Kendell L. Coker

Correlates of improvement in substance abuse among dually diagnosed veterans with post-traumatic stress disorder in specialized intensive VA treatment.

Substantial rates of substance use comorbidity have been observed among veterans with Post-Traumatic Stress Disorder (PTSD), highlighting the need to identify patient and program characteristics associated with improved outcomes for substance abuse. Data were drawn from 12,270 dually diagnosed veterans who sought treatment from specialized intensive Veterans Health Administration PTSD programs between 1993 and 2011. The magnitude of the improvement in Addiction Severity Index (ASI) alcohol and drug use composite scores from baseline was moderate, with effect sizes (ES) of -.269 and -.287, respectively. Multivariate analyses revealed that treatment in longer-term programs, being prescribed psychiatric medication, and planned participation in reunions were all associated with slightly improved outcomes. Reductions in substance use measures were associated with robust improvements in PTSD symptoms and violent behavior. These findings suggest not only synergistic treatment effects linking improvement in PTSD symptoms with substance use disorders among dually diagnosed veterans with PTSD, but also to reductions in violent behavior. Furthermore, the findings indicate that proper discharge planning in addition to intensity and duration of treatment for dually diagnosed veterans with severe PTSD may result in better outcomes. Further dissemination of evidence-based substance abuse treatment may benefit this population.

Using the Massachusetts Youth Screening Instrument–Version 2 on a Community Sample of African American and Latino/a Juvenile Offenders to Identify Mental Health and Substance Abuse Treatment Needs

The Massachusetts Youth Screening Instrument–Version 2 (MAYSI-2) is a brief screening tool used to identify youth in the juvenile justice system who are at-risk of mental-health-related difficulties. The MAYSI-2 was administered to 5,205 African American and Latino/a youth throughout Chicago, Illinois, who were on probation and residing in the community. This study investigated differences (i.e., legal status, gender, age, race/ethnicity) in reporting of mental health symptoms and substance use on the MAYSI-2. Females scored above the clinical cutoffs more frequently than males, and there were few differences found between diverted and adjudicated youth. Age comparisons revealed mixed results. Overall, youth in the current sample scored above the clinical cutoffs less often than youth in the MAYSI-2 norm reference groups. Nonetheless, during the first phase of this study, the MAYSI-2 demonstrated effectiveness by accurately identifying a substantial portion of youth in need of mental health and/or substance abuse treatment.