Competing Constructivisms: The Negotiation of PTSD and Related Stigma Among Post-9/11 Veterans in New York City.

Posttraumatic stress disorder (PTSD) stands as a form of psychopathology that straddles moral and psychiatric domains. Grounded in discrete instances of trauma, PTSD represents an etiological outlier in an era of increased attention to the genetics of mental illness and a prime location for social constructivist analyses of mental illness. This examination of PTSD narratives-as voiced in qualitative interviews and focus groups with 50 veterans of the recent Iraq and Afghanistan wars living in New York City-attends to the processes through which veterans conceive and navigate PTSD symptoms and diagnoses. In so doing we highlight the social constructivist positions undertaken by veterans themselves as they varyingly challenge and internalize symptomology in dialogue with psychiatric definitions and the stigma associated with PTSD. Findings demonstrate the rejection of classic psychopathological etiology-in brain disease, for example-by many veterans as well as the complex balancing of benefit and stigma that veterans undertake when making decisions about presenting to psychiatric clinicians. Drawing on veterans' accounts, we argue for greater cultural specificity in characterizing the diagnosis-seeking behavior of trauma survivors and a greater appreciation for the contradictions and compromise related to both acceptance and rejection of a mental health diagnosis.

Opioid Use Initiation, Progression, and Motivations Among OEF/OIF/OND-Era Veterans in New York City: An Age-Period-Cohort Analysis.

This study examines the temporal relationship between prescription opioid (PO) and heroin use among veterans in New York City. Drawing on survey data from a convenience sample of 214 Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND)-era opioid-using military veterans, analyses demonstrate substantial cohort-level variation. Most notably, heroin use prior to PO initiation and prior to military enlistment was reported more frequently among the cohorts born prior to 1970 and after 1984. Across all cohorts, high percentages of participants reported alleviation of emotional/psychological pain as a reason for both PO and heroin use. Cohort-level variation highlights the need for tailored interventions and targeted prevention efforts.

Opioid-Involved Overdose Among Male Afghanistan/Iraq-Era U.S. Military Veterans: A Multidimensional Perspective.

BACKGROUND: Mirroring nationwide trends in a broad range of U.S. populations, an alarming number of Afghanistan/Iraq-era U.S. Military veterans have experienced opioid-related overdoses. A growing body of research has examined the proximal behaviors that can precipitate an overdose; considerably less is known about more distal physiological, psychosocial and structural influences on these risk behaviors. OBJECTIVES: This study adopts a multidimensional approach to better understand opioid-related overdose among U.S. Military veterans, and seeks to explore not only the proximal behavioral precipitants of overdose events, but also the complex nexus of physiological, psychological, and sociological influences that undergird overdose events. METHODS: This qualitative examination is based on interview data from 36 male veterans who were discharged from the military after September 2001 and experienced at least one opioid-related overdose during or after military service. Participants were recruited in New York City during 2014 to share narrative accounts of their overdoses. RESULTS: Veterans' accounts indicate that background experiences, such as self-medication for social and psychological pain, trauma, social alienation and isolation, and histories of illicit drug use, precondition the more immediate factors and behaviors that precipitate overdose (including bingeing on drugs, mixing drugs, naiveté about dosage, and ambivalence about life/death). CONCLUSIONS: Findings suggest the need for comprehensive drug safety and overdose education that is sensitive to veterans' physiological, psychological, and sociological conditions. A multidimensional understanding of the distal and proximal overdose risks faced by veterans and other vulnerable groups may help lay a foundation for more inclusive/holistic approaches to overdose prevention and education.

A behavioral typology of opioid overdose risk behaviors among recent veterans in New York City.

OBJECTIVE: To identify meaningful classes of opioid-using military veterans in terms of self-reported opioid overdose risk behaviors. METHOD: The study recruited a sample of 218 military veterans in the NYC area who were discharged from active duty service after September 11, 2001 and reported past-month opioid use. Survey data including measures of mental health, social stressors, substance use, and opioid-related overdose risk behaviors were analyzed using Latent Class Analysis (LCA). RESULTS: A five group solution had excellent fit scores and interpretability. Factor analysis confirmed the existence of two major dimensions of variation: non-adherence and heroin use. The five groups included lower-risk prescription opioid users, non-adherent prescription opioid users and heroin users. The non-adherent prescription opioid users and heroin user classes were both further subdivided into "occasional" and "regular" use categories. In addition to endorsing a greater number of overdose risk behaviors, users in the regular use classes were more likely to screen positive for alcohol and substance use disorders, reported greater self-medicating opioid use to relieve anxiety, reported greater problems with physical pain, were more likely to have had mental health, alcohol and drug treatment, and were less likely to be employed or in school. Heroin users also were less likely to report stable housing. CONCLUSIONS: Findings indicate that opioid overdose risk classes are grounded in contextual factors related to experiences of psychological, physiological, and social adjustment pain and distress which should be addressed in tailored interventions targeting opioid users' unique constellations of risk behaviors and comorbid conditions.

Family Transitions in Cohabiting Families: a Longitudinal Investigation of the Role of Parent Depressive Symptoms in Youth Problem Behaviors.

Cohabiting family structures are becoming increasingly prevalent in the United States but are less stable than married family unions. In this longitudinal study we examine the change in psychosocial adjustment of adolescents when a non-biologically related male cohabiting partner (MCP) transitions out of the family home. Of particular interest, the role of maternal and MCP depressive symptoms was examined as a moderator. At wave 1, the sample was comprised of 111 low-income urban Black families, consisting of an adolescent (42.3 % male; Mage = 13), a biological mother, and a non-biologically-related male cohabiting partner (MCP). Wave 2 and 3 assessments occurred over the course of the subsequent 29 months, with 38 % of MCPs transitioning out of the home. We used latent growth curve modeling to characterize trajectories of youth internalizing and externalizing symptom change across the 3 waves. Both maternal and MCP depressive symptoms interacted with whether a transition occurred, consistent with the notion that adolescent problem behaviors are shaped by the dynamic interplay of individual- and family-characteristics.

Vetting and Letting: Cohabiting Stepfamily Formation Processes in Low-Income Black Families.

The authors examined cohabiting union formation processes by analyzing in-depth interview data collected from 30 individuals in cohabiting relationships: 15 low-income Black mothers of adolescents and their partners. Prior research suggests that cohabiting union formation is a gradual, nondeliberative process. In contrast, most couples in this study described a gradual but highly deliberative process. Mothers focused primarily on vetting their partners to ensure child well-being and less on when and how their partners officially came to live with them, a process the authors call vetting and letting. Mothers delineated 4 strategies to ensure their child's well-being when vetting their partners, and their partners reported that they understood the importance of participating in this process. The authors argue that vetting and letting is a child-centered family formation process, not a partner-centered union formation process, and that cohabiting union processes may vary substantially by subpopulation.

Male Cohabiting Partners as Primary Coparents in Low-Income Black Stepfamilies.

Male cohabiting partners in low-income urban Black single mother families may represent an extreme case of stepfathers who have been characterized as "polite strangers" in the household. The purpose of this study was twofold: To examine who serves as a coparent in these families; and to determine if identification of a coparent in addition to or instead of the MCP would be associated with the level of MCP involvement in the family. Participants were 121 mothers and adolescents from cohabiting families. The MCP was identified as a coparent in 75% of the families, an additional coparent was identified in only 30% of the families, and, when the MCP did not serve as a coparent, another individual was identified in this role in only 24% of the families. The identification of an MCP as a coparent was associated with higher levels of MCP childrearing activities, coparenting support provided by the MCP, and relationship quality with the mother relative to no coparent being identified. The identification of another coparent in addition to the MCP was not associated with changes in the higher levels of family involvement found when the MCP was a coparent. The importance of a male cohabiting partner for coparenting of an adolescent is emphasized in the discussion of the findings.

Readjustment of Urban Veterans: A Mental Health and Substance Use Profile of Iraq and Afghanistan Veterans in Higher Education.

OBJECTIVE: To identify the prevalence of substance use and mental health problems among veterans and student service members/veterans (SSM/V) returning from Iraq and Afghanistan to New York City's low-income neighborhoods. PARTICIPANTS: A sample of 122 veterans attending college and 116 veterans not enrolled recruited using respondent-driven sampling. METHODS: Logistic regression analysis of variation in characteristics of those veterans attending college; linear regression examining effects of college attendance on life satisfaction. RESULTS: Having a traumatic brain injury or disability was positively associated with college attendance. Being married, employed, or in college was predictive of overall life satisfaction. SSM/V were significantly less likely to screen positive for depression or drug use disorder. African American veterans were significantly less likely to attend college than white or Hispanic veterans. CONCLUSION: Substance use and some mental health disorders do not preclude inner-city veterans from entering higher education. This study contributes to the sparse literature on African American veterans and SSM/V.

More than Just a Game? Combat-Themed Gaming Among Recent Veterans with Posttraumatic Stress Disorder.

This article examines recent combat veterans' experiences of "first-person shooter" (FPS) gaming and its relationship to posttraumatic stress disorder (PTSD). Current PTSD treatment approaches increasingly use virtual reality (VR) technologies, which have many similarities with FPS games. To explore these similarities, this article presents six case studies from recently separated veterans in New York City who reported both current PTSD symptoms and regular use of combat-themed FPS games. In open-ended interviews, participants discussed a range of benefits as well as the importance of regulating use and avoiding particular contextual dimensions of gaming to maintain healthy gaming habits. Findings demonstrate the need for more comprehensive study and dissemination of best-practices information about FPS gaming in the context of combat-related PTSD symptomatology.

Cohabitation and Repartnering among Low-Income Black Mothers.

Serial cohabitation has increased dramatically in the U.S., especially in the low-income Black population. The purpose of the study is to understand cohabiting and co-parenting relationships among unmarried cohabiting low-income urban Black families on their own terms, identifying the strengths, challenges, and unique needs of these families. Though cohabitation patterns varied widely, most participants had extensive periods living without a partner. This finding provides more support for the unbalanced marriage markets explanation than the serial cohabitation explanation. Indeed, most participants' children (83%) had none or only one resident father prior to the current cohabitation. Implications for having a new resident father and child development are discussed.

PTSD, Depression, Daily Stressors, and Treatment Pathways Among Urban Veterans.

Many veterans face various mental health challenges after separation. This study examines change over 14 months in mental health and related factors among 242 veterans returning to low-income predominately minority sections of New York City. Mental health treatment provided more than reductions in symptoms of PTSD and depression. It also resulted in reductions in substance use disorders and daily stresses. However, many veterans not in treatment are experiencing combat-related concerns at subsyndromal levels. The findings highlight the need for low threshold community-based outreach programs for this population.

Involvement in Child Rearing and Firm Control Parenting by Male Cohabiting Partners in Black Low-Income Stepfamilies: Forecasting Adolescent Problem Behaviors.

Cohabitation is a family structure that is rapidly increasing in the United States. The current longitudinal study examined the interplay of involvement in a youth's daily activities and firm control parenting by male cohabiting partners (MCPs) on change in adolescents' internalizing and externalizing problems. In a sample of 111 inner-city African American families, adolescents reported on involvement and parenting by MCPs at Wave 1 and biological mothers reported on adolescent problem behaviors at Waves 1 and 2. A significant interaction indicated that low involvement and low firm control by MCPs at Wave 1 were associated with the highest level of internalizing problems at Wave 2. An interaction did not emerge when externalizing problems served as the outcome. The findings indicate that male partners play an important role in parenting adolescents in cohabiting families and should be considered potential participants in prevention and intervention programs.

Beyond America's War on Drugs: Developing Public Policy to Navigate the Prevailing Pharmacological Revolution.

This paper places America's "war on drugs" in perspective in order to develop a new metaphor for control of drug misuse. A brief and focused history of America's experience with substance use and substance use policy over the past several hundred years provides background and a framework to compare the current Pharmacological Revolution with America's Nineteenth Century Industrial Revolution. The paper concludes with cautions about growing challenges and provides suggestions for navigating this revolution and reducing its negative impact on individuals and society.

PTSD and Cannabis-Related Coping Among Recent Veterans in New York City.

This article presents interview and focus group data from veterans of recent conflicts in Iraq and Afghanistan about their use of cannabis as a coping tool for dealing with posttraumatic stress disorder. Veterans' comparisons of cannabis, alcohol, and psychopharmaceuticals tended to highlight advantages to cannabis use as more effective and less complicated by side effects. Some participants suggested that cannabis can be part of an approach-based coping strategy that aids with introspection and direct confrontation of the sources of personal trauma. Others, however, held that cannabis use was part of a less productive, avoidant coping strategy. Some self-reports suggested the need for more nuanced theorizations of coping behaviors, as they indicated motivations for use that were grounded in symptom alleviation rather than any direct confrontation with (or avoidance of) sources of trauma.

Parental Mindfulness and Dyadic Relationship Quality in Low-income Cohabiting Black Stepfamilies: Associations with Parenting Experienced by Adolescents.

Cohabitation is a family structure experienced by many Black children; yet, we have limited understanding of how personal and interpersonal processes operate within these families to influence the parenting provided to these children. Informed by both family systems theory and the spillover hypothesis and utilizing a model to account for the interdependence of the mother and her partner, the current study sought to understand the direct and indirect associations among parental mindfulness, the mother-partner relationship quality, and firm parenting practices in a sample of 121 Black cohabiting low-income stepfamilies. Assessment consisted of standardized measurements of maternal and male cohabiting partner reports on mindfulness (i.e., acting with awareness) and relationship quality (i.e., relationship satisfaction, ability to resolve conflict, and coparenting conflict) as well as adolescent report on parenting (i.e., parent's firm control). Mindfulness was directly related to each individual's own perceptions of relationship quality and some support emerged for a cross-informant link (e.g., mother's mindfulness related to partner report of relationship quality). Furthermore, maternal perceptions of relationship quality, as well as mindfulness operating through relationship quality, were related to youth reports of maternal firm parenting. The results suggest that both mindfulness and the relationship quality of adults are variables deserving attention when studying the parenting received by children in cohabiting stepfamilies. Clinical implications of the findings are considered.

Cohabitating Partners and Domestic Labor in Low-Income Black Families.

This article examines the division of domestic labor in low-income cohabiting Black stepfamilies. We analyze survey data collected from 136 such families in order to understand how stepparent gender and relationship length impact the distribution of domestic labor. We hypothesize that women do more domestic work than men across all three family types, and that stepfathers are more involved in domestic labor in established relationships compared to new relationships. Findings indicate that cohabiting stepfathers in both new and established cohabiting Black stepfamilies make substantial contributions to domestic labor. These families demonstrate a division of labor consistent with traditional gender roles, though both partners agree on how much work each does. Parents, regardless of gender, are more involved in domestic labor than stepparents.

Correlates of male cohabiting partner's involvement in child-rearing tasks in low-income urban Black stepfamilies.

Cohabitation is a family structure experienced by many Black children. This study examines the link between family relationships (child relationship with mother and the cohabiting partner; parent and cohabiting partner relationship) and involvement of biologically unrelated male cohabiting partners (MCP) in child rearing. The participants were 121 low-income urban Black families consisting of a single mother, MCP, and an adolescent (56% female, M age = 13.7). Assessments were conducted individually with mothers, MCPs, and adolescents via measures administered by interview. MCPs were involved in both domains of child rearing assessed (daily child-related tasks and setting limits) and those identified as coparents by the mother were more involved in child-rearing tasks than those not identified as coparents. Using structural equation modeling (SEM), the mother-MCP relationship (both support and conflict) and the adolescent-MCP relationship were related to MCP's involvement in both domains of child rearing. The findings indicate that MCPs are actively involved in child rearing and family relationship variables are associated with their involvement in these tasks.

Substance use over the military-veteran life course: an analysis of a sample of OEF/OIF veterans returning to low-income predominately minority communities.

This paper presents an overview of substance use patterns of recent veterans returning to low-income predominately minority communities over four periods of the military-veteran career. Respondent driven sampling (RDS) was used so that unbiased estimates could be obtained for the characteristics of the target population. The majority of participants had used marijuana but no other illegal drugs. In the military, marijuana use was substantially lower and alcohol was the drug of choice; the majority were binge drinkers and nearly half were heavy drinkers. While deployed, alcohol and marijuana use were both lower, though some participants (6%) initiated the misuse of prescription painkillers. After separating from the military and returning to civilian life, heavy drinking was much lower, marijuana use increased, and some veterans misused prescription painkillers (7%). Further research based on these data will examine these distinct periods of substance use, contexts of use, related substance and mental health problems, treatment use and avoidance, and civilian reintegration.