Substance use and other mental health disorders among veterans returning to the inner city: prevalence, correlates, and rates of unmet treatment need.

Estimates of substance use and other mental health disorders of veterans (N = 269) who returned to predominantly low-income minority New York City neighborhoods between 2009 and 2012 are presented. Although prevalences of posttraumatic stress disorder, traumatic brain injury, and depression clustered around 20%, the estimated prevalence rates of alcohol use disorder, drug use disorder, and substance use disorder were 28%, 18%, and 32%, respectively. Only about 40% of veterans with any diagnosed disorder received some form of treatment. For alcohol use disorder, the estimate of unmet treatment need was 84%, which is particularly worrisome given that excessive alcohol use was the greatest substance use problem.

Unmet need for treatment of substance use disorders and serious psychological distress among veterans: a nationwide analysis using the NSDUH.

Many veterans returning from Afghanistan and Iraq experience serious mental health (MH) concerns including substance use disorders (SUD), post-traumatic stress disorder, traumatic brain injury, depression, or serious psychological distress (SPD). This article uses data from the 2004 to 2010 National Survey on Drug Use and Health to examine the prevalence of unmet MH needs among veterans aged 21 to 34 in the general population. The prevalence of untreated SUD among veterans (16%) was twice as high as untreated SPD (8%), a nonspecific diagnosis of serious MH concerns. Surprisingly, similar rates of untreated SUD and SPD were found among a nonveteran comparison sample matched on gender and age. These findings suggest that reducing unmet need for MH treatment for veterans in the general population may require improving outreach to all Americans and creating greater acceptance for MH treatment. The need for further analyses of reasons for not obtaining treatment is discussed.

Correlates of staying safe behaviors among long-term injection drug users: psychometric evaluation of the staying safe questionnaire.

We report on psychometric properties of a new questionnaire to study long-term strategies, practices and tactics that may help injection drug users (IDUs) avoid infection with HIV and hepatitis C. Sixty-two long-term IDUs were interviewed in New York City in 2009. Five scales based on a total of 47 items were formed covering the following domains: stigma avoidance, withdrawal prevention, homeless safety, embedding safety within a network of users, and access to resources/social support. All scales (α ≥ .79) except one (α = .61) were highly internally consistent. Seven single-item measures related to drug use reduction and injection practices were also analyzed. All variables were classified as either belonging to a group of symbiotic processes that are not directly focused upon disease prevention but nonetheless lead to risk reduction indirectly or as variables describing prevention tactics in risky situations. Symbiotic processes can be conceived of as unintentional facilitators of safe behaviors. Associations among variables offer suggestions for potential interventions. These Staying Safe variables can be used as predictors of risk behaviors and/or biological outcomes.

Modified therapeutic community aftercare for clients triply diagnosed with HIV/AIDS and co-occurring mental and substance use disorders.

This clinical trial evaluated a modified therapeutic community aftercare (MTC-A) program for a population triply diagnosed with HIV/AIDS, a substance use disorder, and a mental disorder. After six months of MTC residential treatment (MTC-R), subjects were randomly assigned to MTC-A (n=42) or to standard aftercare (C; n=34). Follow-up interviews at six and 12 months assessed eight outcome domains and adherence to prescribed HIV medication. A propensity model was used to re-balance the retrieved sample. At the six-month follow-up, High stratum MTC-A clients (those with greater psychological functioning and stable physical health at baseline) had greater improvement overall and for substance use and mental health than C clients in the same stratum. In contrast, C clients in the Low/Medium stratum (those with poorer psychological functioning and improved physical health) had more favorable outcomes overall and for substance use than their MTC-A counterparts; however, this stratum was not re-balanced effectively. Differences in HIV medication adherence were not detected. Clients with greater psychological functioning and stable health at treatment entry benefit more from the MTC-A program. In view of the potentially progressive nature of HIV, measuring physical and mental health during treatment and controlling for changes could be important in future research.

Chronic toluene misuse among Roma youth in Eastern Slovakia.

This report presents pilot data on toluene misuse among Roma (Gypsy) youth in eastern Slovakia. Twenty interviews were conducted with field social workers (FSWs) working in seven Roma settlements with a combined population of 17,050 people. An estimated 340 chronic toluene users, mostly males (90%, n = 306), were identified in the researched communities. FSWs reported that children younger than 10 years of age represented about 15% of users (n = 52) and that the majority of users (75%, n = 255) were between 10 and 25 years of age. Consequences of prolonged use on individuals and communities are discussed. The study's limitations are noted.

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.

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.

Meta-analyses of seven of the National Institute on Drug Abuse's principles of drug addiction treatment.

Of the 13 principles of drug addiction treatment disseminated by the National Institute on Drug Abuse (NIDA), 7 were meta-analyzed as part of the Evidence-based Principles of Treatment (EPT) project. By averaging outcomes over the diverse programs included in the EPT, we found that 5 of the NIDA principles examined are supported: matching treatment to the client's needs, attending to the multiple needs of clients, behavioral counseling interventions, treatment plan reassessment, and counseling to reduce risk of HIV. Two of the NIDA principles are not supported: remaining in treatment for an adequate period and frequency of testing for drug use. These weak effects could be the result of the principles being stated too generally to apply to the diverse interventions and programs that exist or unmeasured moderator variables being confounded with the moderators that measured the principles. Meta-analysis should be a standard tool for developing principles of effective treatment for substance use disorders.