The Impact of Hazardous Alcohol Use on Behavioral Healthcare Utilization Among National Guard Service Members.

BACKGROUND: Prior research suggests that both posttraumatic stress disorder (PTSD) and alcohol abuse affect behavioral healthcare utilization among combat-exposed military populations. However, their interactive effect is not well documented, especially after experiencing psychological trauma. OBJECTIVE: This study examined the role of hazardous alcohol use (i.e. repeated patterns of drinking which lead to harmful consequences) on behavioral healthcare utilization among service members stratified by past-year combat exposure. METHOD: This study utilized a sample of National Guard service members who participated in an in-depth survey 2-4 months after returning from Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn deployments (2011-2013) (n = 467). We examine the marginal effect (the change in the probability) of hazardous alcohol use on utilization while controlling for trauma exposure, PTSD and other potential covariates. RESULTS: In the unadjusted logistic model, hazardous alcohol use reduced the probability of behavioral healthcare utilization by 77% among service members who had been exposed to combat within the past year. In the adjusted model, which controlled for socio-demographics (age, gender, and race), health status (PTSD symptoms, depression and physical health), and measures of stigma (perception of services as embarrassing or harmful to one's career or social networks), hazardous alcohol use further reduced the utilization probability by 302%. CONCLUSION/IMPORTANCE: Although these findings require replication, they appear to demonstrate that when combat-exposed service members engaged in hazardous alcohol use at postdeployment, they were much less likely to utilize behavioral healthcare to manage their posttraumatic stress symptoms during this period.

Assessment of a postdeployment Yellow Ribbon Reintegration Program for National Guard members and supporters.

The Yellow Ribbon Reintegration Program (YRRP) was created to meet the needs of National Guard members and their families throughout the deployment cycle. This study examined the perceived utility of the YRRP's delivery of information and assistance during the postdeployment reintegration period by National Guard members and accompanying supporters who were mostly spouses. Over 22 months, from 10 YRRP events, 683 service members and 411 supporters completed questionnaires immediately after the YRRP. We analyzed questions on information and avenues for help, timeliness and concerns related to education, employment, legal, family, and health. Service members and supporters most often endorsed information delivery on education being met (76.8% and 78.2%, respectively) and were least likely to endorse legal information delivery (63.5% and 60%, respectively). Significantly more supporters than service members (p < 0.0001) reported that the YRRP was the first time they learned of available services across all domains. Service members were significantly more likely than supporters to report concerns about education, employment, and health, while supporters were significantly more likely to report concerns about family. Results suggest the YRRP fills gaps in supporter knowledge and provides needed information and resources to most National Guard families 2 to 4 months after a deployment.

Motherhood, Psychological Risks, and Resources in Relation to Alcohol Use Disorder: Are There Differences between Black and White Women?

Rates of alcohol use disorders (AUD) are generally low among women who have ever had children (mothers) compared to women who have never had children (nonmothers), presenting a motherhood advantage. It is unclear if this advantage accrues to "Black" and "White" women alike. Using National Epidemiological Survey on Alcohol and Related Conditions (NESARC) wave 2 cross-sectional data that is rich in alcohol use and psychological measures, we examined the following: (a) if motherhood is protective for past-year AUD among Black (N = 4, 133) and White women (N = 11, 017); (b) potential explanatory psychological mechanisms; and (c) the role of race. Prevalence of a past-year DSM-IV AUD was lower among White mothers compared to White nonmothers, but this same advantage was not observed for Black women. Perceived stress was a risk for all women, but race-ethnic segregated social networks and perceived discrimination predicted current AUD for Black mothers. Unlike White mothers, current psychological factors but not family history of alcohol problems predicted AUD for Black mothers. Future prospective studies should address the mechanisms by which race, motherhood, and psychological factors interactively affect AUD in women.

Temporal trends in marijuana attitudes, availability and use in Colorado compared to non-medical marijuana states: 2003-11.

