title: Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001-2010: Implications for screening, diagnosis and treatment.
abstract: BACKGROUND
  The prevalence and correlates of alcohol use disorder (AUD) and drug use disorder (DUD) diagnoses in Iraq and Afghanistan veterans who are new users of Department of Veterans Affairs (VA) healthcare nationwide has not been evaluated.
  
  
  METHODS
  VA administrative data were used in retrospective cross-sectional descriptive and multivariable analyses to determine the prevalence and independent correlates of AUD and DUD in 456,502 Iraq and Afghanistan veterans who were first-time users of VA healthcare between October 15, 2001 and September 30, 2009 and followed through January 1, 2010.
  
  
  RESULTS
  Over 11% received substance use disorder diagnoses: AUD, DUD or both; 10% received AUD diagnoses, 5% received DUD diagnoses and 3% received both. Male sex, age < 25 years, being never married or divorced, and proxies for greater combat exposure were independently associated with AUD and DUD diagnoses. Of those with AUD, DUD or both diagnoses, 55-75% also received PTSD or depression diagnoses. AUD, DUD or both diagnoses were 3-4.5 times more likely in veterans with PTSD and depression (p < 0.001).
  
  
  CONCLUSIONS
  Post-deployment AUD and DUD diagnoses were more prevalent in subgroups of Iraq and Afghanistan veterans and were highly comorbid with PTSD and depression. Stigma and lack of universal screening may have reduced the number of DUD diagnoses reported. There is a need for improved screening and diagnosis of substance use disorders and increased availability of integrated treatments that simultaneously address AUD and DUD in the context of PTSD and other deployment-related mental health disorders.
authors.affiliation: University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA. Karen.Seal@va.gov
authors.forename: Karen H
authors.initials: KH
authors.lastname: Seal
authors.forename: Greg
authors.initials: G
authors.lastname: Cohen
authors.forename: Angela
authors.initials: A
authors.lastname: Waldrop
authors.forename: Beth E
authors.initials: BE
authors.lastname: Cohen
authors.forename: Shira
authors.initials: S
authors.lastname: Maguen
authors.forename: Li
authors.initials: L
authors.lastname: Ren
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D007493:Iraq; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology; D058014:Veterans Health / Q000706:statistics & numerical data*; D055815:Young Adult