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Chen Y, Christensen Pacella KA, Forbush KT, Thomeczek ML, Negi S, Doan AE, Wendler AM, Morgan RW, Rasheed SI, Johnson-Munguia S, Sharma AR. Examining associations between disordered eating and harmful substance use in a nationally representative sample of US veterans. Int J Eat Disord 2024; 57:1542-1554. [PMID: 38469980 DOI: 10.1002/eat.24194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE The association between eating disorders (EDs) and harmful substance use (substance use that causes psychosocial impairment) is well recognized in the literature, and military veterans may be at heightened risk for both issues due to deployment-related stressors. However, little is known about which ED-related symptoms are associated with harmful substance use in veterans, and whether gender plays a differential role in this relationship. Our aims were to: (1) examine gender differences in ED-related symptoms; and (2) examine whether ED-related symptoms differentially predict harmful substance use in US veteran men and women who had recently separated from service. METHOD This study was based on a nationally representative four-wave longitudinal sample of post-9/11 veterans (N = 835; 61.2% female). Longitudinal mixed modeling was used to test whether specific ED-related behaviors at baseline predicted harmful substance use at follow-ups. RESULTS We replicated gendered patterns of ED-related symptoms observed in civilian populations, wherein men had higher weight-and-body-related concerns (including excessive exercise and muscle building) and negative attitude toward obesity, and women had higher bulimic and restricting symptoms. For women, alcohol, drug, and marijuana problems were predicted by higher bulimic symptoms, whereas for men, these problems were predicted by higher restricting symptoms. CONCLUSION Gender played a differential role in the relationship between EDs and harmful substance use. Bulimic symptoms were the most robust predictor for harmful substance use among veteran women, whereas restricting was the most robust predictor for harmful substance use among veteran men. PUBLIC SIGNIFICANCE The current study found that veteran women had higher bulimic symptoms (characterized by binge eating and purging) and restricting than veteran men. In women, bulimic symptoms predicted future harmful use of alcohol, marijuana, and other drugs. In contrast, veteran men had higher weight-and-body-related concerns (characterized by excessive exercise and muscle building) than veteran women. In men, restricting symptoms predicted future harmful use of alcohol, marijuana, and other drugs.
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Affiliation(s)
- Yiyang Chen
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | | | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | | | - Sonakshi Negi
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Alesha E Doan
- Department of Women, Gender, and Sexuality Studies, University of Kansas, Lawrence, Kansas, USA
- School of Public Affairs and Administration, University of Kansas, Lawrence, Kansas, USA
| | | | - R William Morgan
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Samiya I Rasheed
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | | | - Anjali R Sharma
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
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Tsai J, Kelton K, Blonigen DM, Keith Mcinnes D, Sean Clark, Blue-Howells J, Hooshyar D. A Research Agenda for Criminal Justice Involvement Among U.S. Veterans. Mil Med 2024; 189:e481-e485. [PMID: 37283229 DOI: 10.1093/milmed/usad201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/15/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION A substantial proportion of adults in the U.S. criminal justice system are military veterans. Justice-involved veterans are of particular public concern given their service to the country and the high rates of health and social problems in the general veteran population. This article describes the development of a national research agenda for justice-involved veterans. MATERIALS AND METHODS In the summer of 2022, the VA National Center on Homelessness among Veterans in partnership with the VA Veterans Justice Programs Office convened a national group of subject matter experts and stakeholders across three listening sessions that included 40-63 attendees per session. These sessions were recorded, and transcriptions of all sessions and chats were synthesized to generate a preliminary list of 41 agenda items. The Delphi method involving two rounds of ratings from subject matter experts was used to develop consensus. RESULTS The final research agenda consists of 22 items covering five domains: Epidemiology and knowledge of the population, treatment and services, systems and systems interface, methodology and research resources, and policies. CONCLUSIONS The intent of sharing this research agenda is to spur stakeholders to conduct, collaborate, and support further study in these areas.
