Download Document

After They Return
COORELATION BETWEEN SUBSTANCE ABUSE AND PTSD
1 out of every 3 vets seeking
treatment for substance use
disorders also have PTSD
VA study was the first to show that OEF/OIF vets who had been
diagnosed with mental disorders, particularly PTSD, were more
likely to:
• Receive prescription opioid medication for conditions related
to pain than those without a mental health diagnosis.
• Have co-occurring SUD’s
• Receive higher dose opioids regimens
• Get early refills
• Take opioids for longer periods of time.
A survey conducted by National Epidemiologic showed that those
with alcohol use disorders and PTSD, compared to those without
PTSD were:
• More difficult to treat
• Had more health and physical problems
• Had higher mental health symptoms
• Had higher alcohol use and consequences
• Dropped out of treatment more often
• Cost substantially more than inpatient
Worsening PTSD symptoms –higher alcohol cravings
OP pharmacologic PTSD TX. reduced PTSD symptoms improved
SUP symptoms
AT RISK:
Men: 5 or more drinks in a
day or more than 14 in a week
Women: 4 or more in a day, 7
or more in a week
1 or more times a year
BINGE DRINKING:
Pattern of drinking that brings
BAC to .08 or above after
having 5 more drinks (men) or
4 or more (women) in 2 hours.
MISUSE:
Behavior that increases risk for
health or social problems.
Alcohol Consumption Guidelines
from the National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Substance Use, Depression and Insomnia
Increase depressive symptoms
increased likelihood of
domestic violence by 74%
Active drinking and use of drugs
increases insomnia symptoms
Insomnia , which means difficulty
getting to sleep, staying asleep or
feeling rested from sleep, is a
contributing fact to risk of suicidal
behavior.
Substance Abuse and Suicide
Vets who misuse alcohol with short sleep time, were more likely to identify
the 5 suicidal ideation symptoms over the last year
• not worth living
• wished was dead
• wanting taking own life
• thoughts/plans past year
• attempt
Lack of sleep:
• more time to think about problems
• Become more frustrated
• Escalates seriousness of the problem
• Reduces frontal lobe activity
• decreases executive function, thought inhibition and
emotional regulation
All this together creates opportunity for
irrational thinking
Alcohol—primary source of concern
Marijuana-most
common illegal drug
Opiates-pain medication—
most common misused
prescription drug. SAMHSA
reported that prescription
drug abuse was second only to
marijuana use
Juggling of military and family responsibilities, reintegration into
civilian life in the US after living in unfamiliar settings and
processing exposure to combat
Miss the adrenaline of physical and life-challenging situations
Feel uncomfortable with the lack of structure and goals compared
to military life
Become annoyed with others who
seem more easy-going or less
detailed oriented
Feel isolated and alone, as if no one
understands them
Difficulty asking for help
Peer Pressure—Stigma
Pride
Negative impact of having a SUD diagnosis on their military career
Length of treatment longer because of the chronic and relapsing
nature of substance abuse
ASSESS
Screen for SUD, PTSD, depression, risk of suicide and other behaviors
health issues and concurrence of this problems as early as possible
Those who are misusing alcohol or drugs, and experience insomnia
should automatically prompt a psychiatric assessment.
Those with relatively recent traumas have increased health
complains therefore should have a physical and mental evaluation
and treatment.
Brief intervention including giving feedback about the screenings
result, describe the risk associated with a behavioral health disorder,
and advising about ways to begin addressing SUD or mental
disorders
REFER
To get in-depth assessment, diagnosis and appropriate
facilities. List of where to find referral source provided
through SAMHSA
KNOW THE FACTS
Learn as much as you can of their experiences. There are
excellent websites of interviews of veterans. Gain some
understanding of military culture and combat stress.
http://maketheconnection.net/stories/story.aspx?story_id=301#.UrMC6EGlRH4.email
INTEGRETED, INNOVATIVE THERAPIES
Traditional Treatment does not seem to be the most effective. The
co-occurrence of PTSD, TBI and pain in our military will require
innovation for optimum TX.
CBT, Seeking Safety are forms of integrated treatment
65.7% of veterans with PTSD and SUD preferred treating both
together
47.1% preferred treatment that involve psychotherapy and
pharmacotherapy.
Have 3-4 weeks sobriety prior to working on their trauma
In regards to Opiates s physical therapy
massage,
TENS unit,
thermal and aqua TX,
exercise,
chiropractic and acupuncture, ,
biofeedback, stress management,
deep relaxation training,
yoga
If the vet is already on opiates may want to go to a more
sustainable long term pain management strategies such as
alternative pain relievers, along with some of the above mention.