BACKGROUND: In 2009, policy changes were accompanied by a rapid increase in the number of medical marijuana cardholders in Colorado. Little published epidemiological work has tracked changes in the state around this time. METHODS: Using the National Survey on Drug Use and Health, we tested for temporal changes in marijuana attitudes and marijuana-use-related outcomes in Colorado (2003-11) and differences within-year between Colorado and thirty-four non-medical-marijuana states (NMMS). Using regression analyses, we further tested whether patterns seen in Colorado prior to (2006-8) and during (2009-11) marijuana commercialization differed from patterns in NMMS while controlling for demographics. RESULTS: Within Colorado those reporting "great-risk" to using marijuana 1-2 times/week dropped significantly in all age groups studied between 2007-8 and 2010-11 (e.g. from 45% to 31% among those 26 years and older; p=0.0006). By 2010-11 past-year marijuana abuse/dependence had become more prevalent in Colorado for 12-17 year olds (5% in Colorado, 3% in NMMS; p=0.03) and 18-25 year olds (9% vs. 5%; p=0.02). Regressions demonstrated significantly greater reductions in perceived risk (12-17 year olds, p=0.005; those 26 years and older, p=0.01), and trend for difference in changes in availability among those 26 years and older and marijuana abuse/dependence among 12-17 year olds in Colorado compared to NMMS in more recent years (2009-11 vs. 2006-8). CONCLUSIONS: Our results show that commercialization of marijuana in Colorado has been associated with lower risk perception. Evidence is suggestive for marijuana abuse/dependence. Analyses including subsequent years 2012+ once available, will help determine whether such changes represent momentary vs. sustained effects.

Drug use disorders and post-traumatic stress disorder over 25 adult years: role of psychopathology in relational networks.

BACKGROUND: In traumatized populations, drug use disorders and post-traumatic stress disorder (PTSD) persist for many years. Relational factors that mediate this persistence have rarely been systematically examined. Our aim is to examine the relative effects of psychopathology in familial and non-familial networks on the persistence of both disorders over adulthood. METHODS: We utilized longitudinal data from an epidemiologically ascertained sample of male Vietnam veterans (n=642). Measures included DSM-IV drug use disorders, other psychiatric disorders, network problem history and time-varying marital and employment characteristics. Longitudinal measures of veterans' psychopathology and social functioning were retrospectively obtained for each year over a 25 year period. We used generalized estimating equations (GEE) to estimate the relative effects of network problems on veteran's drug use disorders and PTSD after adjusting for covariates. RESULTS: Veterans' mean age was 47 years in 1996. Prevalence of illicit drug disorders declined from 29.8% in 1972 to 8.3% in 1996, but PTSD remained at 11.7% from 13.2% in 1972. While 17.0% of veterans reported a familial drug use problem, 24.9% reported a non-familial drug use problem. In full GEE models, a non-familial drug problem was a significant predictor of illicit drug use disorders over 25 years (OR=2.21, CI=1.59-3.09), while both familial depression (OR=1.69, CI=1.07-2.68) and non-familial drinking problem (OR=1.66, CI=1.08-2.54) were significant predictors of PTSD over 25 years. CONCLUSIONS: Familial and non-familial problems in networks differentially affect the persistence of drug use disorders and PTSD in traumatized male adults.

Association of contextual factors with drug use and binge drinking among White, Native American, and Mixed-Race adolescents in the general population.

Large-scale surveys have shown elevated risk for many indicators of substance abuse among Native American and Mixed-Race adolescents compared to other minority groups in the United States. This study examined underlying contextual factors associated with substance abuse among a nationally representative sample of White, Native American, and Mixed-Race adolescents 12-17 years of age, using combined datasets from the National Survey on Drug Use and Health (NSDUH 2006-2009, N = 46,675, 48.77 % female). Native American adolescents displayed the highest rate of past-month binge drinking and past-year illicit drug use (14.06 and 30.91 %, respectively). Results of a logistic regression that included seven predictors of social bonding, individual views of substance use, and delinquent peer affiliations showed that friendships with delinquent peers and negative views of substance use were associated significantly with both substance abuse outcomes among White and Mixed-Race adolescents and, to a lesser extent, Native American adolescents. The association of parental disapproval with binge drinking was stronger for White than for Native American adolescents. Greater attention to specific measures reflecting racial groups' contextual and historical differences may be needed to delineate mechanisms that discourage substance abuse among at-risk minority adolescent populations.