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Clinical Topics

Among Veterans, Women as Likely as Men to Have Substance Abuse

by U.S. Medicine

June 13, 2018
Elizabeth Evans, PhD, MA

LOS ANGELES — Childhood adversity increases risk for alcohol and drug disorders for veterans, and, unlike in the civilian population, veteran women are as likely as men to have those types of problems.

That’s based on the results of a national study published online by the journal Social Psychiatry and Psychiatric Epidemiology. The research was led by Elizabeth Evans, PhD, MA, of the VA Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy at the VA Greater Los Angeles Healthcare System, the University of Massachusetts Amherst and the University of Massachusetts Medical School-Baystate in Springfield.1

“Veterans are different in that there is no gender difference in the prevalence of these problems,” Evans explained. “Among veterans, a similar proportion of women and men—about 37%—have ever had an alcohol or drug use disorder.”

Evans and colleagues sought to examine the differences by U.S. military veteran status and gender in associations between childhood adversity and DSM-5 lifetime alcohol and drug use disorders (AUD/DUD).—To do that, they analyzed nationally representative data from 3,119 veterans—379 women and 2,740 men—and 33,182 civilians—20,066 women and 13,116 men—as provided by the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III).

Results indicated that, among civilians, women had lower AUD and DUD prevalence than men, although, with more childhood adversity, the gender gap narrowed for AUD and widened for DUD.

Among veterans, however, similar proportions of women and men had AUD and DUD. With more childhood adversity, AUD-predicted probability among men surpassed that of women, the authors pointed out, while childhood adversity elevated AUD probability among civilian women to levels exhibited by veteran women. Among men, meanwhile, veterans with more childhood adversity were more likely than civilians to have AUD and less likely to have DUD.

“This finding that women veterans are similar to men veterans and are so different from civilian women, is unexpected,” Evans noted. “Also surprising are the high rates of childhood adversity among veterans, especially among women; 68 percent of women veterans report some childhood adversity, and they have the highest rates of childhood sexual abuse.”

Evans suggested that “one of the implications of this study is the need to assess for childhood adversity, to help people recognize its relationship with substance use and cope with its health impacts. When people join the military or when veterans access healthcare at the VA or in the community would be good times to assess and treat childhood adversity, and we’re often missing those opportunities now.”

“As the role of women in our nation’s military expands, we need to better understand the gender-specific patterns of alcohol and drug use and whether patterns by gender are different for veterans and if so, why,” she added. “Provision of health and social services can be improved to better meet the needs of all veterans, and, in particular, for women.”

“Childhood adversity alters the gender gap in AUD and DUD risk, and in ways that are different for veterans compared with civilians,” study authors concluded. “Department of Defense, Veterans Affairs, and community health centers can prevent and ameliorate the harmful effects of childhood adversity by adapting existing behavioral health efforts to be trauma informed, veteran sensitive, and gender tailored.”


11. Evans EA, Upchurch DM, Simpson T, Hamilton AB, Hoggatt KJ. Differences by Veteran/civilian status and gender in associations between childhood adversity and alcohol and drug use disorders. Soc Psychiatry Psychiatr Epidemiol. 2018 Apr;53(4):421-435. doi: 10.1007/s00127-017-1463-0. Epub 2017 Nov 29. PubMed PMID: 29188311.

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