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Affiliation(s)
- Jack Tsai
- U.S. Department of Veterans Affairs (VA) Homeless Programs Office, National Center on Homelessness among Veterans, Washington, DC 20420, USA
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Katherine Kelton
- U.S. Department of Veterans Affairs (VA) Homeless Programs Office, National Center on Homelessness among Veterans, Washington, DC 20420, USA
| | - Daniel M Blonigen
- U.S. Department of Veterans Affairs Palo Alto Health Care System, Center for Innovation to Implementation, Palo Alto, CA 94025, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 01730, USA
| | - D Keith Mcinnes
- U.S. Department of Veterans Affairs , Bedford Health Care System, Bedford, MA 02118, USA
- School of Public Health, Boston University, Boston, MA 20420, USA
| | - Sean Clark
- U.S. Department of Veterans Affairs (VA) Homeless Programs Office, Veterans Justice Programs, Washington, DC 75390, USA
| | - Jessica Blue-Howells
- U.S. Department of Veterans Affairs (VA) Homeless Programs Office, Veterans Justice Programs, Washington, DC 75390, USA
| | - Dina Hooshyar
- U.S. Department of Veterans Affairs (VA) Homeless Programs Office, National Center on Homelessness among Veterans, Washington, DC 20420, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Barry LC, Steffens DC, Covinsky KE, Conwell Y, Boscardin J, Li Y, Byers AL. High Risk of Substance Use Disorder-Related Outcomes in Veterans Released from Correctional Facilities in Mid to Late Life. J Gen Intern Med 2023; 38:1109-1118. [PMID: 36781577 PMCID: PMC10110776 DOI: 10.1007/s11606-023-08057-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 01/26/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Veterans Affairs (VA) is likely to encounter a growing number of veterans returning to the community in mid to late life following incarceration (i.e., experiencing reentry). Yet, rates of negative health outcomes due to substance use disorders (SUDs) in this population are unknown. OBJECTIVE To determine risk of and risk factors for SUD-related emergency department visits and inpatient hospitalizations (ED/IPH) and overdose death among older reentry veterans compared with never-incarcerated veterans. DESIGN Retrospective cohort study using national VA and Medicare healthcare systems data. PARTICIPANTS Veterans age ≥50, incarcerated for ≤5 consecutive years, and released between October 1, 2010, and September 30, 2017 (N = 18,803), were propensity score-matched 1:5 with never-incarcerated veterans (N = 94,015) on demographic characteristics, reason for Medicare eligibility, and SUD history. MAIN MEASURES SUD-related ED/IPH (overall and substance-specific) were obtained from in-/outpatient VA health services and CMS data within the year following release date/index date (through September 30, 2018). Overdose death within 1 year was identified using the National Mortality Data Repository. Fine-Gray proportional hazards regression compared risk of SUD-related ED/IPH and overdose death between the two groups. RESULTS The number of SUD-related ED/IPHs and overdose deaths was 2470 (13.1%) and 72 (0.38%) in the reentry sample versus 4402 (4.7%) and 198 (0.21%) in the never-incarcerated sample, respectively. Mid-to-late-life reentry was associated with higher risk of any SUD-related ED/IPH (13,136.2 vs. 2252.8 per 100,000/year; adjusted hazard ratio [AHR] = 2.19; 95% confidence interval [CI] = 2.08, 2.30) and overdose death (382.9 vs. 210.6 per 100,000/year; AHR = 2.24, 95% CI = 1.63, 3.08). CONCLUSIONS Older reentry veterans have more than double the risk of experiencing SUD-related ED/IPH (overall and substance-specific) and overdose death, even after accounting for SUD history and other likely confounders. These findings highlight the vulnerability of this population. Improved knowledge regarding SUD-related negative health outcomes may help to tailor VA reentry programming.
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Affiliation(s)
- Lisa C Barry
- Department of Psychiatry, UCONN School of Medicine, Farmington, CT, USA.
- UCONN Center On Aging, Farmington, CT, USA.
