Being able to accurately evaluate substance abuse in veterans suffering from posttraumatic stress disorder (PTSD) is important for assessment and treatment planning. However, some suspect that veterans seeking treatment for PTSD may not be truthful about substance abuse because they fear losing entitlement to PTSD-related financial compensation. Yet few veterans seeking help for PTSD lie about substance abuse, according to a study supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00079).
Researchers from Duke University Medical Center and the Veterans Affairs Medical Center (VAMC) in Durham, NC, compared drug urine screening results with self-reports of drug use by 341 male veterans referred to a VAMC PTSD specialty clinic. Through urine tests, patients were screened for use of amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, opiates, and phencyclidine. Veterans also completed a questionnaire asking about their use of these and other drugs during the previous 6 months.
Only 8 percent of veterans with drug screens denied using substances that were detected by urine screen. Self-reports and urine results were consistent in 71 percent of cases. Veterans diagnosed with PTSD who reported substance abuse were more likely to use only marijuana or depressants (79 percent) than stimulants (21 percent). Those who underreported substance use had lower socioeconomic status than accurate reporters or overreporters (those reporting use of drugs not detected by urine testing). However, underreporters did not differ from the others by race, age, level of combat exposure, PTSD diagnosis, or other factors. If all those who refused drug testing, denied using drugs, or underreported substance use (as detected by urine drug screens) were grouped together, only 11 percent of veterans studied would have underreported substance use. Given the validity of self-reports and their many advantages (low cost, ease of administration, and noninvasiveness), they are desirable for this population, conclude the researchers.
For more details, see "Drug use and validity of substance use self-reports in veterans seeking help for posttraumatic stress disorder," by Patrick S. Calhoun, Hayden B. Bosworth, Michael A. Hertzberg, and others, in the Journal of Consulting and Clinical Psychology 68(5), pp. 923-927, 2000.