Abstinence is the most consistent factor with improving
the quality of life for someone who has PTSD.
The key is to help our veterans develop
resilience. Resilience is not an innate ability
but can be learned.
Websites and Reading Material
Afterdeployment.org
Issues Facing Returning Veterans, Resource Links, Volume 6, Issue 1, 2007
Make the Connection—http://maketheconnection.org
Military OneSource
National Institute on Drug Abuse--NIDA
Real Warriors, Real Battles, Real Strength, www.realwarriors.net
Tools to Use When Counseling Service Members
Upload videos of those who have sought care and are still in the military
Substance Abuse and Mental Health Service Administration--SAMHSA –online store and
treatment locator
Seeking Safety by Lisa Najavits
VA Website—www.va.gov
References
Behavioral health issues among afghanistan and iraq us war veterans. In (2012). In Brief
Summer 2012 (1 ed., Vol. 7). SAMHSA. Retrieved from
http://www.samhsa.gov/shin/content/SMA12-4670
Saxon, A. J. (July 14, 2011). Returning veterans with addictions. Psychiatric Times,
Retrieved from http://www.psychiatrictimes.com/militar-mental/returning-veteransaddiction
Green.K.T, Beckham,J.C., Youseff, N., Elbogen, E.B. (2014). Alcohol misuse and
psychological resilience among u.s. iraq and afghanistan era veterans. Addictive
Behaviors 39, 406-413. Retrieved from
http://sciencedirect.com/science/article/pii/SO0306460313002475
Chakravorty.S, Grandner, M.A., Mavandadi, S., Oslin, D.W., Perlis, M.L., Sturgis, E.B.
(2014). Suicidal ideation in veterans misusing alcohol: relationships with insomnia
symptoms and sleep duration. Addictive Behaviors 39, 399-405. Retrieved from
http://sciencedirect.com/science/article/pii/S)306460313002918
Heltemes, K.J., Clouser, M.C., MacGregor, A.J., Norman, S.B., Galarneau, M.R. (2014). Cooccurring mental health and alcohol misuse: Dual disorder symptoms in combat injured
veterans. Addictive Behaviors 39, 392-39. Retrieved from
http://sciencedirect.com/science/article/pii/S0306460313001603
References Continued:
Ralevski, E., Gianoli, M.O., McCarthy, E., Petrakis, I. (2014). Quality of life in veterans with
alcohol dependence and co-occurring mental illness. Addictive Behaviors, 386-391.
Retrieved from http://sciencedirect.com/science/article/pii/S06460313001615
Back., S.E., Killeen, T.K., Teer, A.P., Hartwell, E.E., Federline, A., Beylotte, F., Cox, E. (2014).
Substance use disorders and ptsd: An exploratory study of treatment preferences among
military veterans. Addictive Behaviors 39, 369-373. Retrieved from
http://www.sciencedirect.com/science/article/pii/S0306460313002761
Bedard-Gillian, M.,Chard, K., Kaysen,D., Schumm, J., Pedersen, E.R., Seim, R.W., (2014).
Cognitive processing therapy for veterans with comorbid ptsd and alcohol use disorders.
Addictive Behaviors 39, 420-427. Retrieved from
http://www.sciencedirect.com/science/article/pii/S0306460313002311
Shuman.J. (June 18, 2012). Returning soldiers. Primary Issues, Retrieved from
http://www.primaryissues.org/2012/06/returning-soldiers/
SAMHSA. (n.d.). Half of substance abuse treatment admissions among veterans age 21 to
39 involve alcohol as the primary substance of abuse. Data Spotlight, Retrieved from
http?//www.samhsa.gov.data/spotlight/spot106VeteransAlcoholAbuse2012.pdf
References cont.:
(n.d.). Tools and tips for health professionals. Real warriors, real battles, Retrieved
from
http://www.realwarriors.net/healthprofessionals/militaryculture/counseling.php
Army, (2012). Army 2020: the generating health and discipline in the forces ahead
of the strategic resist . Retrieved from website:
http://www.nia.army.mil/docs/GoldBook.pdf
Veterans Administration, PTSD: National center for PTSD. (n.d.). Ptsd and substance
abuse in veterans. Retrieved from website:
http://www.ptsd.va.gov/public/problems/ptsd_substance_abuse_veterans.asp