Veteran Reintegration, Mental Health and Substance Use in the Inner-City

描述（由申请人提供）：返回市中心的退伍军人面临药物滥用，精神健康障碍和相关的平民重返社会问题的风险增加。然而，这些退伍军人的经历还没有被直接详细研究。为了减少他们的健康风险，解决他们的问题，增加他们对社会的持续贡献，需要更多的信息，了解导致他们风险升高的复杂因素、成功的应对策略、有效的治疗和治疗障碍。该项目旨在通过三个相互关联的分析来填补研究中的这一重要空白：（1）为期五年的小组研究，（2）嵌入式民族志，以及（3）对两个主要的国家代表性数据集进行重点二次分析。为此，这项研究纳入了以下创新的研究要素：一）主要是非洲裔美国退伍军人返回内城的定向重点;二）物质，心理健康和重返社会问题与治疗和生活经验的动态相互作用的纵向分析;三）多方法设计，以提供更丰富的统计结果，并将人种学的结果的角度;（四）运用理论观点，将研究分析整合为文献综述。该项目的具体目标如下（注：所有三个研究组成部分都涉及所有三个具体目标）：了解随着时间的推移，在物质使用（包括非法药物，精神治疗药物，没有处方，酒精和烟草），问题的使用，治疗经验，以及从阿富汗（持久自由行动或OEF）和伊拉克（伊拉克自由行动或OIF）返回到内城的退伍军人之间的治疗障碍的变化。这包括社会力量和个人经验，影响增加使用和负面后果以及恢复。目标B：精神健康障碍。记录返回内城的OEF/OIF退伍军人的心理健康问题（特别是创伤后应激障碍（PTSD），创伤性脑损伤（TBI）和抑郁症的后果），以及促进或阻碍恢复力和有效使用治疗的因素。目标C：平民重返社会。确定成功的应对策略，促进健康，生产性的重新融入平民生活在市中心，以及个人问题，非生产性行为，以及挑战退伍军人在家庭，艾滋病毒感染/风险，工作和社区生活的社会力量。 公共卫生相关性：返回的退伍军人中有很大一部分人滥用药物、酗酒、吸烟、严重的心理困扰和相关的重返平民社会问题（例如，无家可归、失业、家庭困难）。这项研究旨在提供新的，深入的见解，这将导致外展活动和治疗方案的改善，主要是非洲裔美国退伍军人返回市中心，谁面临特别高的风险和更复杂的问题比其他退伍军人。最终，研究结果将有助于保护这些退伍军人的身心健康;减少药物滥用和艾滋病毒感染;降低护理成本;并减轻心理健康和药物滥用问题未得到满足的退伍军人的社会负担。

DESCRIPTION (provided by applicant): Veterans returning to the inner-city face elevated risks for substance abuse, mental health disorders, and related civilian reintegration problems. However, the experiences of these veterans have not yet been directly studied in detail. To reduce their health risks, address their problems and increase their continued social contributions, more information is needed about the complex of factors that lead to their elevated risks, successful coping strategies, effective treatments and barriers to treatment. This project seeks to fill this important gap in the research using three interrelated analyses: (1) a five-year panel study, (2) an embedded ethnography, and (3) a focused secondary analysis of two major nationally-representative datasets. To this end, the study incorporates the following innovative research elements: i) a directed focus on the predominately African American veterans returning to the inner city; ii) a longitudinal analysis of the dynamic interactions of substance, mental health, and reintegration problems with treatment and life experiences; iii) a multi-methods design to provide richer statistical findings and to place ethnographic findings in perspective; and iv) use of theoretical perspectives to integrate the study's analyses into a synthesis of the literature. The specific aims of the project are as follows (Note: all three research components address all three specific aims): AIM A: Substance use. To understand changes over time in substance use (including illegal drugs, psychotherapeutic drugs without a prescription, alcohol, and tobacco), problem use, treatment experiences, and barriers to treatment among veterans returning from Afghanistan (Operation Enduring Freedom or OEF) and Iraq (Operation Iraqi Freedom or OIF) to the inner city. This includes the social forces and personal experiences that affect increased use and negative consequences as well as recovery. AIM B: Mental health disorders. To document the path to mental health problems (especially Post-Traumatic Stress Disorder (PTSD), consequences of Traumatic Brain Injury (TBI) and depression) among OEF/OIF veterans returning to the inner city, as well as factors that promote or impede resilience and effective use of treatment. AIM C: Civilian reintegration. To identify successful coping strategies that promote healthy, productive reintegration to civilian life in the inner-city, as well as personal problems, unproductive behaviors, and social forces that challenge veterans with regard to family, HIV infection/risk, work and community life. PUBLIC HEALTH RELEVANCE: A high proportion of returning veterans have been experiencing drug abuse, alcohol abuse, smoking, serious psychological distress, and related civilian reintegration problems (e.g., homelessness, unemployment, family distress). This study seeks to provide new, in-depth insights that will lead to improvements in outreach initiatives and treatment programs for the predominately African American veterans returning to the inner-city, who face particularly high risks and more complex problems than other veterans. Ultimately, the findings will help preserve these veterans' physical and mental health; reduce substance abuse and HIV infection; reduce the cost of care; and reduce the social burden of troubled veterans with unmet mental health and substance abuse concerns.