title: Cannabis use disorder treatment barriers and facilitators among veterans with PTSD.
abstract: In light of recent data demonstrating large variability in the diagnosis of cannabis use disorders (CUDs) within the Veterans Affairs Health Care System (VA), it is important to elucidate VA-specific barriers and facilitators to CUD diagnosis and treatment engagement. This issue is particularly salient among veterans with posttraumatic stress disorder (PTSD), given that PTSD is the most common co-occurring psychiatric disorder among veterans with CUD and is associated with poorer treatment outcomes. The goal of the current study was to evaluate the potential role of system-, clinician-, and patient-level factors associated with both CUD diagnosis and treatment engagement. Key personnel were interviewed from PTSD programs with both low and high rates of CUD and substance use disorder (SUD) programs with both low and high rates of SUD treatment engagement. Common themes emerged across clinics that may represent barriers to CUD diagnosis and treatment engagement and included, for example, clinician's concerns about negative consequences associated with CUD diagnosis (e.g., service connection). Potential facilitators to CUD diagnosis and treatment also emerged and included the use of formal assessment approaches when evaluating veterans for SUDs. Together, findings suggest opportunities, such as CUD-specific education and training for clinicians, to improve VA care.
authors.affiliation: Psychological Science, University of Arkansas.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Bujarski
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center.
authors.forename: Jessica N
authors.initials: JN
authors.lastname: Galang
authors.affiliation: Department of Psychology, Florida State University.
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Short
authors.affiliation: Center for Innovation to Implementation, VA Palo Alto Health Care System.
authors.forename: Jodie A
authors.initials: JA
authors.lastname: Trafton
authors.affiliation: Center for Innovation to Implementation, VA Palo Alto Health Care System.
authors.forename: Elizabeth V
authors.initials: EV
authors.lastname: Gifford
authors.affiliation: National Center for PTSD, VA Palo Alto Health Care System.
authors.forename: Rachel
authors.initials: R
authors.lastname: Kimerling
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center.
authors.forename: Anka A
authors.initials: AA
authors.lastname: Vujanovic
authors.affiliation: Department of Human Development and Family Science, University of Georgia.
authors.forename: Laura G
authors.initials: LG
authors.lastname: McKee
authors.affiliation: Center for Innovation to Implementation and National Center for PTSD, VA Palo Alto Health Care System.
authors.forename: Marcel O
authors.initials: MO
authors.lastname: Bonn-Miller
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D002189:Marijuana Abuse / Q000453:epidemiology* / Q000628:therapy; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000628:therapy; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data*