San Francisco VA Health Care System, 4150 Clement St., San Francisco, CA 94121, USA; University of California, Department of Medicine, 505 Parnassus Ave, San Francisco, CA 94143, USA.
Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA; Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.
Drug Alcohol Depend. 2021 Aug 1;225:108791. doi: 10.1016/j.drugalcdep.2021.108791. Epub 2021 May 31.
Substance use and related disorders are common among US Veterans, but the population burden of has never been directly assessed among Veterans Health Administration (VA) patients. We surveyed VA patients to measure substance use and related disorders in the largest US integrated healthcare system.
We surveyed N = 6000 outpatients from 30 geographically-representative VA healthcare systems. We assessed substance use (lifetime, past 12-month, daily in past 3 months) and past 12-month disorders following DSM-5 criteria and estimated the association with Veteran characteristics (age, gender, race/ethnicity, socioeconomic status, VA utilization).
Alcohol was the most commonly-reported substance (24% used past 12 months, 11% daily in past 3 months, 10% met criteria for alcohol use disorder), followed by cannabis (42% lifetime use, 12% use in past 12 months, 5% daily use in past 3 months, 3% met criteria for cannabis use disorder). Overall, 5% met criteria for non-alcohol drug use disorder (13% for substance use disorder (SUD)). SUD prevalence was highest for young Veterans and those who were unemployed or otherwise not employed for wages. Past 12-month cannabis use was common, even among older adults (65-74 years: 10%; 75 and older: 2%).
Prevalence data are important inputs into decisions around population health monitoring, treatment capacity, and quality measurement strategies. Substance use and SUD are more prevalent than previously reported, and VA may need to screen for non-alcohol drugs to identify patients who need care. More tailored assessment may be needed for cannabis use, high-prevalence subgroups, and older adults.
物质使用和相关障碍在美国退伍军人中很常见，但退伍军人健康管理局 (VA) 患者中从未直接评估过人群负担。我们调查了 VA 患者，以衡量美国最大的综合性医疗保健系统中的物质使用和相关障碍。
我们从 30 个地理位置代表性的 VA 医疗保健系统中调查了 6000 名门诊患者。我们根据 DSM-5 标准评估了物质使用（终身、过去 12 个月、过去 3 个月内每天）和过去 12 个月的障碍，并评估了退伍军人特征（年龄、性别、种族/族裔、社会经济地位、VA 使用情况）与这些障碍之间的关联。
酒精是最常报告的物质（24%的人过去 12 个月使用过，11%的人过去 3 个月内每天使用，10%符合酒精使用障碍标准），其次是大麻（42%的人终身使用，12%的人过去 12 个月使用，5%的人过去 3 个月内每天使用，3%符合大麻使用障碍标准）。总体而言，5%的人符合非酒精药物使用障碍标准（13%的人符合物质使用障碍标准）。年轻退伍军人和那些失业或其他非工资就业的退伍军人中 SUD 患病率最高。过去 12 个月大麻的使用很普遍，即使在老年人中也是如此（65-74 岁：10%；75 岁及以上：2%）。
流行数据是围绕人群健康监测、治疗能力和质量测量策略做出决策的重要投入。物质使用和 SUD 的流行程度高于先前报告的水平，VA 可能需要筛查非酒精药物，以确定需要护理的患者。对于大麻使用、高流行亚组和老年人，可能需要更有针对性的评估。
