title: Prevalence of Alcohol Misuse and Follow-Up Care in a National Sample of OEF/OIF VA Patients With and Without TBI.
abstract: Information on prevalence and management of alcohol misuse among Afghanistan and Iraq veterans with traumatic brain injury (TBI) is limited. This study compared rates of alcohol misuse and follow-up care-brief intervention (BI) and addiction treatment-among Afghanistan and Iraq veterans with and without TBI receiving care from the Department of Veterans Affairs (VA).
  
  
  
  The sample included veterans ages 18 and older screened with the Alcohol Use Disorders Identification Test alcohol consumption questions (AUDIT-C) in 2012 who received VA health care in the prior year (N=358,417). Overall and age-specific estimates of alcohol misuse (AUDIT-C score ≥5) were compared for men and women with and without TBI by logistic regression. BI and addiction treatment after screening were compared between groups by using multivariable logistic regression.
  
  
  
  Alcohol misuse was higher among men with TBI than among men without TBI (20.3%, 95% confidence interval [CI]=19.9-20.8, versus 16.4%, CI=16.3-16.6) and among women with TBI than among women without TBI (6.8%, CI=5.8-8.1, versus 5.6%, CI=5.4-5.8); younger (age <30) patients with TBI had the highest rates. BI rates did not differ by TBI status (76.4%-80.2%). Addiction treatment rates for those with severe misuse were higher among those with TBI (men, 20.0%, CI=18.4-21.6, versus 15.4%, CI=14.9-15.9; women, 36.6%, CI=21.8-51.3, versus 21.1%, CI=18.2-24.0).
  
  
  
  Alcohol misuse is common among Iraq and Afghanistan veterans with TBI, particularly young men. BI rates were high and did not vary by TBI status, although addiction treatment rates were higher among patients with TBI than among those without TBI.
authors.affiliation: Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: eric.hawkins@va.gov ).
authors.forename: Joel
authors.initials: J
authors.lastname: Grossbard
authors.affiliation: Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: eric.hawkins@va.gov ).
authors.forename: Carol A
authors.initials: CA
authors.lastname: Malte
authors.affiliation: Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: eric.hawkins@va.gov ).
authors.forename: Gwen
authors.initials: G
authors.lastname: Lapham
authors.affiliation: Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: eric.hawkins@va.gov ).
authors.forename: Kathleen
authors.initials: K
authors.lastname: Pagulayan
authors.affiliation: Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: eric.hawkins@va.gov ).
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Turner
authors.affiliation: Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: eric.hawkins@va.gov ).
authors.forename: Anna D
authors.initials: AD
authors.lastname: Rubinsky
authors.affiliation: Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: eric.hawkins@va.gov ).
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
authors.affiliation: Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: eric.hawkins@va.gov ).
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Saxon
authors.affiliation: Dr. Grossbard, Ms. Malte, Dr. Turner, Dr. Rubinsky, Dr. Saxon, and Dr. Hawkins are with the Department of Veterans Affairs (VA) Center of Excellence in Substance Abuse Treatment and Education, Puget Sound Health Care System, Seattle. Dr. Turner is also with the Department of Rehabilitation Medicine, University of Washington, Seattle. Dr. Saxon and Dr. Hawkins are also with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where Dr. Pagulayan is affiliated. Dr. Rubinsky is also with the Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Health Services Research and Development (HSR&D), Seattle. Dr. Lapham and Dr. Bradley are with the Group Health Research Institute, Seattle. Dr. Bradley is also with the Department of Health Services, University of Washington, Seattle. Send correspondence to Dr. Hawkins (e-mail: eric.hawkins@va.gov ).
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Hawkins
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000359:Aftercare / Q000706:statistics & numerical data*; D000437:Alcoholism / Q000453:epidemiology* / Q000628:therapy*; D000070642:Brain Injuries, Traumatic / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D015995:Prevalence; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult