The Epidemiology of Substance Use Disorders in US Veterans: A Systematic Review & Analysis of Assessment Methods

BACKGROUND:

Substance use disorders (SUDs), which encompass alcohol and drug use disorders (AUDs, DUDs), constitute a major public health challenge among US veterans. SUDs are among the most common and costly of all health conditions among veterans.

OBJECTIVES:

This study sought to examine the epidemiology of SUDs among US veterans, compare the prevalence of SUDs in studies using diagnostic and administrative criteria assessment methods, and summarize trends in the prevalence of SUDs reported in studies sampling USveterans over time.

METHODS:

Comprehensive electronic database searches were conducted. A total of 3,490 studies were identified. We analyzed studies samplingUS veterans and reporting prevalence, distribution, and examining AUDs and DUDs.

RESULTS:

Of the studies identified, 72 met inclusion criteria. The studies were published between 1995 and 2013. Studies using diagnostic criteria reported higher prevalence of AUDs (32% vs. 10%) and DUDs (20% vs. 5%) than administrative criteria, respectively. Regardless of assessmentmethod, both the lifetime and past year prevalence of AUDs in studies sampling US veterans has declined gradually over time.

CONCLUSION:

The prevalence of SUDs reported in studies sampling US veterans are affected by assessment method. Given the significant public health problems of SUDs among US veterans, improved guidelines for clinical screening using validated diagnostic criteria to assess AUDs and DUDs in US veteran populations are needed.

SCIENTIFIC SIGNIFICANCE:

These findings may inform VA and other healthcare systems in prevention, diagnosis, and intervention for SUDs among US veterans.

Below:  Prevalence of lifetime alcohol use disorders (AUDs) among US veterans reported by studies using diagnostic (ie, DSM) criteria (Panel A) and administrative (ie, ICD-9) criteria (Panel B), by publication year. Note: black solid lines represent trend lines, calculated using weighted least squares regression. Note: Some of the data points overlap with each other since they had the same or very similar data point. DSM, Diagnostic and Statistical Manual of Mental Disorders; DUD, drug use disorder; ICD-9, international classification of diseases.

Below:  Prevalence of past year alcohol use disorders (AUDs) among US veterans reported by studies using diagnostic (ie, DSM) criteria (Panel A) and administrative (ie, ICD-9) criteria (Panel B), by publication year. Note: black solid lines represent trend lines, calculated using weighted least squares regression. Note: Some of the data points overlap with each other since they had the same or very similar data point. AUD, alcohol use disorder; DSM, Diagnostic and Statistical Manual of Mental Disorders; ICD-9, international classification of diseases.

Below:  Prevalence of lifetime drug use disorders (DUDs) among US veterans reported by studies using diagnostic (ie, DSM) criteria (Panel A) and administrative (ie, ICD-9) criteria (Panel B), by publication year. Note: black solid lines represent trend lines, calculated using weighted least squares regression. Note: Some of the data points overlap with each other since they had the same or very similar data point. AUD, alcohol use disorder; DSM, Diagnostic and Statistical Manual of Mental Disorders; ICD-9, international classification of diseases.

Full article at:   http://goo.gl/H6dSHm

By:  Lan CW1, Fiellin DA2, Barry DT3,4, Bryant KJ5, Gordon AJ6,7,8, Edelman EJ2, Gaither JR9, Maisto SA10, Marshall BD11.

• 1Department of Community Health Sciences, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, California.
• 2Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
• 3Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
• 4Pain Treatment Services, APT Foundation, Inc., New Haven, Connecticut.
• 5National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland.
• 6Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
• 7Mental Health Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
• 8Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania.
• 9Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
• 10Department of Psychology, Syracuse University, Syracuse, New York.
• 11Department of Epidemiology, Brown University, School of Public Health, Providence, Rhode Island. 

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