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

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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.