title: PTSD Care Among Veterans With and Without Co-Occurring Substance Use Disorders.
abstract: OBJECTIVE
  This study examined whether a co-occurring substance use disorder contributed to disparities in receipt of Veterans Health Administration (VHA) posttraumatic stress disorder (PTSD) specialty care or psychotherapy.
  
  
  METHODS
  Logistic regression, controlling for sociodemographic characteristics, was used to examine predictors of PTSD care among 424,211 veterans with confirmed PTSD (two or more PTSD diagnosis encounters) who accessed care in a VHA facility between fiscal years 2009 and 2010.
  
  
  RESULTS
  Overall, 16% of veterans had PTSD and a co-occurring substance use disorder diagnosis. In adjusted analyses, veterans with a co-occurring substance use disorder were more likely than veterans with PTSD alone to receive any outpatient PTSD specialty care and complete eight or more sessions of outpatient psychotherapy within 14 weeks, but they were less likely to be treated in inpatient PTSD specialty units.
  
  
  CONCLUSIONS
  Co-occurring substance use disorders did not appear to hinder receipt of outpatient specialty PTSD treatment or of sufficient psychotherapy among VHA-enrolled veterans.
authors.affiliation: Dr. Mansfield and Ms. Schaper are with the National Center for PTSD-Pacific Islands Division, U.S. Department of Veterans Affairs (VA) Pacific Islands Health Care System, Honolulu, and Dr. Mansfield is also with the Department of Health Policy and Management, University of North Carolina at Chapel Hill (e-mail: damon@unc.edu ). Mr. Greenbaum, Dr. Banducci, and Dr. Rosen are with the National Center for PTSD-Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California. Mr. Greenbaum is also with the VA Sierra Pacific Network Mental Illness Research, Education and Clinical Center, Palo Alto, California. Dr. Banducci and Dr. Rosen are also with the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Alyssa J
authors.initials: AJ
authors.lastname: Mansfield
authors.affiliation: Dr. Mansfield and Ms. Schaper are with the National Center for PTSD-Pacific Islands Division, U.S. Department of Veterans Affairs (VA) Pacific Islands Health Care System, Honolulu, and Dr. Mansfield is also with the Department of Health Policy and Management, University of North Carolina at Chapel Hill (e-mail: damon@unc.edu ). Mr. Greenbaum, Dr. Banducci, and Dr. Rosen are with the National Center for PTSD-Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California. Mr. Greenbaum is also with the VA Sierra Pacific Network Mental Illness Research, Education and Clinical Center, Palo Alto, California. Dr. Banducci and Dr. Rosen are also with the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Greenbaum
authors.affiliation: Dr. Mansfield and Ms. Schaper are with the National Center for PTSD-Pacific Islands Division, U.S. Department of Veterans Affairs (VA) Pacific Islands Health Care System, Honolulu, and Dr. Mansfield is also with the Department of Health Policy and Management, University of North Carolina at Chapel Hill (e-mail: damon@unc.edu ). Mr. Greenbaum, Dr. Banducci, and Dr. Rosen are with the National Center for PTSD-Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California. Mr. Greenbaum is also with the VA Sierra Pacific Network Mental Illness Research, Education and Clinical Center, Palo Alto, California. Dr. Banducci and Dr. Rosen are also with the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Kim M
authors.initials: KM
authors.lastname: Schaper
authors.affiliation: Dr. Mansfield and Ms. Schaper are with the National Center for PTSD-Pacific Islands Division, U.S. Department of Veterans Affairs (VA) Pacific Islands Health Care System, Honolulu, and Dr. Mansfield is also with the Department of Health Policy and Management, University of North Carolina at Chapel Hill (e-mail: damon@unc.edu ). Mr. Greenbaum, Dr. Banducci, and Dr. Rosen are with the National Center for PTSD-Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California. Mr. Greenbaum is also with the VA Sierra Pacific Network Mental Illness Research, Education and Clinical Center, Palo Alto, California. Dr. Banducci and Dr. Rosen are also with the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Anne N
authors.initials: AN
authors.lastname: Banducci
authors.affiliation: Dr. Mansfield and Ms. Schaper are with the National Center for PTSD-Pacific Islands Division, U.S. Department of Veterans Affairs (VA) Pacific Islands Health Care System, Honolulu, and Dr. Mansfield is also with the Department of Health Policy and Management, University of North Carolina at Chapel Hill (e-mail: damon@unc.edu ). Mr. Greenbaum, Dr. Banducci, and Dr. Rosen are with the National Center for PTSD-Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, California. Mr. Greenbaum is also with the VA Sierra Pacific Network Mental Illness Research, Education and Clinical Center, Palo Alto, California. Dr. Banducci and Dr. Rosen are also with the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Rosen
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D011613:Psychotherapy / Q000379:methods; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy*; D019966:Substance-Related Disorders / Q000150:complications*; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: Posttraumatic stress disorder (PTSD), Dual diagnosis, Alcohol abuse; drug abuse, Outpatient treatment, Inpatient treatment