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The association of engagement in substance use treatment with negative separation from the military among soldiers with post-deployment alcohol use disorder
•Among soldiers with post-deployment AUD, 40 % initiated and 24 % engaged in treatment.•35 % of soldiers with AUD had a negative separation from the military.•Engagement in SUD treatment was associated with increased negative separation.•To improve retention, SUD treatment should be offered earlier...
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| Published in: | Drug and alcohol dependence 2021-04, Vol.221, p.108647-108647, Article 108647 |
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| container_title | Drug and alcohol dependence |
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| creator | Gray, Joshua C. Larson, Mary Jo Moresco, Natalie Ritter, Grant A. Dufour, Steven Milliken, Charles S. Adams, Rachel Sayko |
| description | •Among soldiers with post-deployment AUD, 40 % initiated and 24 % engaged in treatment.•35 % of soldiers with AUD had a negative separation from the military.•Engagement in SUD treatment was associated with increased negative separation.•To improve retention, SUD treatment should be offered earlier to soldiers with AUD.
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.
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.
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.
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. |
| doi_str_mv | 10.1016/j.drugalcdep.2021.108647 |
| format | article |
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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.
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.
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.
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.</description><identifier>ISSN: 0376-8716</identifier><identifier>EISSN: 1879-0046</identifier><identifier>DOI: 10.1016/j.drugalcdep.2021.108647</identifier><identifier>PMID: 33647586</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>Adolescent ; Adult ; Afghan Campaign 2001 ; Alcohol related disorders ; Alcohol use ; Alcohol use disorder ; Alcoholism ; Alcoholism - diagnosis ; Alcoholism - psychology ; Alcoholism - therapy ; Armed forces ; Careers ; Criteria ; Deployment ; Diagnosis ; Disability ; Drug use ; Engagement ; Female ; Follow-Up Studies ; Health care ; Humans ; Iraq War, 2003-2011 ; Male ; Medical diagnosis ; Medical treatment ; Military ; Military deployment ; Military health system ; Military personnel ; Military Personnel - psychology ; Misconduct ; Patient Participation - methods ; Patient Participation - psychology ; Retention ; Separation ; Soldiers ; Substance abuse ; Substance use ; Surveys and Questionnaires ; Treatment ; Treatment Outcome ; Young Adult</subject><ispartof>Drug and alcohol dependence, 2021-04, Vol.221, p.108647-108647, Article 108647</ispartof><rights>2021</rights><rights>Published by Elsevier B.V.</rights><rights>Copyright Elsevier Science Ltd. Apr 1, 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c507t-fccb37e6f140ac779295587deff352fea7645c4cc8068d57d4745a24f525f2f23</citedby><cites>FETCH-LOGICAL-c507t-fccb37e6f140ac779295587deff352fea7645c4cc8068d57d4745a24f525f2f23</cites><orcidid>0000-0002-2468-6292 ; 0000-0002-5351-561X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,786,790,891,27957,27958,31034</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33647586$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gray, Joshua C.</creatorcontrib><creatorcontrib>Larson, Mary Jo</creatorcontrib><creatorcontrib>Moresco, Natalie</creatorcontrib><creatorcontrib>Ritter, Grant A.</creatorcontrib><creatorcontrib>Dufour, Steven</creatorcontrib><creatorcontrib>Milliken, Charles S.</creatorcontrib><creatorcontrib>Adams, Rachel Sayko</creatorcontrib><title>The association of engagement in substance use treatment with negative separation from the military among soldiers with post-deployment alcohol use disorder</title><title>Drug and alcohol dependence</title><addtitle>Drug Alcohol Depend</addtitle><description>•Among soldiers with post-deployment AUD, 40 % initiated and 24 % engaged in treatment.•35 % of soldiers with AUD had a negative separation from the military.•Engagement in SUD treatment was associated with increased negative separation.•To improve retention, SUD treatment should be offered earlier to soldiers with AUD.
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.
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.
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.
