Effects of repeated deployment to Iraq and Afghanistan on the health of New Jersey Army National Guard troops: implications for military readiness.

OBJECTIVES: We assessed the effects of prior military service in Iraq or Afghanistan on the health of New Jersey Army National Guard members preparing for deployment to Iraq. METHODS: We analyzed anonymous, self-administered predeployment surveys from 2543 National Guard members deployed to Iraq in 2008. We used bivariate and multivariate analyses to measure the effects of prior service in Afghanistan (Operation Enduring Freedom [OEF]) or Iraq (Operation Iraqi Freedom [OIF]) on mental and physical health. RESULTS: Nearly 25% of respondents reported at least 1 previous OEF or OIF deployment. Previously deployed soldiers were more than 3 times as likely as soldiers with no previous deployments to screen positive for posttraumatic stress disorder (adjusted odds ratio [AOR]=3.69; 95% confidence interval [CI]=2.59, 5.24) and major depression (AOR=3.07; 95% CI=1.81, 5.19), more than twice as likely to report chronic pain (AOR=2.20; 95% CI=1.78, 2.72) and more than 90% more likely to score below the general population norm on physical functioning (AOR=1.94; 95% CI=1.51, 2.48). CONCLUSIONS: Repeated OEF and OIF deployments may adversely affect the military readiness of New Jersey National Guard combat soldiers.

Early experiences of employing consumer-providers in the VA.

OBJECTIVES: Following guidelines in the mental health strategic plan of the Department of Veterans Affairs (VA), VA began in 2005 to fund a number of new positions for consumer-providers (CPs)--that is, individuals with personal experience of serious mental illness who provide support services to others with serious mental illness, typically as clinical team members. This study explored the challenges of CP implementation in its early stages within the VA. METHODS: Four focus groups were conducted with a total of 59 VA CPs and 34 VA supervisors from across the United States. Group notes were coded by using a modified grounded theory approach to generate themes. RESULTS: Data from the groups suggest that hiring and employing CPs within VA has been feasible, beneficial, and acceptable to a majority of teammates. CPs reported experiencing some role confusion and resistance and fears among professional staff about how CPs would fit in. The authors make three recommendations on the basis of the focus group findings. First, CPs, traditional staff, and administrators need to be adequately prepared so that CPs can be effectively incorporated into clinical teams. Second, training for CPs varies widely, and efforts should be made to determine the best training package. Third, systems that are considering using CPs should establish a continuous quality improvement system to help evaluate CPs' performance and patient outcomes and to gather data to improve the knowledge base about CPs and their functions. CONCLUSIONS: CPs provide a wide range of recovery-oriented services and are valued by staff and consumers.

A brief community linkage intervention for veterans with a persistent mental illness and a co-occurring substance abuse disorder

No disponible

Objective: Individuals with co-occurring psychiatric and substance abuse problems often exhibit poor outpatient treatment engagement and re-hospitalization following discharge from acute psychiatric services. Although case management can improve treatment engagement and reduce attrition, these services are often delivered indefinitely, limiting the availability of treatment slots. In an effort to reduce re-hospitalization rates and improve outcomes during the transition from inpatient to outpatient treatment, we developed and evaluated Time-Limited Case Management (TLC), an eight-week integrated mental health and substance abuse augmentation intervention. Method: Sixty-five dually diagnosed veterans admitted to inpatient psychiatric treatment were included in the program evaluation, 32 who received the TLC service in addition to Treatment as Usual (TAU) that began during inpatient treatment and continued after the transition to outpatient services, and a comparison group of 33 who received only TAU without transitional support provided through the TLC augmentation service. Results: The TLC group had fewer days and episodes of hospitalization at two and six month post-study entry. Furthermore, the TLC group exhibited greater improvements on the Global Assessment of Functioning from baseline to the six-month follow-up. Conclusion: TLC appears to be an effective transitional augmentation service with benefits that persist beyond the eight weeks of the program. Future research should include a larger and more rigorously controlled trial to confirm the efficacy and unique contributions of the intervention (AU)

The validity and reliability of a brief measure of cocaine craving.

INTRODUCTION: Although craving plays an important role in relapse, there are few brief, valid and reliable instruments to measure the desire to use cocaine in routine clinical practice. The 45-item Cocaine Craving Questionnaire-Now (CCQ-Now) is widely used in research, but its length makes its use in everyday clinical work relatively impractical. This study sought to determine the psychometric properties of the CCQ-Brief, a measure composed of 10 items from the CCQ-Now, in treatment-seeking cocaine abusers. METHOD: Subjects with cocaine abuse or dependence (n=247) completed the CCQ-Brief, the CCQ-Now, the Voris Cocaine Craving Scale, the Beck Depression Inventory-II, the Beck Anxiety Inventory, and the Addiction Severity Index. RESULTS: The CCQ-Brief was significantly correlated with the CCQ-Now (r=.85, p<.01), the CCQ-Now with the items in common with the CCQ-Brief removed (r=.78, p<.01), all four subscales of the VCCS (craving intensity: r=.47, p<.01; mood: r=.27, p<.01; energy: r=.30, p<.01; sick feelings: r=.28, p<.01), the BDI-II (r=.39, p<.01), the BAI (r=.35, p<.01) and recent drug use (r=.26, p<.01). The internal consistency of the CCQ-Brief was strong (alpha=.90). DISCUSSION: The CCQ-Brief is a valid and reliable instrument that can be easily administered as a measure of current cocaine craving.

A double-blind placebo-controlled pilot study of risperidone for decreasing cue-elicited craving in recently withdrawn cocaine dependent patients.

Cocaine use causes an initial increase in dopamine and serotonin neurotransmission that is largely responsible for the pleasurable and reinforcing effects of the drug. Dysregulation of these neurotransmitters during withdrawal plays an important role in craving. Recent research has focused on the use of dopamine and serotonin antagonists early in recovery to reduce cocaine craving in both schizophrenic and non-schizophrenic cocaine dependent patients. This 2-week, double blind, placebo-controlled study compared risperidone vs. placebo in reducing cue-elicited cocaine craving. Thirty-four subjects with cocaine dependence were randomized to either risperidone or a placebo and underwent a weekly cue-exposure procedure. Although both groups had a reduction in craving over time, there were no significant differences among those treated with risperidone (n=19) compared to those taking a placebo (n=16) on the four craving dimensions. The results do not support the hypothesis that risperidone reduces cocaine craving among non-schizophrenic cocaine-dependent individuals.