What are Alcohol and Substance Use Disorders (ASUD)?
Alcohol and Substance Use Disorders: The misuse, dependence, and
addiction to alcohol and/or legal or illegal drugs. Substance use disorders
(SUD) encompass a range of severity levels, from problem use to dependence and
addiction. Often, ASUDs result in significant impairment in daily life or
noticeable distress, including health problems, disability, and failure to meet
major responsibilities at work, school, or home.
Alcohol Use Disorder (AUD): Excessive alcohol use can
increase a person’s risk of developing serious health problems in addition to
those issues associated with intoxication behaviors and alcohol withdrawal
symptoms. To be diagnosed with an AUD, individuals must meet certain diagnostic
criteria. Some of these criteria include problems controlling intake of
alcohol, continued use of alcohol despite problems resulting from drinking,
development of a tolerance, drinking that leads to risky situations, or the
development of withdrawal symptoms. The severity of an AUD—mild, moderate, or
severe—is based on the number of criteria met.
Opioid Use Disorder (OUD): Opioids reduce the
perception of pain but can also produce drowsiness, mental confusion, euphoria,
nausea, constipation, and, depending upon the amount of drug taken, depressed
respiration. Illegal opioid drugs, such as heroin, and legally available pain
relievers, such as oxycodone and hydrocodone, can cause serious health effects
in those who misuse them. Some people experience a euphoric response to opioid
medications, and it is common that people misusing opioids try to intensify
their experience by snorting or injecting them. These methods increase their
risk for serious medical complications, including overdose. Symptoms of opioid
use disorders include strong desire for opioids, inability to control or reduce
use, continued use despite interference with major obligations or social
functioning, use of larger amounts over time, development of tolerance,
spending a great deal of time to obtain and use opioids, and withdrawal
symptoms that occur after stopping or reducing use.
How common are ASUDs?
In 2018, approximately 22
million people aged 12 and older had at least one alcohol and substance use
disorder (ASUD), including alcohol use disorder and illicit drug use disorder.
Of those 22 million, an estimated 15 million which equates to 5.4% of the
population or 1 in 19 people had an alcohol use disorder .
ASUD in the US Military
A 2011 Department of Defense
(DoD) study estimated that nearly 17% of Operation Enduring Freedom
(OEF)/Operation Iraqi Freedom (OIF) veterans suffer from substance abuse problems, nearly
twice the rate of the general population [2,3]. While only a short while later,
drug misuse in veterans increased from 14% in 2010 to 21% in 2016; a 1%
increase per year . Higher environmental stressors associated with combat
level increase the likelihood of veterans to engage in binge drinking to 54.8%
compared to the civilian population [5, 6]. Approximately, 11% of veterans at
their first treatment at a VA healthcare facility met criteria for a diagnosis
of SUD .
ASUD and Comorbidities
Alcohol and Substance Use
Disorders (ASUDs) are often associated with negative mental health disorders
such as post-traumatic stress disorder (PTSD), the known ‘signature wound’ of
OEF and OIF [3,5]. Of the OEF and OIF veterans who have utilized VA health care
between October 1, 2001 and December 31, 2014, over 30% met the criteria for
possible diagnosis of PTSD . Comorbid PTSD and ASUD exacerbate symptoms as
compared to having PTSD or ASUD alone and are highly comorbid among OEF and OIF
An additional study showed that
veterans with probable AUD, 20.3% met criteria for probable PTSD. Among those,
with probable PTSD, 16.8% met criteria for probable AUD. Compared to veterans
with AUD only, veterans with AUD/PTSD were more likely to screen positive for
major depression (36.8% vs. 2.3%), generalized anxiety disorder (43.5% vs. 2.9%),
suicidal ideation (39.1% vs. 7.0%); to have attempted suicide (46.0% vs. 4.1%);
and to be receiving mental health treatment (44.8% vs. 7.5%). Veterans with
comorbid AUD/PTSD were more than three times as likely as veterans with PTSD
only to have attempted suicide in their lifetimes . Given the high
comorbidity of PTSD and ASUD and the greater symptom severity associated with
having coexisting disorders, there is a critical need to treat PTSD and ASUD
ASUD Treatment 
Addiction is a treatable,
chronic disease that can be managed successfully. Research shows that combining
behavioral therapy with medications, where available, is the best way to ensure
success for most patients. Treatment approaches must be tailored to address
each patient’s drug use patterns and drug-related medical, psychiatric, and
social problems. Treatment may include individual and group counseling,
inpatient and residential treatment, intensive outpatient treatment, partial
hospital programs, case or care management, medication, recovery support
services, 12-Step fellowship, and peer support. For many people, the most
effective behavioral health approach involves a combination of counseling and
Medications can reduce the
cravings and other symptoms associated with withdrawal from a substance by
occupying receptors in the brain associated with using that drug (agonists or
partial agonists), block the rewarding sensation that comes with using a
substance (antagonists), or induce negative feelings when a substance is taken.
There are multiple FDA-approved medications for AUD, OUD, and PTSD diagnosis;
however, none of these combined disorders have FDA-approved pharmacotherapies,
and while TBI is of interest, there is no FDA-approved specific pharmacotherapy.
Why is the PASA Consortium needed and how will it help advance ASUD prevention and treatment?
The goal of the PASA Consortium
is to fund research for developing new medications that can be brought to
therapeutic use to improve treatment outcomes for ASUD, especially in the
presence of PTSD and traumatic brain injury (TBI). These medications will
ideally address the comorbidity between ASUDs and PTSD because this comorbidity
is common in a military population along with mild to moderate TBI.
Along with an observed lack of
integration in care for ASUDs with behavioral health and medical care, a 2013
IOM report found that use of pharmacotherapy-based treatment options tended to
be limited in the military, despite the availability of a solid evidence base
regarding their effectiveness . Additionally, the potential for side
effects and poor patient treatment may make the FDA medications currently
approved for the treatment of alcohol dependence less-than-ideal options. Thus,
new pharmacotherapies for treatment of ASUD are sorely needed.
The PASA Consortium uses a
state-of-the-art translational approach (from animal models to humans) to
understand the complex interaction of substance abuse with the now-common
military stress comorbidity of associated PTSD and TBI.
 Substance Abuse and Mental Health Services
Administration (SAMHSA). Substance use disorders. Retrieved from https://www.samhsa.gov/data/sites/default/files/
 Center for Behavioral Health Statistics and
Quality. (2015). Behavioral health trends in the United States: Results from
the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA
15-4927, NSDUH Series H-50). Retrieved from http://www.samhsa.gov/data/
 Bagalman, Erin. (2011). Congressional
Research Service: Suicide, PTSD, and substance use among OEF/OIF veterans using
VA health care: Facts and figures (July 18, 2011). Report prepared for
members and committees of Congress.
 Lin, Lewei Allison, et al. "Changing
Trends in Opioid Overdose Deaths and Prescription Opioid Receipt Among
Veterans." American journal of preventive medicine 57.1 (2019):
 Teeters, J. B., Lancaster, C. L., Brown, D.
G., & Back, S. E. (2017). Substance use disorders in military veterans:
prevalence and treatment challenges. Substance abuse and
rehabilitation, 8, 69–77.
 Bray RM, Brown JM, Williams J. Trends in
binge and heavy drinking, alcohol-related problems, and combat exposure in the
U.S. military. Subst Use Misuse. 2013 Jul;48(10):799-810. doi: 10.3109/10826084.2013.796990.
 Veterans Health Administration Office of
Public Health (2015). Analysis of VA health care utilization among Operation
Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn
(OND) Veterans: Cumulative from 1st Qtr FY 2002 through 2nd Qtr FY 2015
(October 1, 2001-March 31, 2015). Retrieved from:
 Norman SB, Haller M, Hamblen JL, Southwick SM,
Pietrzak RH. The burden of co-occurring alcohol use disorder and PTSD in
U.S. Military veterans: Comorbidities, functioning, and suicidality.
Psychol Addict Behav. 2018 Mar;32(2):224-229. doi: 10.1037/adb0000348. PMID:
 Substance Abuse and Mental Health Services
Administration (SAMHSA). Substance use disorders. Retrieved from http://www.samhsa.gov/disorders/substance-use
 Institute of Medicine. (2013). Returning
home from Iraq and Afghanistan: Assessment of readjustment needs of veterans,
service members, and their families. Washington, D.C.: National Academies