Combat Trauma, Substance Dependence, and Treatment

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Transcript Combat Trauma, Substance Dependence, and Treatment

Combat Trauma, Substance
Dependence, and Treatment
Providers: Understanding What
We’ll Never Fully Understand
Rodney J.S. Deaton, MD, JD
Clinical Director, Substance Abuse Treatment Section,
Richard L Roudebush VA Medical Center
Associate Professor of Clinical Psychiatry, Indiana
University School of Medicine
The National Institute on Drug Abuse
(NIDA)
• “Prescription drug abuse doubled among US military
personnel from 2002 to 2005 and almost tripled from
2005 to 2008.”
• “Army soldiers screened 3 to 4 months after returning
from deployment to Iraq showed that 27 percent met
criteria for alcohol abuse and were at increased risk for
related harmful behaviors (e.g., drinking and driving,
using illicit drugs).”
• “Drug or alcohol abuse . . . was involved in 30 percent
of the Army’s suicide deaths from 2003 to 2009 and in
more than 45 percent of non-fatal suicide attempts
from 2005 to 2009.”
Goals
• Workable Model for to Use in Individual and
Group Settings
• A “Provocative” Encouragement
What Doesn’t Work
• “Silo” Treatment
• “Business as Usual” Trauma Treatment (i.e.,
Combat Trauma = Other Trauma)
Seeking Safety
• Najavits, Lisa M. Seeking Safety: A Treatment
Manual for PTSD and Substance Abuse
• Developing Specific Skills of Emotional
Regulation So That More Trauma-Focused
Work Can Proceed
Judith Herman’s Model of Trauma
Treatment
• Phase of Safety
• Phase of Mourning
• Phase of Re-Connection
The Advantage
• From the beginning, the veteran is urged to
see combat PTSD and substance use disorders
as inextricably linked
The Recurring Message
• You never need to use substances to cope.
There is always a better (in the long run)
alternative
Description of Course
• Twenty-Four Related, Yet Independent Units
• Focus on Safety (Strength? Principles?)
• Strong Focus on Case (Self) Management
CAVEATS
Harm Reduction:
Abstinence as Goal, Not as PreRequisite
Relapse =
Trigger for More Focused
Interventions,
NOT Bump-Up of Care Level
“Cookbook Therapy”
--and Safety from Emotional
Overload
(for both veteran and clinician)
Summary
• Self-Medication Meets Biological Substrate
Issues with Combat
Trauma/Military Culture
Do YOU Have What It Takes?
Types of Trauma
• Acts of God
• Acts of Others
• Acts of Self
Volunteers in Time of War:
Honor and Intensity
Love, Rage—and Horrific
Excitement
Dare You Look Inward?
Personality and Personality
“Disorders”
• Entitlement and the Ubiquity of Shame
• “Posttraumatic Identity”
“Readiness”
• Can Your Prescribers “Hack It”?
• Are You Physically Ready?
• Are You Worthy of Respect? or the Art of
Managing the Hysterical
On Street Hustlers, Rebellious
Rakes, and Good-Old Country
Boys
Further Resources
• www.seekingsafety.org
• Van Winkle, Clint. Soft Spots: A Marine’s Memoir
of Combat and Post Traumatic Stress Disorder
•
• Johnson, James D. Combat Trauma: A Personal
Look at Long-Term Consequences
• Shay, Jonathan. Achilles in Vietnam.