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Does comorbidity predict treatment barriers in alcohol-dependent Veterans?

Arnold B, Rodrigues AE, Funderburk JS, Possemato K, Lantinga LJ, Maisto SA, Oslin DW. Does comorbidity predict treatment barriers in alcohol-dependent Veterans? Paper presented at: VA HSR&D National Meeting; 2011 Feb 17; National Harbor, MD.

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Objectives: Alcohol use is a common problem in the US, with approximately 8% of the population meeting criteria for an alcohol use disorder. However, less than one fourth of these individuals will receive treatment. Given the negative consequences of alcohol use disorders, it is important to better understand the barriers that prevent individuals from seeking treatment. Previous research shows that one predictor of perceived treatment barriers may be psychiatric comorbidity. Wang found that individuals with comorbid mental disorders were more likely to report treatment barriers than those with only one disorder. The current study investigated this link between comorbidity and treatment barriers in Veterans with alcohol dependence. We hypothesized that in individuals with a diagnosis of alcohol dependence, self-reported comorbid psychiatric symptoms (i.e., depression, posttraumatic stress, and generalized anxiety) would be associated with greater perceived barriers to treatment. Exploratory analyses further refined these hypotheses by examining whether psychiatric comorbidity had different effects on internal (e.g., embarrassment, ambivalence) versus external (e.g., scheduling, cost) treatment barriers. Methods: As part of a larger study, 197 (97% male, 41% white) Veterans with alcohol dependence from the Philadelphia, Syracuse, and Rochester VA facilities completed a standardized psychiatric interview and a self-report measure assessing both internal and external treatment barriers. Descriptive statistics investigated relationships between symptoms and treatment barriers. Separate linear regressions examined whether number of mental health diagnoses and number of posttraumatic stress, depression, and generalized anxiety symptoms predicted the total level of perceived treatment barriers, as well as internal and/or external treatment barriers. Results: Descriptive analyses revealed a positive relationship between number of self-reported depressive symptoms, total perceived level of treatment barriers, and internal treatment barriers. Regression analyses indicated that after controlling for demographic variables, number of total mental health diagnoses positively predicted perceived level of internal treatment barriers (Beta = .15, p < .05). Implications: The results of the current study underscore the importance of assessing mental health symptomatology when working with Veterans with alcohol dependence. Further exploration of internal treatment barriers may help increase motivation for alcohol dependence treatment. Impacts: The current study allowed us to gain a better understanding of the perceived treatment barriers of Veterans suffering from alcohol dependence and for which Veterans these barriers are most salient. Understanding this information will allow perceived treatment barriers to be addressed, with the potential of engaging more alcohol-dependent Veterans in treatment.

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