Adrian J. Blow

Prevalence and correlates of alcohol misuse among returning Afghanistan and Iraq Veterans

OBJECTIVE Several studies have reported high rates of alcohol misuse and low rates of substance use treatment among OEF/OIF military service members. This study assessed the prevalence and correlates of alcohol misuse and the factors associated with treatment utilization among recently returned National Guard service members. METHODS The sample included 585 members of the National Guard who volunteered to complete an anonymous survey assessing mental health and substance use problems, functional status, and past treatment experiences. Bivariate and multivariate logistic regression analyses were performed examining the significance of associations between alcohol misuse and mental health service use as outcomes and demographic variables, mental health symptoms, and military service characteristics as predictors. Barriers to treatment and factors facilitating treatment were also examined. RESULTS Thirty-six percent of the service members met criteria for alcohol misuse. Of those misusing alcohol, 31% reported receiving any mental health treatment and 2.5% reported receiving specific substance use treatment in the past year. The barrier to treatment most commonly endorsed by those misusing alcohol was concern that the information about treatment would appear in their records. Among those misusing alcohol who had received services, spouses were most commonly endorsed as facilitating the pursuit of care. CONCLUSIONS Rates of alcohol misuse are high and rates of substance use treatment are low among National Guard service members. Additional research is needed to identify means of overcoming barriers to care and establish more effective approaches to facilitate linkage to care and receipt of appropriate interventions.

Buddy-to-Buddy, a citizen soldier peer support program to counteract stigma, PTSD, depression, and suicide.

Citizen soldiers (National Guard and Reserves) represent approximately 40% of the two million armed forces deployed to Afghanistan and Iraq. Twenty‐five to forty percent of them develop PTSD, clinical depression, sleep disturbances, or suicidal thoughts. Upon returning home, many encounter additional stresses and hurdles to obtaining care: specifically, many civilian communities lack military medical/psychiatric facilities; financial, job, home, and relationship stresses have evolved or have been exacerbated during deployment; uncertainty has increased related to future deployment; there is loss of contact with military peers; and there is reluctance to recognize and acknowledge mental health needs that interfere with treatment entry and adherence. Approximately half of those needing help are not receiving it. To address this constellation of issues, a private–public partnership was formed under the auspices of the Welcome Back Veterans Initiative. In Michigan, the Army National Guard teamed with the University of Michigan and Michigan State University to develop innovative peer‐to‐peer programs for soldiers (Buddy‐to‐Buddy) and augmented programs for military families. Goals are to improve treatment entry, adherence, clinical outcomes, and to reduce suicides. This manuscript describes training approaches, preliminary results, and explores future national dissemination.

Hazardous Drinking and Family Functioning in National Guard Veterans and Spouses Postdeployment

The current study examined rates of alcohol misuse among National Guard (NG) service members and their spouses/partners, concordance of drinking behaviors among couples, and the effects of alcohol misuse, depression, and posttraumatic stress disorder (PTSD) on three measures of family functioning. This study is important because it addresses the topics of heavy drinking and family functioning in an at-risk population-NG service members returning from a combat zone deployment. We surveyed NG service members (1,143) and their partners (674) 45-90 days after returning from a military deployment. Service member rates of hazardous drinking were 29.2% and spouses/partners 10.7%. Of the 661 linked couples, 26.2% were discrepant where only one member met the criteria for hazardous drinking and 5.4% were congruent for alcohol misuse where both members met hazardous drinking criteria. Service members belonging to either congruent or discrepant drinking groups were more distressed in their marriages/relationships than those in the nonhazardous group. In dyadic analyses, an unexpected partner effect was found for parenting outcomes; that is, when service members drink more, their spouses/partners are less stressed when it comes to parenting. Importantly, both service member and spouse/partner depression was significantly associated with negative family outcomes. Results from this study suggest that when working with these families, it is important to understand the drinking status of both soldier and spouse and to treat depression in addition to alcohol misuse.

A Model of Meaning-Making Coping and Growth in Combat Veterans

More than 1.6 million military men and women have deployed to fight the global war on terror. Although studies have suggested that approximately one third of these service men and women return with a mental health condition or a brain injury, a gap remains in our understanding about how these individuals cope with and grow from their experiences. In this article, we review the existing body of research related to growth and recovery from trauma and then propose an empirically informed and contextually sensitive model to guide future research with combat veterans. We draw from research focused on resilience, posttraumatic growth, and decline (negative or pathological) change trajectories, and we propose that meaning-making coping is a core mechanism of the posttraumatic growth process for combat veterans. Implications for practitioners and the next steps for future research are presented.

