Rising to the Challenge of Treating OEF/OIF Veterans with Co-Occurring PTSD and Substance Abuse
Research Brief
Article Citation: Bernhardt, A. (2009). Rising to the challenge of treating OEF/OIF veterans with co‐occurring PTSD and substance abuse. Smith College Studies in Social Work, 79(3-4), 344-367.
Key Words: Trauma, Addiction, Engagement, and Integrated Treatment
Target Audience: Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans, the Entire veteran population in general (this includes combat and non-combat veterans), policy makers on the federal, state, and community levels, veteran advocates, social workers, and the general population (Community).
Abstract: In the United States, soldiers are returning home from war
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Integrated treatment programs along with evidence supporting its effectiveness are later brought up in this article, along with recent policy changes from the Department of Veteran Affairs predicting future positive outcomes of PTSD/SUD treatment.
Implications: This section includes the following three sections –
a. Practice: This article first identifies the scope of the problem, followed by the effect of dual diagnosis on treatment outcome, followed by how individual PTSD treatments work and how they view substance abuse, followed by addressing the problems with sequential treatment of PTSD/SUD, lastly addressing the integrated treatment approaches. These implications are supported by empirical data collected from various studies.
b. Policy: Policy reform will require federal leadership to engage health plans, professional organizations, states, and local communities in strategies to improve veterans’ access to high-quality services (Burnam et. al, 2009). Bernhardt (2009) claims that there needs to be leadership at the highest levels of administration within the VA in order to inflict meaningful change for PTSD/SUD
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Future Research: Effective treatments for PTSD and depression exist, yet there are disparities in how these treatments are being geographically/regionally dispersed. Above, we highlighted key challenges: veterans’ perceptions of the negative consequences of seeking care; inadequate availability of mental health professionals; diverse and often competing mental health specialties and training approaches that inadequately prepare many practitioners to deliver evidence-based treatments for combat-related disorders or to understand military experience (Burnam et. al, 2009); and limited dissemination and implementation of QI strategies in mental health care settings . Overcoming these obstacles will require federal, state, and local leadership.
Since there is no reported data or analyses to help the nation or specific regions and communities assess veterans’ needs for services by geographic area, and to plan for and coordinate service delivery across community-based, TRICARE, and VHA resources; we purpose several general directions for moving forward (Burnam et. al, 2009). The general directions for moving forward include a need for confidentiality, consumer education, treatment choices, workforce policy, training and certification, QI needs, and technical assistance to the
Tarnished by lack of efficiency, communication and a vision are inconsistent and divided. My findings of evidence paralleled with my literature reviews because this issue is starting to emerge as a imminent threat to the structural failures that the veterans rely on. The LACK of justice is the primary value my stance emphasizes. As citizens, we are expected to follow guidelines, laws, and abide by or pay the consequences. Both the DoD and the VA have violated all agreements and initiatives to collaborate to form a larger accessible health care system and have neglected to take initiative. Veterans risk their lives to support the prosperity and freedom of the United States, and in return they are marginalized in a sense that provisions within these complex bureaucracies make it difficult for them to be treated. The Old Public Administration has proven to be a detriment to the purpose of the departments and raises the question as to whether the veterans they neglect are really a concern at
The mission statement of the VA Social Workers is to eliminate significant barriers to clients in need and offer interventions for veterans and families. It is accomplished by developing and maintaining integrated, in-depth programs in patient care, research, and education (Hoffer, Elizabeth. F., Dekle, Judith. Ward., & Sheets, Carol., 2014). Its proposed 11 percent to 20 percent of Iraq, Afghanistan veterans as well as 30 percent of Vietnam vets encounter (PTSD) posttraumatic stress disorder traumatic incidents like combat can lead to PTSD, military sexual trauma of military service member, and veterans may possibly deal with depression, anxiety in addition to other mental health concerns. Vets distress from these mental health and cognitive
The Department of Veterans Affairs are constantly performing and perfecting innovative services to veterans as they strive to provide quality services in the 21st century to veteran and their families. The Department of Veterans affairs hopes to build their services on the principles of being more person centered toward the care they provide, providing measurable results , and by continuing to look at future services needed for veterans. This paper will examine the challenges, plans, and goals that would need to be in place so that the Department of Veterans Affairs can continue to meet their strategic challenges.
In the United States, Veteran’s health care at an economical rate is a continuous debate. It is warranted that the health care should improve at a constant rate to uphold the health needs of veterans, new and old. Government has the veterans association (VA) and with all the help it has available for veterans there are still times when that care is not enough. There are so many individuals that are without health care because of one reason for another and it leaves many injured and hurt veterans without the care they need and deserve. Better access to health for veterans, men and women is important since many new problems such as PTSD have become better understood and need more focus and to be better
The VA runs the largest substance use disorder treatment program in the world. Treatment of veterans with SUDs and co-occurring psychiatric disorders is one of the following three paradigms; parallel, sequential, and integrated. Most VA programs are parallel, where the patient receives treatment for SUD in one program and treatment for PTSD in another. Many SUD-PTSD veterans may be unable to navigate the separate systems or make sense of the disparate messages about PTSD treatment and recovery. One challenge to dissemination and implementation of EBTs is that of dual disorders, particularly SUD and PTSD. These patients use costly inpatient services, tend to have frequent relapses, and are less likely to adhere to or complete treatment.
Focusing on these research questions, I propose to conduct research on decreasing wait times for PTSD related appointments, reducing, or eliminating, the stigma attached to PTSD in veterans, providing a way for veterans to receive immediate PTSD crisis help, and a way to ensure that veterans diagnosed with PTSD continue treatment.
