title: The epidemiology of substance use disorders in US Veterans: A systematic review and analysis of assessment methods.
abstract: BACKGROUND
  Substance use disorders (SUDs), which encompass alcohol and drug use disorders (AUDs, DUDs), constitute a major public health challenge among US veterans. SUDs are among the most common and costly of all health conditions among veterans.
  
  
  OBJECTIVE
  This study sought to examine the epidemiology of SUDs among US veterans, compare the prevalence of SUDs in studies using diagnostic and administrative criteria assessment methods, and summarize trends in the prevalence of SUDs reported in studies sampling US veterans over time.
  
  
  METHODS
  Comprehensive electronic database searches were conducted. A total of 3,490 studies were identified. We analyzed studies sampling US veterans and reporting prevalence, distribution, and examining AUDs and DUDs.
  
  
  RESULTS
  Of the studies identified, 72 met inclusion criteria. The studies were published between 1995 and 2013. Studies using diagnostic criteria reported higher prevalence of AUDs (32% vs. 10%) and DUDs (20% vs. 5%) than administrative criteria, respectively. Regardless of assessment method, both the lifetime and past year prevalence of AUDs in studies sampling US veterans has declined gradually over time.
  
  
  CONCLUSIONS
  The prevalence of SUDs reported in studies sampling US veterans are affected by assessment method. Given the significant public health problems of SUDs among US veterans, improved guidelines for clinical screening using validated diagnostic criteria to assess AUDs and DUDs in US veteran populations are needed.
  
  
  CONCLUSIONS
  These findings may inform VA and other healthcare systems in prevention, diagnosis, and intervention for SUDs among US veterans.
authors.affiliation: Department of Community Health Sciences, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, California.
authors.forename: Chiao-Wen
authors.initials: CW
authors.lastname: Lan
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.|Pain Treatment Services, APT Foundation, Inc., New Haven, Connecticut.
authors.forename: Declan T
authors.initials: DT
authors.lastname: Barry
authors.affiliation: National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland.
authors.forename: Kendall J
authors.initials: KJ
authors.lastname: Bryant
authors.affiliation: Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.|Mental Health Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.|Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Gordon
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: E Jennifer
authors.initials: EJ
authors.lastname: Edelman
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Julie R
authors.initials: JR
authors.lastname: Gaither
authors.affiliation: Department of Psychology, Syracuse University, Syracuse, New York.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Maisto
authors.affiliation: Department of Epidemiology, Brown University, School of Public Health, Providence, Rhode Island.
authors.forename: Brandon D L
authors.initials: BD
authors.lastname: Marshall
mesh_terms: D000068598:Data Accuracy; D006801:Humans; D015995:Prevalence; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*