Volume 3, June 2009
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PTSD in the news
The contemporary battlefields of Operation Iraqi Freedom (OIF; Iraq) and Operation Enduring Freedom (OEF; Afghanistan) have posed profound and unique challenges to the more than 1.64 million U.S. troops deployed to the region since 2001. From severe trauma associated with combat exposure to the stress of multiple and prolonged deployments, recent findings suggest that the wars in Iraq and Afghanistan are producing a new generation of veterans at high risk for a host of mental health problems.
Further evidence of the high psychological toll on today’s troops is highlighted in a 2004 study of combat-related mental health problems conducted by Charles W. Hoge, M.D., et al. This landmark study reported that both frequency and intensity of exposure to combat experiences is strongly associated with the risk of developing chronic post traumatic stress disorder (PTSD), a mental disorder marked by flashbacks and debilitating anxiety. Moreover, the study indicated that the estimated risk for PTSD from service in the Iraq war was 18 percent; as contrasted by an estimated 11 percent from the Afghanistan mission.
Unlike the physical wounds of war that disfigure or injure — PTSD remains invisible to the eye and often goes untreated. According to a 2008 RAND Center for Military Health Policy Research Report, approximately 300,000 veterans returning from combat in Iraq and Afghanistan showed signs of either PTSD or depression, conditions which are closely linked with substance abuse.
“Research shows that there is a very strong association between PTSD and substance use disorder. In fact, these problems co-occur frequently,” said Dr. Lisa Najavits, Professor of Psychiatry at Boston University School of Medicine. “Most returning veterans don’t realize that they have post traumatic stress disorder and try to get relief from their symptoms by self -medicating with alcohol, tobacco, and other substance use.”
Movement to develop effective treatments that address both PTSD and substance abuse problems simultaneously is critical. For years, many mental health professionals believed that — for patients with PTSD and co-morbid substance use disorders — it was necessary to treat the substance use problem first. Today, a wealth of new research shows that this is not true. “You can actually treat both conditions concurrently. It all depends on how you go about it,” said Dr. Najavits. “If you take away the substance use without helping an individual learn alternative ways of coping with symptoms of PTSD, he or she may quickly go back to abusing substances.”
Dr. Najavits adds that when the trauma piece of PTSD is combined with substance abuse treatment, a whole new layer of healing often emerges. “Once patients understand that there are real emotional issues that are sending them to drugs, they can begin to find a new perspective and motivation to work on their addiction.”
Teaching veterans about coping skills has shown significant positive outcomes. One of the most effective methods has been found in a model developed by Dr. Najavits in 1992 called, “Seeking Safety,” a specialized cognitive behavioral treatment for PTSD and substance use disorder that provides skills for managing symptoms of PTSD — with the goal of less reliance on substances.
Studies also show that cognitive behavioral therapy is a validated treatment option in treating PTSD, including: exposure therapy which focuses on working through past trauma, and eye movement desensitization and reprocessing (EMDR) which focuses on reprogramming the memory of past trauma within a positive framework, while using rapid eye movements.
Experts agree that more research is needed in the area of evidence-based treatment of co-morbid PTSD and substance use disorders. “A lot of good work has been done over the past decade, but we’re still at an early stage,” said Dr. Najavits. “We need to better understand the neuroscience component of this co-morbidity.”
The cost of mental health issues such as PTSD and substance use disorder resulting from the wars in Afghanistan and Iraq is expensive to both individual and society. If not treated, these conditions can have wide ranging and negative consequences that affect health, work productivity, and family relationships. Therefore, it is important to address and support the mental health needs of the troops to prevent long term course of mental health problems.