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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: The study of the mental health effects of deployment in Iraq and Afghanistan by Dr Hoge and colleagues¹ may have systematically underreported the impact of combat exposure due to incomplete surveillance for substance use disorders, a major source of mental illness and health care utilization in veterans. For instance, alcohol abuse and dependence alone have a prevalence ranging between 13% and 19% in Vietnam and Persian Gulf veterans.^2-3 Data from the Veterans Health Administration indicate that of the 144 000 recently discharged US veterans previously deployed in Iraq and Afghanistan who have applied for health care, alcohol dependence was diagnosed or considered in 3116; nondependent abuse of drugs was diagnosed or considered in 17 768, second in prevalence only to posttraumatic stress disorder (PTSD).⁴

The authors state that "[t]he PDHA [Post-Deployment Health Assessment] also does not include screening for substance abuse because access to alcohol and other substances is . . . [Full Text of this Article]

David A. Fiellin, MD
david.fiellin@yale.edu
Yale University School of Medicine
New Haven, Conn

Andrew Saxon, MD
University of Washington School of Medicine
Seattle

John A. Renner, Jr, MD
Boston University School of Medicine
Boston, Mass

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