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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Afghan Campaign 2001</subject><subject>Alcohol related disorders</subject><subject>Alcohol use</subject><subject>Alcohol use disorder</subject><subject>Alcoholism</subject><subject>Alcoholism - diagnosis</subject><subject>Alcoholism - psychology</subject><subject>Alcoholism - therapy</subject><subject>Armed forces</subject><subject>Careers</subject><subject>Criteria</subject><subject>Deployment</subject><subject>Diagnosis</subject><subject>Disability</subject><subject>Drug use</subject><subject>Engagement</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health care</subject><subject>Humans</subject><subject>Iraq War, 2003-2011</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical treatment</subject><subject>Military</subject><subject>Military deployment</subject><subject>Military health system</subject><subject>Military personnel</subject><subject>Military Personnel - psychology</subject><subject>Misconduct</subject><subject>Patient Participation - methods</subject><subject>Patient Participation - psychology</subject><subject>Retention</subject><subject>Separation</subject><subject>Soldiers</subject><subject>Substance abuse</subject><subject>Substance use</subject><subject>Surveys and Questionnaires</subject><subject>Treatment</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0376-8716</issn><issn>1879-0046</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><recordid>eNqFUsuO1DAQjBCIHRZ-AVniwiWD7fiRXJBgxUtaictytjx2O-NREgfbmdX-Cx-LZ7Isjwu-WHJXVVe7q6oQwVuCiXhz2Nq49HowFuYtxZSU51Yw-ajakFZ2NcZMPK42uJGibiURF9WzlA64HNHhp9VF0xQwb8Wm-nGzB6RTCsbr7MOEgkMw9bqHEaaM_ITSsktZTwbQkgDlCDqfS7c-79EEfaEdASWYdVwVXAwjykV29IPPOt4hPYapRykM1kNMK3MOKdfF_hDuznJlmLAPw7mJ9SlEC_F59cTpIcGL-_uy-vbxw83V5_r666cvV--ua8OxzLUzZtdIEI4wrI2UHe04b6UF5xpOHWgpGDfMmBaL1nJpmWRcU-Y45Y462lxWb1fdedmNYE3xE_Wg5ujHYl8F7dXflcnvVR-OqiXlI4UoAq_vBWL4vkDKavTJwDDoCcKSFGUdZ7gh9NTr1T_QQ1jiVMZTlFMiOGkJK6h2RZkYUorgHswQrE4RUAf1OwLqFAG1RqBQX_45zAPx184L4P0KgPKlx7IRlYyHsmDrI5isbPD_7_ITFWfM1g</recordid><startdate>20210401</startdate><enddate>20210401</enddate><creator>Gray, Joshua C.</creator><creator>Larson, Mary Jo</creator><creator>Moresco, Natalie</creator><creator>Ritter, Grant A.</creator><creator>Dufour, Steven</creator><creator>Milliken, Charles S.</creator><creator>Adams, Rachel Sayko</creator><general>Elsevier B.V</general><general>Elsevier Science Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2468-6292</orcidid><orcidid>https://orcid.org/0000-0002-5351-561X</orcidid></search><sort><creationdate>20210401</creationdate><title>The association of engagement in substance use treatment with negative separation from the military among soldiers with post-deployment alcohol use disorder</title><author>Gray, Joshua C. ; Larson, Mary Jo ; Moresco, Natalie ; Ritter, Grant A. ; Dufour, Steven ; Milliken, Charles S. ; Adams, Rachel Sayko</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c507t-fccb37e6f140ac779295587deff352fea7645c4cc8068d57d4745a24f525f2f23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Afghan Campaign 2001</topic><topic>Alcohol related disorders</topic><topic>Alcohol use</topic><topic>Alcohol use disorder</topic><topic>Alcoholism</topic><topic>Alcoholism - diagnosis</topic><topic>Alcoholism - psychology</topic><topic>Alcoholism - therapy</topic><topic>Armed forces</topic><topic>Careers</topic><topic>Criteria</topic><topic>Deployment</topic><topic>Diagnosis</topic><topic>Disability</topic><topic>Drug use</topic><topic>Engagement</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Health care</topic><topic>Humans</topic><topic>Iraq War, 2003-2011</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Medical treatment</topic><topic>Military</topic><topic>Military deployment</topic><topic>Military health system</topic><topic>Military personnel</topic><topic>Military Personnel - psychology</topic><topic>Misconduct</topic><topic>Patient Participation - methods</topic><topic>Patient Participation - psychology</topic><topic>Retention</topic><topic>Separation</topic><topic>Soldiers</topic><topic>Substance abuse</topic><topic>Substance use</topic><topic>Surveys and Questionnaires</topic><topic>Treatment</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gray, Joshua C.