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得到直接的详细研究。为了减少他们的健康风险，解决他们的问题，并增加他们对社会的持续贡献，需要更多地了解导致他们风险增加的复杂因素、成功的应对策略、有效的治疗方法和治疗障碍。该项目试图利用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)嵌入的人种学，(3)对两个具有国家代表性的主要数据集的重点二级分析。为此，这项研究纳入了以下创新的研究内容：i)有针对性地关注返回市中心的以非裔美国人为主的退伍军人；ii)纵向分析物质、心理健康和重返社会问题与治疗和生活经历之间的动态互动；iii)采用多种方法设计，以提供更丰富的统计结果，并从人种学的角度看待研究结果；以及iv)使用理论视角，将研究的分析整合为文献的综合。该项目的具体目标如下(注：所有三个研究部分都涉及所有三个具体目标)：目标A：物质使用。了解从阿富汗(持久自由行动或OEF)和伊拉克(伊拉克自由行动或OIF)返回市中心的退伍军人在药物使用(包括非法药物、无处方的精神治疗药物、酒精和烟草)、问题使用、治疗经验和治疗障碍方面随时间的变化。这包括影响使用增加和负面后果以及恢复的社会力量和个人经历。目标B：精神健康障碍。记录返回市中心的OEF/OIF退伍军人的精神健康问题(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)的途径，以及促进或阻碍复原力和有效使用治疗的因素。目标C：重新融入平民社会。确定成功的应对战略，促进健康、有成效地重新融入市中心的平民生活，以及在家庭、艾滋病毒感染/风险、工作和社区生活方面对退伍军人构成挑战的个人问题、非生产性行为和社会力量。 与公共卫生有关：回国的退伍军人中有很大一部分经历了药物滥用、酗酒、吸烟、严重的心理困扰以及相关的重返社会问题(例如，无家可归、失业、家庭痛苦)。这项研究旨在提供新的、深入的见解，以改善以非洲裔美国人为主的返回市中心的退伍军人的外联倡议和治疗计划，他们面临的风险特别高，面临的问题比其他退伍军人更复杂。最终，这些发现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，并减轻有未得到满足的心理健康和药物滥用担忧的陷入困境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.