treatment of SUD, nor does a comorbid diagnosis of SUD present a barrier to PTSD treatment. However, our findings highlight the need for continued focus on increasing opportunity and access to receiving care for both PTSD and SUD among returning OEF/OIF Veterans.


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