| | - David C Steffens
- Department of Psychiatry, UCONN School of Medicine, Farmington, CT, USA
| | - Kenneth E Covinsky
- San Francisco VA Healthcare System, San Francisco, CA, USA
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA
| | - John Boscardin
- San Francisco VA Healthcare System, San Francisco, CA, USA
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, USA
| | - Yixia Li
- San Francisco VA Healthcare System, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Amy L Byers
- San Francisco VA Healthcare System, San Francisco, CA, USA
- Department of Medicine, Division of Geriatrics, University of California, San Francisco, USA
- Department of Psychiatry, University of California, San Francisco, CA, USA
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Blonigen DM, Cucciare MA, Byrne T, Shaffer PM, Giordano B, Smith JS, Timko C, Rosenthal J, Smelson D. A randomized controlled trial of moral reconation therapy to reduce risk for criminal recidivism among justice-involved adults in mental health residential treatment. J Consult Clin Psychol 2022; 90:413-426. [PMID: 35404638 PMCID: PMC9426716 DOI: 10.1037/ccp0000721] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Moral reconation therapy (MRT) is a cognitive-behavioral intervention to reduce risk for criminal recidivism. Despite being implemented widely in correctional settings, there are no randomized controlled trials of MRT, and its effectiveness for reducing recidivism among justice-involved adults in noncorrectional settings is unknown. METHOD In a pragmatic trial, 341 justice-involved patients (95.3% male; 57.8% White/non-Hispanic) admitted to one of three mental health residential treatment programs were randomly assigned to usual care (UC) or UC plus two MRT groups per week for 12 weeks. Follow-ups were conducted at 6- and 12-month postbaseline (71.3% and 74.8% retention, respectively). Primary outcomes were criminal thinking and criminal associates. Secondary outcomes were legal problem severity, days incarcerated in the past 30, rearrested/charged (per official records), substance use, and employment and family/social problems. The study design, analysis, and outcomes were preregistered (ClinicalTrials.gov; ID: NCT02524171). RESULTS Patients in both conditions improved over time on most outcomes. In intent-to-treat analyses, the rate of change in outcomes over time did not differ by condition, nor did the prevalence of being rearrested and charged within 1 year of baseline (UC = 20.2%, MRT = 24.9%; OR = 1.14; 95% CI [0.67, 1.94], p = .63). MRT engagement was low; 37% of those randomized to MRT received a minimum dose-that is, completed at least Step 3. In per-protocol analyses, this subgroup, relative to UC, improved more on criminal associates, days incarcerated, legal problem severity, and alcohol use severity. CONCLUSIONS In this study, MRT was not more effective than UC at reducing recidivism risk for patients in mental health residential treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Daniel M. Blonigen
- HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA USA
| | - Michael A. Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR 72205, USA
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72205, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Thomas Byrne
- HSR&D Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA USA
- University of Massachusetts Medical School, Worcester, MA USA
| | - Paige M. Shaffer
- HSR&D Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA USA
- University of Massachusetts Medical School, Worcester, MA USA
| | - Brenna Giordano
- Clinical Psychology PhD Program, Palo Alto University, Palo Alto, CA USA
| | - Jennifer S. Smith
- HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA USA
| | - Christine Timko
- HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA USA
| | - Joel Rosenthal
- Veterans Justice Programs, Veterans Health Administration, Washington DC USA
| | - David Smelson
- HSR&D Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA USA
- University of Massachusetts Medical School, Worcester, MA USA
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Desistance from crime following substance use treatment: the role of treatment retention, social network and self-control. BMC Psychiatry 2021; 21:563. [PMID: 34772369 PMCID: PMC8588672 DOI: 10.1186/s12888-021-03518-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reductions in crime are often reported following substance use treatment. We explore the relationship between desistance from crime, treatment type, treatment retention and positive changes in known risk factors for crime. METHODS We used data from the NorComt-study; a longitudinal study of substance users (n = 341) enrolled in comprehensive treatment in Norway (2012-2015). At treatment initiation (T0) and 1 year later (T1), we collected self-reported data on criminal involvement, treatment, substance use, social network and self-control. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) with multinomial logistic regression analysis. RESULTS Overall, 1 year following treatment initiation 69% reported desistance from crime, 18% reported continued crime and 12% reported no crime at all in the study period. Desistance was high for OMT patients in ongoing treatment (79% desisted) and for inpatients regardless of treatment status (79-93% desisted), while not as high among OMT patients with interrupted treatment (47% desisted). For participants that continued crime during follow-up, the average number of criminal acts per month was reduced (p < 0.001). Desistance at follow-up was associated with being older (aOR: 1.05, CI: 1.00-1.10), inpatient treatment (aOR: 3.71, CI: 1.12-12.29), being in ongoing treatment (inpatient or OMT) (aOR: 2.90, CI: 1.01-8.36), having no stimulant use in the study period (aOR: 4.86, CI: 1.72-13.70), leaving a substance using social network (aOR 2.87, CI: 1.15-7.18) and improvement in self-control score (aOR: 1.08, CI: 1.04-1.13). CONCLUSIONS Retention in treatment is particularly important for crime outcomes among OMT patients. Positive changes in social network and self-control are potential contributors to desistance from crime. Targeted interventions towards crime reduction are recommended for patients with stimulant use, which appears to be a persistent risk factor for crime over time.
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