Joshua C Gray1, Mary Jo Larson2, Natalie Moresco2, Grant A Ritter2, Steven Dufour3, Charles S Milliken4, Rachel Sayko Adams5. 1. Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA. Electronic address: joshua.gray@usuhs.edu. 2. Heller School, Institute for Behavioral Health, Brandeis University, 415 South Street MS 035, Waltham, MA, 02453, USA. 3. Department of Medical and Clinical Psychology, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA. 4. Army's Substance Use Disorder Clinical Care, Office of the Army Surgeon General, Defense Health Headquarters, 7700 Arlington Blvd, Falls Church, VA, 22042, USA. 5. Heller School, Institute for Behavioral Health, Brandeis University, 415 South Street MS 035, Waltham, MA, 02453, USA; Rocky Mountain Mental Illness Research Education and Clinical Center, Veterans Health Administration, 1700 N. Wheeling Street, Aurora, CO, 80045, USA.
Abstract
BACKGROUND: Alcohol use disorder (AUD) reduces the health of soldiers and the readiness of the Armed Forces. It remains unknown if engagement in substance use treatment in the Military Health System improves retention in the military. METHODS: The sample consisted of active duty soldiers returning from an Afghanistan/Iraq deployment in fiscal years 2008-2010 who received an AUD diagnosis within 150 days of completing a post-deployment health re-assessment survey (n = 4,726). A Heckman probit procedure was used to examine predictors of substance use treatment initiation and engagement in accordance with Healthcare Effectiveness Data and Information Set (HEDIS) criteria. Cox proportional hazard modeling was used to examine the association between treatment engagement and retention, defined as a negative separation for a non-routine cause (e.g., separation due to misconduct, poor performance, disability) from the military in the two years following the index AUD diagnosis. RESULTS: 40 % of soldiers meeting HEDIS AUD criteria initiated and 24 % engaged in substance use treatment. Among soldiers diagnosed with AUD, meeting criteria for treatment engagement was associated with a significantly higher hazard of having a negative separation compared to soldiers who did not engage in treatment. CONCLUSIONS: Rates of initiation and engagement in substance use treatment for post-deployment AUD were relatively low. Soldiers with AUD who engaged in substance use treatment were more likely to have a negative separation from the military than soldiers with AUD who did not engage. Our findings imply that in the study cohort, treatment did not mitigate negative career consequences of AUD. Published by Elsevier B.V.
BACKGROUND: Alcohol use disorder (AUD) reduces the health of soldiers and the readiness of the Armed Forces. It remains unknown if engagement in substance use treatment in the Military Health System improves retention in the military. METHODS: The sample consisted of active duty soldiers returning from an Afghanistan/Iraq deployment in fiscal years 2008-2010 who received an AUD diagnosis within 150 days of completing a post-deployment health re-assessment survey (n = 4,726). A Heckman probit procedure was used to examine predictors of substance use treatment initiation and engagement in accordance with Healthcare Effectiveness Data and Information Set (HEDIS) criteria. Cox proportional hazard modeling was used to examine the association between treatment engagement and retention, defined as a negative separation for a non-routine cause (e.g., separation due to misconduct, poor performance, disability) from the military in the two years following the index AUD diagnosis. RESULTS: 40 % of soldiers meeting HEDIS AUD criteria initiated and 24 % engaged in substance use treatment. Among soldiers diagnosed with AUD, meeting criteria for treatment engagement was associated with a significantly higher hazard of having a negative separation compared to soldiers who did not engage in treatment. CONCLUSIONS: Rates of initiation and engagement in substance use treatment for post-deployment AUD were relatively low. Soldiers with AUD who engaged in substance use treatment were more likely to have a negative separation from the military than soldiers with AUD who did not engage. Our findings imply that in the study cohort, treatment did not mitigate negative career consequences of AUD. Published by Elsevier B.V.
Entities:
Keywords:
Alcohol use disorder; Engagement; Military health system; Retention; Treatment
Authors: Danielle S Berke; Nora K Kline; Jennifer Schuster Wachen; Carmen P McLean; Jeffrey S Yarvis; Jim Mintz; Stacey Young-McCaughan; Alan L Peterson; Edna Foa; Patricia A Resick; Brett T Litz Journal: Behav Res Ther Date: 2019-03-08
Authors: Shira Maguen; Erin Madden; Thomas C Neylan; Beth E Cohen; Daniel Bertenthal; Karen H Seal Journal: Psychiatr Serv Date: 2014-10-31 Impact factor: 3.084
Authors: Sonya B Norman; Ryan Trim; Moira Haller; Brittany C Davis; Ursula S Myers; Peter J Colvonen; Erika Blanes; Robert Lyons; Emma Y Siegel; Abigail C Angkaw; Gregory J Norman; Tina Mayes Journal: JAMA Psychiatry Date: 2019-08-01 Impact factor: 21.596
Authors: Eric B Elbogen; H Ryan Wagner; Mira Brancu; Nathan A Kimbrel; Jennifer C Naylor; Cindy M Swinkels; John A Fairbank Journal: Mil Med Date: 2018-09-01 Impact factor: 1.437
Authors: Robert Dunigan; Andrea Acevedo; Kevin Campbell; Deborah W Garnick; Constance M Horgan; Alice Huber; Margaret T Lee; Lee Panas; Grant A Ritter Journal: J Behav Health Serv Res Date: 2014-01 Impact factor: 1.505
Authors: Rachel Sayko Adams; Erich J Dietrich; Joshua C Gray; Charles S Milliken; Natalie Moresco; Mary Jo Larson Journal: Health Aff (Millwood) Date: 2019-08 Impact factor: 6.301