Veterans’ care for PTSD not hindered by co-occurring substance use disorders

March 20, 2017

A UNC Gillings School of Global Public Health-led study of veterans enrolled in the United States’ Veterans Health Administration (VHA) found that veterans with more than one substance use disorder were not hindered from receiving outpatient specialty post-traumatic stress disorder (PTSD) treatment or sufficient psychotherapy.

Published online March 1 in Psychiatric Services, the study examined whether a co-occurring substance use disorder contributed to disparities in receipt of PTSD specialty care or psychotherapy at a VHA facility in fiscal years 2009 and 2010.

Dr. Alyssa Mansfield (Damon)

Dr. Alyssa Mansfield (Damon)

Alyssa J. Mansfield (Damon), PhD, assistant professor of health policy and management at the UNC Gillings School, is the study’s lead author. Mansfield formerly was with the National Center for PTSD, in the Pacific Islands Division of the U.S. Department of Veterans Affairs (VA) Pacific Islands Health Care System.

Substance use commonly co-occurs with post-traumatic stress disorder (PTSD), and veterans with co-occurring PTSD and substance use disorders often present with more clinical and psycho-social difficulties compared with veterans with PTSD only.

Using logistic regression, and controlling for socio-demographic characteristics, the researchers examined predictors of PTSD care among 424,211 veterans with confirmed PTSD (two or more PTSD diagnosis encounters) who accessed care in a VHA facility in fiscal years 2009 and/or 2010.

Overall, 16 percent of veterans had PTSD and a co-occurring substance use disorder diagnosis. All but 104 veterans had at least one outpatient PTSD visit in the year following the veterans’ second PTSD encounter. The percentage of veterans with an outpatient PTSD visit who received PTSD specialty care during the follow-up year was 43 percent among veterans with a co-occurring substance use disorder diagnosis, compared with 38 percent for those without a co-occurring substance use disorder diagnosis.

Multivariate models, controlling for factors such as gender, age, type of substance use diagnosis and distance to the nearest VA point of service, showed that a diagnosis of a co-occurring substance use disorder was associated with increased odds of receiving outpatient PTSD specialty care compared to those with only a PTSD diagnosis. The finding was contrary to the predictions of the study’s authors whose research suggests that a substance-related diagnosis was not a barrier to accessing specialized outpatient PTSD services among veterans with PTSD.

“Previously, it had been thought that individuals diagnosed with drug- or alcohol-related disorders in addition to PTSD may be missing out on the evidence-based treatments included in specialized PTSD services—those most likely to lead to symptom reduction—as a result of their substance use,” Mansfield said. “Based on our study, that does not appear to be the case. The VA has devoted considerable resources in the past several years to addressing the mental health needs of veterans, including adding a significant number of mental health providers to serve those with PTSD and substance abuse, among other conditions.”

Mansfield said that initiating any VA mental health treatment may help facilitate access to PTSD specialty care.

The study’s co-authors are Kim M. Schaper, MA, of the National Center for PTSD–Pacific Islands Division, U.S. Department of Veterans Affairs (VA) Pacific Islands Health Care System; and Mark A. Greenbaum, MS, MA, Anne N. Banducci, PhD, and Craig S. Rosen, PhD, all with the National Center for PTSD–Dissemination and Training Division, VA Palo Alto Health Care System. Banducci and Rosen also are with the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine.

The research was supported by a VA Health Services Research and Development Quality Enhancement Research Initiative grant to Mansfield.


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Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu