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2018 VISN 20 MIRECC Staff Research Articles and Presentations

VISN 20 MIRECC Staff Research Articles and Presentations

The findings of NW MIRECC research are disseminated through MIRECC Presents, lectures and presentations, and publications. Below is a list of publications and presentations by VISN 20 NW MIRECC researchers and fellowship program faculty that were published in 2018. 

Adams, M. H., Dobscha, S. K., Smith, N. X., Yarborough, B. J., Deyo, R. A., & Morasco, B. (2018). Prevalence and
correlates of low pain interference among patients with high pain intensity. The Journal of Pain, 19, 1074-1081.

ABSTRACT: The pain experience may vary greatly among individuals reporting equally high levels of pain. We sought to examine the demographic and clinical characteristics associated with pain interference in patients with high pain intensity. Among patients with chronic musculoskeletal pain who were prescribed long-term opioid therapy... Read full research article: Prevalence and correlates of low pain interference among patients with high pain intensity who are prescribed long-term opioid therapy

Balba, N. M., Elliott, J. E., Weymann, K. B., Opel, R. A., Duke, J. W., Oken, B. S., ... & Lim, M. M. (2018). Increased
sleep disturbances and pain in veterans with comorbid Traumatic Brain Injury and Posttraumatic Stress Disorder. Journal of Clinical Sleep Medicine 14(11), 1865-1878.

ABSTRACT: Veterans are at an increased risk for traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD), both of which are associated with sleep disturbances and increased pain. Furthermore, sleep disturbances and pain are reciprocally related such that each can exacerbate the other. Although both TBI and PTSD are independently linked to sleep disturbances and pain, it remains unclear whether Veterans with comorbid TBI+PTSD show worse sleep disturbances and pain compared to those with only TBI or PTSD. We hypothesized that sleep and pain would be worse in Veterans with comorbid TBI+PTSD compared to Veterans with only TBI or PTSD. Read full research article: Increased sleep disturbances and pain in veterans with comorbid Traumatic Brain Injury and Posttraumatic Stress Disorder

Boffa, J., Norr, A. M., Tock, J., Amir, N., & Schmidt, N. (2018). Development of the Interpretation Bias Index for PTSD.
Cognitive Therapy and Research, 42(5), 720-734. doi:10.1007/s10608-018-9915-8

ABSTRACT: Cognitive models of posttraumatic stress disorder (PTSD) implicate interpretation biases as a maintaining factor of symptoms. Existing measures index symptoms and negative beliefs in PTSD patients, but not threatening interpretation of socially-ambiguous information, which would further inform cognitive models of PTSD. Here we describe the development of a measure of interpretation bias specific to individuals with PTSD.

Browne, K., Dolan, M., Simpson, T. L., Fortney, J., & Lehavot, K. (2018). Regular past year cannabis use in women veterans
and associations with sexual trauma. Addictive Behaviors, 84, 144-150. doi:10.1016/j.addbeh.2018.04.007

ABSTRACT: This study sought to describe the prevalence of regular past year cannabis use (i.e., at least monthly use) in women veterans, to characterize women veterans reporting this level of use, and to examine the independent contributions of sexual trauma across the lifespan on regular past year cannabis use.

Carlson, K. F., Gilbert, T. A., Morasco, B. J., Wright, D., Otterloo, J. V., Herrndorf, A., & Cook, L. J. (2018). Linkage
of VA and state prescription drug monitoring program data to examine concurrent opioid and sedative-hypnotic prescriptions among veterans. Health Services Research, 53, 5285-5308.

ABSTRACT: Examines the prevalence of concurrent Veterans Health Administration (VA) and non‐VA prescriptions for opioids and sedative‐hypnotic medications among post‐9/11 veterans in Oregon.... Read full research article: Linkage of VA and state prescription drug monitoring program data to examine concurrent opioid and sedative-hypnotic prescriptions among veterans

Dash, G. F., Wilson, A. C., Morasco, B. J., & Feldstein Ewing, S. W. (2018). A model of the intersection of pain and
opioid misuse in children and adolescents. Clinical Psychological Science, 6(5), 629-646.

ABSTRACT: Despite being a significant public health concern, the role of opioid prescriptions in potentiating risk of opioid misuse in the context of pediatric pain has been underinvestigated. To address this gap, the present review identifies theory-based hypotheses about these associations, reviews the extant literature on opioid prescriptions that supports these hypotheses, and provides routes for future empirical studies. Read full research article: A model of the intersection of pain and opioid misuse in children and adolescents

Deming, Y., Dumitrescu, L., Barnes, L., Thambisetty, M., Kunkle, B., Gifford, K., … & Hohman, T. (2018). Sex-specific
genetic predictors of Alzheimer’s disease biomarkers. Acta Neuropathologica, 136(6), 857-872. doi:10.1007/s00401-018-1881-4

ABSTRACT: Cerebrospinal fluid (CSF) levels of amyloid-β 42 (Aβ42) and tau have been evaluated as endophenotypes in Alzheimer's disease (AD) genetic studies. Although there are sex differences in AD risk, sex differences have not been evaluated in genetic studies of AD endophenotypes. We performed sex-stratified and sex interaction genetic analyses of CSF biomarkers to identify sex-specific associations.

Hendrickson, R. C., Nishanth, J., & Michael, S. (2018). Diagnostic prevalence of common psychiatric comorbidities of
Alcohol Use Disorders in India: A systematic review. International Journal of Mental Health and Addiction. doi:10.1007/s11469-018-9951-3

ABSTRACT: The diagnostic prevalence of mood and anxiety disorders in Indian individuals with alcohol use disorders (AUDs) has important implications for clinical decision making and for cross-cultural psychiatry research. Here, we present a systematic review of comorbid mood and anxiety disorders in Indian patients with AUDs.

Hendrickson, R. C., Raskind, M. A., Millard, S., Sikkema, C., Terry, G., Pagulayan, K. F., … & Peskind, E. R. (2018).
Evidence for altered brain reactivity to norepinephrine in Veterans with a history of traumatic stress. Neurobiology of Stress, 8, 103-111. doi:10.1016/j.ynstr.2018.03.001

 Increases in the quantity or impact of noradrenergic signaling have been implicated in the pathophysiology of posttraumatic stress disorder (PTSD). This increased signaling may result from increased norepinephrine (NE) release, from altered brain responses to NE, or from a combination of both factors. Here, we tested the hypothesis that Veterans reporting a history of trauma exposure would show an increased association between brain NE and mental health symptoms commonly observed after trauma.

Hendrickson, R. C., Schindler, A., & Pagulayan, K. F. (2018). Untangling PTSD and TBI: Challenges and strategies in
clinical care and research. Current Neurology and Neuroscience Reports, 18(12), 106. doi:10.1007/s11910-018-0908-5

ABSTRACT: Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) can result from similar injuries and can result in similar symptoms, such as problems with sleep, concentration, memory, and mood. Although PTSD and persistent sequelae due to a TBI (PST) have generally been viewed as pragmatically confounded but conceptually separable entities, we examine emerging evidence emphasizing the breadth of overlap in both clinical presentation and underlying pathophysiology between PST and PTSD.

Hulen, E., Saha, S., Morasco, B., Zeigler, C., Mackey, K., & Edwards, S. (2018). Sources of distress in primary
care opioid management and the role of a controlled substance review group: A qualitative study. Pain Medicine, 19(8), 1570-1577. doi:10.1093/pm/pnx259

ABSTRACT: The objective of the study was to explore provider perspectives surrounding opioid prescribing in the context of the early implementation of a multidisciplinary group, called the Controlled Substance Review Group, that provided structured opioid case discussion and consultation to primary care providers.

Kow, R., Sikkema, C., Wheeler, J., Wilkinson, C., & Kraemer, B. C. (2018). Dopa decarboxylase modulates tau toxicity.
Biological Psychiatry, 83(5), 438-446. doi:10.1016/j.biopsych.2017.06.007

ABSTRACT: The microtubule-associated protein tau accumulates into toxic aggregates in multiple neurodegenerative diseases. We found previously that loss of D2-family dopamine receptors ameliorated tauopathy in multiple models including a Caenorhabditis elegans model of tauopathy.

Krystal, J. H., Davis, L. L., Neylan, T. C., Raskind, M. A., Schnurr, P. P., Stein, M. B., … & Huang, G. D. (2018).
Reply to: It is time to look for new treatments for posttraumatic stress disorder: Can sympathetic system modulation be an answer? Biological Psychiatry, 84, e19-e20. doi:10.1016/j.biopsych.2017.09.031

Kumthekar, A. A., Shull, S., Lovejoy, T., Morasco, B., Chang, M., & Barton, J. (2018). Eradication of Hepatitis C
among US veterans: Examination of changes in pain severity and prescription opioid use following treatment. Journal of Investigative Medicine, 66(1), 78.

ABSTRACT: Hepatitis C virus is associated with chronic wide spread pain, fatigue, myalgia, arthritis, sicca symptoms and vasculitis. Data regarding prior interferon-based treatment of Hepatitis C virus on pain is conflicting and the impact of direct acting antivirals on extrahepatic manifestations is unknown. The study objective is to assess the impact of direct acting antivirals treatment on pain and opioid use among patients treated at a single VA medical center. Read full research article: Eradication of Hepatitis C among US veterans: Examination of changes in pain severity and prescription opioid use following treatment

Lehavot, K., Goldberg, S., Chen, J., Katon, J., Glass, J., Fortney, J., … & Schnurr, P. P. (2018). Do trauma type,
stressful life events, and social support explain women veterans’ high prevalence of PTSD? Social Psychiatry and Psychiatric Epidemiology, 53, 943-953. doi:10.1007/s00127-018-1550-x

ABSTRACT: To examine factors that account for women veterans’ higher prevalence of past-year DSM-5 posttraumatic stress disorder (PTSD) compared to women civilians and men veterans. Number of trauma types, type of trauma, and social factors may together help explain women veterans’ higher PTSD prevalence compared to women civilians, but do not fully account for differences between men and women veterans. Results highlight a need to explore additional explanatory factors and evaluate associations with longitudinal data.

Lehavot, K., Katon, J., Chen, J., Fortney, J., & Simpson, T. L. (2018). Post-traumatic Stress Disorder by gender and
Veteran status. American Journal of Preventive Medicine, 54(1), e1-e9. doi:10.1016/j.amepre.2017.09.008

ABSTRACT: Population-based data on the prevalence, correlates, and treatment utilization of post-traumatic stress disorder by gender and veteran status are limited. With changes in post-traumatic stress disorder diagnostic criteria in 2013, current information from a uniform data source is needed. Conclusions: Post-traumatic stress disorder is a common mental health disorder that varies by gender and veteran status. Women veterans' high rates of post-traumatic stress disorder highlight a critical target for prevention and intervention, whereas understanding treatment barriers for men veterans and civilians is necessary.

Logsdon, A., Meabon, J., Cline, M., Bullock, K., Raskind, M. A., … & Cook, D. G. (2018). Blast exposure elicits blood-brain
barrier disruption and repair mediated by tight junction integrity and nitric oxide dependent processes. Scientific Reports. doi:10.1038/s41598-018-29341-6

ABSTRACT: Mild blast-induced traumatic brain injury (TBI) is associated with blood-brain barrier (BBB) disruption. However, the mechanisms whereby blast disrupts BBB integrity are not well understood. To address this issue BBB permeability to peripherally injected 14C-sucrose and 99mTc-albumin was quantified in ten brain regions at time points ranging from 0.25 to 72 hours.

Lovejoy, T. I., Morasco, B. J., Demidenko, M. I., Meath, T. H. A., & Dobscha, S. K. (2018). Clinician referrals for
non-opioid pain care following discontinuation of long-term opioid therapy differ based on reasons for discontinuation. JGIM: Journal of General Internal Medicine, 33, 24-30.

ABSTRACT: Little is known about pain care offered to patients discontinued from long-term opioid therapy (LTOT) by their prescriber due to aberrant behaviors versus other reasons. This study aimed to compare rates of non-opioid analgesic pharmacotherapy initiation and clinician referrals for non-pharmacologic pain treatment, complementary and integrative pain therapies, and specialty mental health and substance use disorder treatment between patients discontinued from opioid therapy due to aberrant behaviors versus other reasons. Read full research article: Clinician referrals for non-opioid pain care following discontinuation of long-term opioid therapy differ based on reasons for discontinuation

Lovejoy, T., Morasco, B., Meath, T., Wyse, J., & Dobscha, S. (2018). (182) - Pain care utilization following episodes of
specialty substance use disorder treatment. Journal of Pain, 19, S35-S36. (Full article not available)

Lozier, C. C., Nugent, S. M., Smith, N. X., Yarborough, B. J., Dobscha, S. K., Deyo, R. A., & Morasco, B. J. (2018).
Correlates of use and perceived effectiveness of non-pharmacologic strategies for chronic pain among patients prescribed long-term opioid therapy. JGIM: Journal of General Internal Medicine, 33, 46-53.

ABSTRACT: Non-pharmacologic treatments (NPTs) are recommended for chronic pain. Information is limited on patient use or perceptions of non-pharmacologic treatments. We examined the frequency and correlates of use and self-rated helpfulness of NPTs for chronic pain among patients who are prescribed long-term opioid therapy. Read full research article: Correlates of use and perceived effectiveness of non-pharmacologic strategies for chronic pain among patients prescribed long-term opioid therapy

McClure, E. A., Baker, N., Sonne, S. C., Ghitza, U. E., Tomko, R. L., Montgomery, L., Babalonis, S., Terry, G., & Gray, K. M. (2018).
Tobacco use during cannabis cessation: Use patterns and impact on abstinence in a National Drug Abuse Treatment Clinical Trials Network study. Drug and Alcohol Dependence, 192, 59-66.

ABSTRACT: It is common for cannabis users to also use tobacco. While data suggest that tobacco users have more difficulty achieving cannabis cessation, secondary analyses of clinical trial data sets may provide insight into the moderating variables contributing to this relationship, as well as changes in tobacco use during cannabis treatment. Those were the aims of this secondary analysis.

McPherson, S., Smith, C. L., Dobscha, S. K., Morasco, B. J., Demidenko, M. I., Meath, T. H. A., ... Lederhos Smith, C. (2018).
Changes in pain intensity after discontinuation of long-term opioid therapy for chronic noncancer pain. Pain (03043959), 159(10), 2097-2104.

ABSTRACT: Little is known about changes in pain intensity that may occur after discontinuation of long-term opioid therapy. The objective of this study was to characterize pain intensity after opioid discontinuation over 12 months. This retrospective U.S. Department of Veterans Affairs (VA) administrative data study identified 551 patients nationally who discontinued long-term opioid therapy. Read full research article: Changes in pain intensity after discontinuation of long-term opioid therapy for chronic noncancer pain

Meyerhoff, D. J., Murray, D., Durazzo, T., & Pennington, D. L. (2018). Brain GABA and glutamate concentrations following chronic
gabapentin administration: A convenience sample studied during early abstinence from alcohol. Front Psychiatry, 15, 9:78. doi:10.3389/fpsyt.2018.00078

ABSTRACT: Gabapentin (GBP), a GABA analog that may also affect glutamate (Glu) production, can normalize GABA and Glu tone during early abstinence from alcohol, effectively treating withdrawal symptoms and facilitating recovery. Using in vivo magnetic resonance spectroscopy, we tested the degree to which daily GBP alters regional brain GABA and Glu levels in short-term abstinent alcohol-dependent individuals.

Morasco, B., Lovejoy, T., Hyde, S., Shull, S., & Dobscha, S. (2018). (231) - Limitations of pain numeric rating scale scores
collected during usual care: Need for enhanced assessment. Journal of Pain, 19, S57-S58. (Full article not available)

Morasco, B. J., Lovejoy, T. I., & Ilgen, M. A. (2018). Management of chronic pain in patients with a comorbid substance use
disorder. In D. C. Turk & R. J. Gatchel (Eds.), Psychological approaches to pain management: A practitioner's handbook, 3rd ed. (pp. 530-540). New York, NY: The Guilford Press. (Full article not available)

Morasco, B. J., Shull, S. E., Adams, M. H., Dobscha, S. K., & Lovejoy, T. I. (2018). Development of an algorithm to identify
cannabis urine drug test results within a multi-site electronic health record system. Journal of Medical Systems, 42(9), 1. (Full article not available)

Murray, D., Durazzo, T., Schmidt, T. P., Murray, T. A., Abé, C., Guydish, J., & Meyerhoff, D. J. (2018). Regional cerebral blood
flow in opiate dependence relates to substance use and neuropsychological performance. Addiction Biology, 23, 781-795.

ABSTRACT: Neuroimaging of opiate-dependent individuals indicates both altered brain structure and function. Magnetic resonance-based arterial spin labeling has been used to measure noninvasively cerebral blood flow (i.e. perfusion) in alcohol, tobacco and stimulant dependence; only one arterial spin labeling paper in opiate-dependent individuals demonstrated frontal and parietal perfusion deficits. Additional research on regional brain perfusion in opiate dependence and its relationship to cognition and self-regulation (impulsivity, risk taking and decision making) may inform treatment approaches for opiate-dependent individuals.

Norr, A. M., Smolenski, D., & Reger, G. (2018). Effects of prolonged exposure and virtual reality exposure on suicidal ideation in
active duty soldiers: An examination of potential mechanisms. Journal of Psychiatric Research, 103, 69-74. doi:10.1016/j.jpsychires.2018.05.009

ABSTRACT: The current study sought to investigate the effects of exposure therapy on suicidal ideation (SI), as well as potential mechanistic pathways of SI reduction among active duty military personnel.

Nugent, S. M., Yarborough, B. J., Smith, N. X., Dobscha, S. K., Deyo, R. A., Green, C. A., & Morasco, B. J. (2018). Patterns and
correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. General Hospital Psychiatry, 50, 104-110.

ABSTRACT: Little is known about co-occurring long-term opioid therapy and medical cannabis use. We compared characteristics of patients prescribedlong-term opioid therapy who endorsed using medical cannabis for pain to patients who did not report cannabis use. Read full research article: Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy

Pagulayan, K. F., Petrie, E., Cook, D. G., Hendrickson, R. C., Rau, H., Reilly, M., … & Kleinhans, N. (2018). Effect of blast-related
mTBI on the working memory system: a resting state fMRI study. Brain Imaging and Behavior. Advance Online Publication. doi:10.1007/s11682-018-9987-9

ABSTRACT: Reduced working memory is frequently reported by Veterans with a history of blast-related mild traumatic brain injury (mTBI), but can be difficult to quantify on neuropsychological measures. This study aimed to improve our understanding of the impact of blast-related mTBI on the working memory system by using resting state functional magnetic resonance imaging (fMRI) to explore differences in functional connectivity between OEF/OIF/OND Veterans with and without a history of mTBI.

Pagulayan, K. F., Rau, H., Madathil, R., Werhane, M., Millard, S., Petrie, E., … & Peskind, E. R. (2018). Retrospective and
prospective memory among OEF/OIF/OND Veterans with a self-reported history of blast-related mTBI. Journal of the International Neuropsychological Society, 24(04), 324-334. doi:10.1017/S1355617717001217

ABSTRACT: Objectives: To evaluate prospective and retrospective memory abilities in Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans with and without a self-reported history of blast-related mild traumatic brain injury (mTBI).

Painter, J. M., Brignone, E., Gilmore, A. K., Lehavot, K., Fargo, J., Suo, Y., … & Gundlapalli, A. V. (2018). Gender
differences in service utilization among Operations Enduring Freedom, Iraqi Freedom, and New Dawn Veterans Affairs patients with severe mental illness and substance use disorders. Psychological Services, 15(1), 11-20. doi:10.1037/ser0000144

ABSTRACT: Severe mental illness (SMI) and substance use disorders (SUD) are among the more chronic and costly mental health conditions treated in the Department of Veterans Affairs (VA). Service use patterns of returning veterans with SMI and SUD have received little attention. We examined gender differences in the utilization of VA services among a national sample of Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND) VA patients with SMI, SUD, and their comorbidity (SMI/SUD) in their first year of established VA care (N=24,166).

Raskind, M. A., Peskind, E. R., Chow, B., Harris, C., Davis-Karim, A., Holmes, H., … & Rosenheck, R. A. (2018). Trial of
Prazosin for Post-Traumatic Stress Disorder in military Veterans. New England Journal of Medicine, 378(6), 507-517. doi:10.1056/NEJMoa1507598

ABSTRACT: In randomized trials, prazosin, an α1-adrenoreceptor antagonist, has been effective in alleviating nightmares associated with post-traumatic stress disorder (PTSD) in military veterans.

Roggenkamp, H., & Li, G. (2018). Tai Chi as a potential intervention for symptoms of mild Traumatic Brain Injury in Veterans.
Journal of Yoga & Physiotherapy, 4(4), 555645. doi:10.19080/JYP.2018.04.555645

ABSTRACT: Many Veterans of the conflicts in Afghanistan/Iraq who experienced repeated concussions due to blast exposure, also referred to as mild traumatic brain injury (mTBI), have persistent post-concussive symptoms (PCS). Additionally, these Veterans often have comorbid, overlapping posttraumatic stress disorder (PTSD) symptoms that further impact recovery. Emerging evidence supports the effectiveness of Tai Chi in improving physical and mental well-being, including many common PCS.

Simpson, T. L., Saxon, A. J., Stappenbeck, C., Malte, C., Lyons, R., Tell, D., … & Raskind, M. A. (2018). Double-blind
randomized clinical trial of Prazosin for Alcohol Use Disorder. American Journal of Psychiatry. Advance Online Publication. doi:10.1176/appi.ajp.2018.17080913

ABSTRACT: Current medications for alcohol use disorder do not target brain noradrenergic pathways. Theoretical and preclinical evidence suggests that noradrenergic circuits may be involved in alcohol reinforcement and relapse. After a positive pilot study, the authors tested the α-1 adrenergic receptor antagonist prazosin to treat alcohol use disorder in a larger sample.

Tinajero, R., Williams, P., Cribbet, M., Rau, H., Bride, D., & Suchy, Y. (2018). Nonrestorative sleep in healthy,
young adults without insomnia: associations with executive functioning, fatigue, and pre-sleep arousal. Sleep Health, 4(3), 284-291. doi:10.1016/j.sleh.2018.02.006

ABSTRACT: Previous research suggests that nonrestorative sleep (NRS), even in the absence of insomnia symptoms or other sleep disorders, may be associated with daytime dysfunction. This study examined the association between NRS and daytime dysfunction in healthy adults screened for insomnia and sleep apnea.

Tucker, R., Testa, R., Simpson, T. L., Shipherd, J., Blosnich, J., & Lehavot, K. (2018). Hormone therapy, gender
affirmation surgery, and their association with recent suicidal ideation and depression symptoms in transgender veterans. Psychological Medicine, 14, 1-8. doi:10.1017/S0033291717003853

ABSTRACT: Access to transition-related medical interventions (TRMIs) for transgender veterans has been the subject of substantial public interest and debate. To better inform these important conversations, the current study investigated whether undergoing hormone or surgical transition intervention(s) relates to the frequency of recent suicidal ideation (SI) and symptoms of depression in transgender veterans.

Undurti, A., Colasurdo, E., Sikkema, C., Schultz, J., Peskind, E. R., Pagulayan, K. F., & Wilkinson, C. (2018). Chronic
hypopituitarism associated with increased postconcussive symptoms is prevalent after blast-induced mild Traumatic Brain Injury. Frontiers in Neurology. doi:10.3389/fneur.2018.00072

ABSTRACT: The most frequent injury sustained by US service members deployed to Iraq or Afghanistan is mild traumatic brain injuries (mTBI), or concussion, by far most often caused by blast waves from improvised explosive devices or other explosive ordnance. TBI from all causes gives rise to chronic neuroendocrine disorders with an estimated prevalence of 25-50%. The current study expands upon our earlier finding that chronic pituitary gland dysfunction occurs with a similarly high frequency after blast-related concussions.

Wang, L., Raskind, M. A., Wilkinson, C., Shofer, J., Sikkema, C., Szot, P., … & Peskind, E. R. (2018). Associations
between CSF cortisol and CSF norepinephrine in cognitively normal controls and patients with amnestic MCI and AD dementia. International Journal of Geriatric Psychiatry, 33(5), 763-768. doi:10.1002/gps.4856

ABSTRACT: This study evaluated the effects of Alzheimer disease (AD) on the relationship between the brain noradrenergic system and hypothalamic pituitary adrenocortical axis (HPA). Specifically, relationships between cerebrospinal fluid (CSF) norepinephrine (NE) and CSF cortisol were examined in cognitively normal participants and participants with AD dementia and amnestic mild cognitive impairment (aMCI). We hypothesized that there would a positive association between these 2 measures in cognitively normal controls and that this association would be altered in AD.

Wyse, J. J., Gordon, A. J., Dobscha, S. K., Morasco, B. J., Tiffany, E., Drexler, K., ... Lovejoy, T. I. (2018). Medications
for opioid use disorder in the Department of Veterans Affairs (VA) health care system: Historical perspective, lessons learned, and next steps. Substance Abuse, 39(2), 139-144.

ABSTRACT: The US Department of Veterans Affairs (VA), the largest health care system in the US, has been confronted with the health care consequences of opioid disorder (OUD). Increasing access to quality OUD treatment, including pharmacotherapy, is a priority for the VA. We examine the history of medications (e.g., methadone, buprenorphine, injectable naltrexone) used in the treatment of OUD within VA, document early and ongoing efforts to increase access and build capacity, primarily through the use of buprenorphine, and summarize research examining barriers and facilitators to prescribing and medication receipt. (Link to full article not available)

Yarborough, B. J. H., Stumbo, S. P., Stoneburner, A., Smith, N., Dobscha, S. K., Deyo, R. A., Morasco, B. J. (2018).
Correlates of benzodiazepine use and adverse outcomes among patients with chronic pain prescribed long-term opioid therapy. Pain Medicine. Advance online publication. doi: 10.1093/pm/pny179

ABSTRACT: Objective: to examine the correlates and odds of receiving overlapping benzodiazepine and opioid prescriptions and whether co-prescription was associated with greater odds of falling or visiting the emergency department. Read full research article: Correlates of benzodiazepine use and adverse outcomes among patients with chronic pain prescribed long-term opioid therapy

Zou, Y., Murray, D., Durazzo, T., Schmidt, T. P., Murray, T. A., & Meyerhoff, D. J. (2018). White matter microstructural
correlates of relapse in alcohol dependence. Psychiatry Research - Neuroimaging, 281, 92-100. doi:10.1016/j.pscychresns.2018.09.004

ABSTRACT: Identification of neural correlates of relapse to alcohol after treatment is clinically important as it may inform better substance abuse treatment. Few studies have specifically analyzed the white matter microstructure in treatment seekers as it might relate to relapse risk versus long-term abstinence. Using 4 Tesla diffusion tensor imaging, we compared two groups of one-month-abstinent treatment-seekers, who were classified based on their drinking status between six and nine months after treatment initiation.

NW MIRECC Research Articles:   In Press | 2019 | 2018 | 2017 | 2016 | 2015 | 2014

VISN 20 encompasses 23% of the US land mass with medical centers in Alaska, Idaho, Oregon, and Washington. VISN 20 is home to 273 federally recognized American Indian and Alaskan Native tribes, 229 of which are located in Alaska. Serving 135 counties, VISN 20 is the largest geographic region of VA spanning three time zones, across 817,417 square miles, including Del Norte County California and Lincoln County Montana. In the fall of 1997, VISN 20 leaders from VA Puget Sound Health Care System (VAPSHCS) and the Portland VA Health Care System (VAPORHCS) were commissioned by Congress and the U.S. Department of Veterans Affairs (VA) to establish one of the first three Mental Illness Research, Education, and Clinical Centers (MIRECCs) in the United States. VAPSHCS serves Veterans from a five-state area in the Pacific Northwest with two main divisions: American Lake VA Medical Center and Seattle VA Medical Center. VA Outpatient Clinics and Vet Centers in Washington are located in Bellingham, Bellevue, Bremerton, Chehalis, Edmunds, Everett, Federal Way, Lacey, Mount Vernon, Olympia, Port Angeles, Puyallup, Richland, Renton, Silverdale, Seattle, Spokane, Union Gap, Vancouver, Walla Walla, Wenatchee, and Yakima. Veterans in Washington are also served by VA Medical Centers in Spokane, Vancouver, and Walla Walla. VAPORHCS serves Veterans in Oregon and Southwest Washington with two main divisions: Portland VA Medical Center and Vancouver VA Medical Center. VA Outpatient Clinics and Vet Centers in Oregon are located in Bend, Boardman, Brookings, Enterprise, Eugene, Fairview, Grants Pass, Hines, Hillsboro, Klamath Falls, LaGrande, Lincoln City, Newport, Portland, Salem, The Dalles, Warrenton, and West Linn. Veterans in Oregon are also served by VA Medical Centers in Roseburg, White City, and Vancouver, Washington.

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VA provides health care for Veterans from providers in the local community outside of VA. Veterans may be eligible to receive care from a community provider when VA cannot provide the care needed. VA launched its new and improved Veterans Community Care Program (VCCP) on June 6, 2019, implementing portions of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (MISSION Act), which both ended the Veterans Choice Program and established VCCP. Types of care under the new VCCP include General Community Care, Urgent Care, Emergency Care, Foreign Medical Care, Home Health and Hospice Care, Indian and Tribal Health Services, In Vitro Fertilization, State Veterans Home, and Flu Shots. Veterans work with their VA health care provider or other VA staff to see if they are eligible to receive community care based on new criteria. The VA Community Care Network (CCN) is VA’s direct link with community providers to ensure Veterans receive timely, high-quality care.

VA Vet Center LogoVet Centers in the VISN 20 Health Care Network are community-based counseling centers that provide a wide range of social and psychological services, including professional readjustment counseling to eligible Veterans, active-duty Army, Navy, Marine Corps, Coast Guard, Air Force, and Space Force service members, including National Guard and Reserve components, and their families. 1-877-WAR-VETS is an around the clock confidential call center where Veterans, service members and their families can talk about their military experience or any other issue they are facing in transitioning after military service or trauma and get connected to their nearest Vet Center.

Vet Centers in VISN 20

Vet Centers provide counseling to make a successful transition from military to civilian life or after a traumatic event experienced in the military. Individual, group, marriage and family counseling is offered in addition to referral and connection to other VA or community benefits and services. If you can’t make it to a nearby Vet Center, VA offers satellite Vet Center locations and Mobile Vet Centers that may be closer to you.


Anchorage Vet Center (Anchorage, AK)

Anchorage Satellite Vet Centers in Anchor Point and Homer

Fairbanks Vet Center (Fairbanks, AK)

Fairbanks Satellite Vet Centers in Fort Greely and Fort Wainwright

Kenai Vet Center Outstation (Soldotna, AK)

Wasilla Vet Center (Wasilla, AK)


Central Oregon Vet Center (Bend, OR)

Eugene Vet Center (Eugene, OR)

Eugene Satellite Vet Centers in Florence and Reedsport 

Grants Pass Vet Center (Grants Pass, OR)

Grants Pass Satellite Vet Center in Cave Junction and Grants Pass Mobile Vet Center

Portland, OR Vet Center (Portland, OR)

Portland Satellite Vet Centers in Oregon City, St. Helens, and Vancouver, Washington

Salem Vet Center (Salem, OR)

Salem Mobile Vet Center


Boise Vet Center (Boise, ID)

Boise Satellite Vet Center in Ontario, Oregon and Boise Mobile Vet Center

Spokane Satellite Vet Centers in Couer d'Alene, Kootenai, Post Falls, Fairchild AFB, and Newport, Washington


Bellingham Vet Center (Bellingham, WA)

Everett Vet Center (Everett, WA)

Federal Way Vet Center (Federal Way, WA)

Lacey Vet Center Outstation (Lacey, WA)

Seattle Vet Center (Seattle, WA)

Spokane Vet Center (Spokane, WA)

Spokane Satellite Vet Centers in Fairchild AFB, Newport, Post Falls and Couer d'Alene, Idaho

Spokane Mobile Vet Center

Tacoma Vet Center (Tacoma, WA)

Tacoma Mobile Vet Center

Vancouver Vet Center - Washington State University, Clark County (Vancouver, WA)

Walla Walla Vet Center (Walla Walla, WA)

Yakima Valley Vet Center (Yakima, WA)

Yakima Satellite Vet Center in Ellensburg

Veterans Crisis "988" - The Military Crisis Line is a free, confidential resource for all service members, including members of the National Guard and Reserve, and Veterans, even if they’re not enrolled in VA benefits or health care. Call 988 then Press 1 If you are a Veteran, service member, or any person concerned about one who is hard of hearing, you can connect with professional, caring VA responders through online chat and text message (838255). 

Suicide Risk 988 Military Veterans Crisis Line

In Europe
Call 00800 1273 8255 or DSN 118

In Korea
Call 080-855-5118 or DSN 118

In Afghanistan
Call 00 1 800 273 8255 or DSN 111

In the Philippines
Call #MYVA or 02-8550-3888 and press 7

A Veteran overseas may contact the Veterans Crisis Line via the chat modality at If the Veteran prefers a phone call, they can request this within the chat venue. For TTY users: Use your preferred relay service or dial 711 then 1-800-273-8255. Are you looking for clinical care or counseling? Assistance with benefits? No matter what you’re experiencing, we’re here to connect you with resources and support systems to help. The Veterans Crisis Line is free and confidential. When you call, chat, or text, a qualified responder will listen and help. You decide how much information to share. Support doesn't end with your conversation. Our responders can connect you with the resources you need.


VA has a variety of mental health resources, information, treatment options, and more — all accessible to Veterans, Veterans’ supporters, and the general public. Explore the pages below to learn more about a specific mental health topic. Each of these pages includes resources, information on treatment options, and more.

Stories of Support

Telehealth Therapy

For Daniel, Don, and Jennifer, convenient video counseling made it easier to put their health first. Adjusting from military service to civilian life can be both exciting and challenging. Make the Connection

Dial 988 then press 1

Connect with the Veterans Crisis Line to reach caring, qualified responders with the Department of Veterans Affairs. The Veterans Crisis Line is free and confidential. Support doesn't end with your conversation. Our responders can connect you with the resources you need.

Mental Health Updates

Explore the latest mental health news, resources, and real-life stories of mental health recovery.

Plan your trip to VA

In 1946, Veterans Canteen Service (VCS) was established by law to provide comfort and well-being to America’s Veterans. With our many retail stores, cafés and coffee shops across the country, we serve those who have served our country. Our Canteens are whole health spaces for Veterans to connect, relax, share and care for themselves in an environment that is their benefit. We are proud to Serve America’s Veterans and those who provide for their care.

VCS operates over 200 Patriot Stores in Veterans Administration (VA) Medical Centers nationwide. Many of our stores have been recently updated and expanded to provide our customers with a modern, clean and comfortable shopping experience. Our stores welcome our customers with wider aisles, wood-like floors, enhanced lighting and directional signage. PatriotStores have expanded hours of operation to provide service for customers on weekends at most locations.

The Patriot Cafe is the best place in the VA Medical Center to enjoy delicious, freshly prepared breakfast or lunch served hot or cold each weekday. Providing Veterans, their families, VA employees, volunteers and visitors a place to relax and enjoy a meal or take-out for their convenience. With a wide variety of food from traditional comfort food, specialized menu selections and a large assortment of healthy choices; there is something for everyone's taste buds.

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