Veterans are everywhere throughout the United States, but just because they are everywhere, doesn’t meant they are getting the proper care. According to the Iraq and Afghanistan veterans of America, “One in three veterans return home and suffer from some sort of mental health issue.” Their mental health issues vary from post traumatic stress disorder to anxiety and depression. The switch from fighting everyday to being home is tough for the veterans and they need to receive the proper treatment so they can possibly live a life as normal as possible. The state Department of Mental Health and Addiction Services, started a $810,000 program to support these veterans with their issues returning home. The transition is hard, not
Current funding for veteran healthcare care is low and insufficient because of the large number of veterans, who are being discharged from the military as the country transitions to a democratic President. According to Dr. Rachel Nardin in her article about veteran healthcare, “Soldiers get excellent acute care when injured on active duty, but as revelations of poor conditions for soldiers receiving ongoing outpatient care at the Walter Reed Army Medical Center highlighted, service members often have trouble getting the care they need once active duty ends” (Nardin 1)
A holistic approached of various services would appear to be paramount in setting up veterans for a successful transition into civilian life. Transitioning can prove to be challenging based on the common stressors many veterans aren’t normally used to dealing with, including and not limited to securing housing, employment and understanding how to access and navigate services through the VHA and Veterans Benefits Administration (VBA). Some of the problems that derived from securing these resources may have not been an issue in the past, since the military provides most of these resources without a hassle and at the service member’s convenience. Adding to these stressors is the fact that most veterans are not used to dealing with conflicts derived from personal relationships or at home. This occurs simply by the veterans being absent through a lot intrapersonal relationships due to being on a deployment cycle or when they are consumed by training, field life, and other military
One of the most common things veterans encounter during the war is Post-Traumatic Stress Disorder or PTSD. PTSD is an anxiety disorder that may develop after exposure to a terrifying event or ordeal in which severe physical harm occurred or was threatened. The most common symptoms of PTSD is difficulty concentrating, lack of interest/apathy, feelings of detachment, loss of appetite, hypervigilance, exaggerated startle response and sleep disturbances. The statistics show that at least 20% of Iraq and Afghanistan veterans have PTSD. But 50% of those with PTSD do not seek treatment out of the half that seek treatment, only half of them get “minimally adequate treatment.” This issue is very serious because of how much stress it puts on these veterans. With a rehabilitation center these veterans could get the help that they need until they are healthy enough to go out on their own.
Most veterans are seeking care from the VA more than before. According to the U.S. Government Accountability Office, 2.1 million veterans received mental health treatment from the U.S. Department of Veterans Affairs in the five year period from 2006 through 2010 (Foundation, N. V. 2016). PTSD is the most prevalent mental health diagnoses for Afghanistan and Iraq veterans; therefore, it is important that these veterans have/are offered the best treatments to help them with their PTSD. Because 1 in 5 veterans are homeless in the United States, it is evident that these veterans are either not seeking treatment or the treatment that is currently being offered is not working. It is safe to assume that the lack of treatment options available is problematic in America. Only a quarter of Iraq and Afghanistan veterans search for treatment options in the U.S (Stecker, Fortney, and Sherbourne, 2007). When a veteran goes into treatment, they do not stay for very long because their are many barriers that affect their mental illness (Drapalski et al., 2008). Drapalski(2008) assessed barriers to medical and mental health care among Veterans with serious mental illness and found similar results. In 2006-2007 a study was done for 490 men and women veteran with PTSD in regards to
Posttraumatic stress disorder (PTSD) is a commonly recognized stress disorder found in many combat soldiers after exposure to life-threatening and traumatic experiences. Since 2001, the prevalence of PTSD has increased with over 2.4 million troops deployed to warzones in Afghanistan and Iraq (U.S. Department of Veterans Affairs, 2012). Although researchers and civilians commonly understand symptoms of PTSD, they often fail to recognize the difficulties veterans’ face- reintegration into civilian society, alienation, and identity crises (Demers, 2011). Currently there exist two major sources for best practice guidelines in the management of PTSD. They include the VA/DoD Clinical Practice Guidelines for Management of Post-traumatic
The United States of America has one of the largest military forces on earth, employing nearly 1.5 million active personnel (Armed Forces). However, that number represents more than just a dedicated group; it represents citizens that will eventually become veterans and transition back into civilian life. For some this comes easily, but for others the struggles impede their ability to thrive. These hurdles can include the following: physical and psychological ailments; difficulties finding support; and trouble affording necessary treatment. In order to improve upon this lacking state of veteran care in the U.S., the government needs to expand current services within health care, as well as research new ways to make re-entry into everyday life
Every day a man comes home from war. Most having left their families as boys or young men trained in tactics and combat but never being trained effectively on stress management or the dangers of PTSD. Going into war soldiers are instructed to choke it down and bury it deep. Once introduced back into civilian life, where emotions are acceptable and tactics are not the answer, how do these men survive? How do they learn to cope? And most importantly how does the U.S. government train them for the next portion of their lives? In October of 2001 Operation Enduring Freedom, OEF, and Operation Iraqi Freedom, OIF, began and since then over 1.8 million troops have served at least one term
Access to quality care can mean everything to healthy living for individuals in a community. Veterans living in rural areas are no exception and in particular make up an extraordinary demographic that often have specialized mental and health care needs due to various war traumas. (Rural Health, 2016) states that “there are 22 million Veterans nationwide, with 5.3 million who live in rural communities.” (Rural Health, 2016) continues that “fifty-seven percent of these rural Veterans are enrolled in the U.S. Department of Veterans Affairs (VA) health care system.” (Rural Health, 2016) also asserts that “between fiscal years 2006-2014, there was a seven percent increase in VA-enrolled rural Veterans.” It is important to