Variations in Family System Boundaries

Literature focused on the strength of the boundary around the family system has often provided mixed advice with some suggesting a rigid boundary and others suggesting a diffuse boundary. This study argues that these conflicting findings are due to the limitation of underlying research methods. This study employs a mixed method design that incorporates qualitative data, social network analysis, and multilevel modeling to categorize family businesses into three distinct boundary strength categories. Findings from this study suggest that extremes in boundary strengths provide unique challenges for family businesses. This study also identifies the impact of various levels of boundary strength on nonfamily employees.

Civilian employment among recently returning Afghanistan and Iraq National Guard veterans.

OBJECTIVE National Guard service members face deactivation from active duty soon after they return to the United States and rapid entry into the civilian workforce; therefore, it is important to examine employment among these Veterans. METHODS The sample included 585 National Guard service members. Bivariate and multivariable analyses were conducted examining the associations between mental health symptoms, alcohol use, number of deployments, and combat exposure with employment status and full-time versus part-time employment as outcomes. RESULTS Forty-one percent of National Guard service members were employed 45 to 60 days following demobilization. Among those who were employed, 79% were employed full-time. Age, family income, and combat exposure were associated with employment; income and health status were associated with part-time versus full-time employment. CONCLUSIONS Mental health status may not be strongly associated with initiating civilian employment among National Guard service members; however, better mental health status is associated with being employed full-time versus part-time.

Reported barriers to mental health care in three samples of U.S. Army National Guard soldiers at three time points.

The military community and its partners have made vigorous efforts to address treatment barriers and increase appropriate mental health services use among returning National Guard soldiers. We assessed whether there were differences in reports of treatment barriers in 3 categories (stigma, logistics, or negative beliefs about treatment) in sequential cross-sectional samples of U.S. soldiers from a Midwestern Army National Guard Organization who were returning from overseas deployments. Data were collected during 3 time periods: September 2007-August 2008 (n = 333), March 2009-March 2010 (n = 884), and August 2011-August 2012 (n = 737). In analyses using discretized time periods and in trend analyses, the percentages of soldiers endorsing negative beliefs about treatment declined significantly across the 3 sequential samples (19.1%, 13.9%, and 11.1%). The percentages endorsing stigma barriers (37.8%, 35.2%, 31.8%) decreased significantly only in trend analyses. Within the stigma category, endorsement of individual barriers regarding negative reactions to a soldier seeking treatment declined, but barriers related to concerns about career advancement did not. Negative treatment beliefs were associated with reduced services use (OR = 0.57; 95% CI [0.33, 0.97]).

Change processes in couple therapy: an intensive case analysis of one couple using a common factors lens.

The article describes a research study that explored the process of how change occurred for one distressed couple and a specific therapist in a naturalistic setting. Quantitative and qualitative data were collected on the couple at multiple points in the therapy. A research team comprised of five members met regularly to analyze the data and collectively they arrived at a theory of change for the couple posttherapy. Conclusions are made related to how change occurred for the couple with an emphasis on the role of extratherapeutic events, client motivational factors, the therapeutic alliance, hope and expectancy factors, therapist factors, specific techniques and interventions, and other surprise factors that contributed to change.

Peers and Peer-Based Interventions in Supporting Reintegration and Mental Health Among National Guard Soldiers: A Qualitative Study

National Guard soldiers experience high levels of mental health symptoms following deployment to Iraq and Afghanistan, yet many do not seek treatment. We interviewed 30 National Guard soldiers with prior deployments to Iraq or Afghanistan to assess mental health treatment barriers and the role of peers in treatment engagement. Interview transcripts were analyzed by a multidisciplinary research team using techniques drawn from grounded theory. The following themes were identified: (1) personal acceptance of having a mental health problem rather than treatment access is the major barrier to treatment entry; (2) tightly connected, supportive peer networks can decrease stigma related to mental health problems and encourage treatment; however, soldiers in impoverished or conflicted peer networks are less likely to receive these benefits; and (3) soldiers are generally positive about the idea of peer-based programs to improve treatment engagement, although they note the importance of leadership support, peer assignment, and unit specialty in implementing these programs. We conclude that some, but not all, naturally occurring peer networks serve to overcome stigma and encourage mental health treatment seeking by soldiers. Formal peer-based programs may assist soldiers not sufficiently benefitting from natural peer networks, although there are barriers to implementation.

The Role of the Therapist in Therapeutic Change: Does Therapist Gender Matter?

ABSTRACT Clients are often matched with therapists based on certain criteria. These may include characteristics such as age, race, religion, sexual orientation, and gender. This article reviews the literature on the role of gender matching in therapy. While there is still much to be learned about therapist variables in the change process, gender alone does not appear to influence clinical outcomes directly, except in some cases for adolescents. However, research suggests that other variables may moderate or mediate the impact of gender in the process of therapy, especially when working with couples and families. This article focuses on the field of couples and family therapy and how gender affects the therapy process when there is more than one client in the room.