</creatorcontrib><creatorcontrib>Larson, Mary Jo</creatorcontrib><creatorcontrib>Moresco, Natalie</creatorcontrib><creatorcontrib>Ritter, Grant A.</creatorcontrib><creatorcontrib>Dufour, Steven</creatorcontrib><creatorcontrib>Milliken, Charles S.</creatorcontrib><creatorcontrib>Adams, Rachel Sayko</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Drug and alcohol dependence</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gray, Joshua C.</au><au>Larson, Mary Jo</au><au>Moresco, Natalie</au><au>Ritter, Grant A.</au><au>Dufour, Steven</au><au>Milliken, Charles S.</au><au>Adams, Rachel Sayko</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The association of engagement in substance use treatment with negative separation from the military among soldiers with post-deployment alcohol use disorder</atitle><jtitle>Drug and alcohol dependence</jtitle><addtitle>Drug Alcohol Depend</addtitle><date>2021-04-01</date><risdate>2021</risdate><volume>221</volume><spage>108647</spage><epage>108647</epage><pages>108647-108647</pages><artnum>108647</artnum><issn>0376-8716</issn><eissn>1879-0046</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><notes>Acquisition of data: Larson, Adams</notes><notes>Critical revision: Gray, Adams, Ritter, Moresco, Larson, Dufour, Milliken</notes><notes>Contributor’s statement</notes><notes>Study conception and design: Gray, Adams, Larson, Ritter</notes><notes>Drafting of manuscript: Gray, Adams, Ritter, Moresco, Larson, Dufour, Milliken</notes><notes>All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.</notes><notes>Analysis and interpretation of data: Gray, Adams, Ritter, Moresco, Larson, Dufour, Milliken</notes><abstract>•Among soldiers with post-deployment AUD, 40 % initiated and 24 % engaged in treatment.•35 % of soldiers with AUD had a negative separation from the military.•Engagement in SUD treatment was associated with increased negative separation.•To improve retention, SUD treatment should be offered earlier to soldiers with AUD.
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.
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.
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.
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.</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>33647586</pmid><doi>10.1016/j.drugalcdep.2021.108647</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-2468-6292</orcidid><orcidid>https://orcid.org/0000-0002-5351-561X</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Drug and alcohol dependence, 2021-04, Vol.221, p.108647-108647, Article 108647 |
| issn | 0376-8716 1879-0046 |
| language | eng |
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| source | Applied Social Sciences Index & Abstracts (ASSIA); ScienceDirect Freedom Collection |
| subjects | Adolescent Adult Afghan Campaign 2001 Alcohol related disorders Alcohol use Alcohol use disorder Alcoholism Alcoholism - diagnosis Alcoholism - psychology Alcoholism - therapy Armed forces Careers Criteria Deployment Diagnosis Disability Drug use Engagement Female Follow-Up Studies Health care Humans Iraq War, 2003-2011 Male Medical diagnosis Medical treatment Military Military deployment Military health system Military personnel Military Personnel - psychology Misconduct Patient Participation - methods Patient Participation - psychology Retention Separation Soldiers Substance abuse Substance use Surveys and Questionnaires Treatment Treatment Outcome Young Adult |
| title | The association of engagement in substance use treatment with negative separation from the military among soldiers with post-deployment alcohol use disorder |
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