title: Long-term use of VA mental health services by older patients with substance use disorders.
abstract: OBJECTIVE
  The authors studied long-term patterns and predictors of use of mental health services by older surviving patients with substance use disorders in the Veterans Affairs (VA) health care system.
  
  
  METHODS
  In this prospective longitudinal study, patient treatment records were used to determine long-term (ten-year) patterns and predictors of use of VA mental health services in a nationwide cohort of 10,678 surviving patients with a substance use disorder who were 55 years of age or older. The patients were categorized into three groups based on diagnosis during the index episode: patients with alcohol or drug abuse or dependence, patients with alcohol or drug psychosis, and patients with both a substance use and a psychiatric disorder. Most of the patients had alcohol use disorders.
  
  
  RESULTS
  Over the ten-year period, successively fewer patients obtained outpatient and inpatient mental health care. Among patients who did obtain such care, the intensity of service use increased. Medical care did not substitute for mental health treatment. Younger age, being unmarried, and having a more severe disorder were associated with a greater likelihood of mental health service use over the ten-year period. Patients with a dual diagnosis were significantly more likely to obtain outpatient mental health care. Treatment on a residential care unit and longer initial hospital stay were associated with a lower rate of mental health readmissions.
  
  
  CONCLUSIONS
  Of the substantial number of patients with substance use disorders who survive into old age, those with more long-standing substance use problems and with dual diagnoses have the greatest need for long-term mental health treatment.
authors.affiliation: Center for Health Care Evaluation and the Program Evaluation and Resource Center of the Department of Veterans Affairs Palo Alto Health Care System and Stanford university Medical Center in Palo Alto, California 94025, USA. penny.brennan@med.ca.gov
authors.forename: Penny L
authors.initials: PL
authors.lastname: Brennan
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Nichols
authors.forename: Rudolf H
authors.initials: RH
authors.lastname: Moos
mesh_terms: D000553:Ambulatory Care; D017831:Diagnosis, Dual (Psychiatry); D005544:Forecasting; D006778:Hospitals, Psychiatric; D006787:Hospitals, Veterans; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D010359:Patient Readmission; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000523:psychology* / Q000628:therapy*; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*