Posttraumatic Stress Disorder also known as PTSD is a common problem now days, more common in the military with war veterans. PTSD was officially accepted into the books in 1980 as diagnosable disorder. There are people who get PTSD from going through traumatic events like war, sexual assault, abuse and even accidents, it can happen to anyone at any time. Not everyone who goes through a traumatic event will suffer from PTSD though. There are numerous scenarios that war veterans go through while at war that cause PTSD. While PTSD is a huge problem among many military soldiers and there families there is also a readjustment process that soldiers go through after returning from war. There is a lot of strain put on to soldiers and their families that people do not see, they see and hear what the news reports and that it is. Military families go through many days and nights separated from their families due to training or deployments. Moving across the country every three years, missing numerous birthdays, holidays or even births of their children. Holidays for many families are really important but military families will celebrate holidays’ months early just so their loved ones can be there. In consideration for the sacrifices there are things that military families get to experience that not everyone else does. For example, traveling, meeting new people all over the world from all over the world, creating friendships that last a life time, getting to experience a first kiss more then just once and having the pride when you the national anthem. Being in the military can also cause a lot hardship on a person personally, like being overwhelmed, too much work strain causing marriage problems. These kinds of issues cause a person to drink or do drugs, which leads to a substance abuse problem. The military is the backbone of America and they are going to perform best with the proper support of families and support when they are in need of help like effective treatment process for PTSD and other issues they encounter like substance abuse.
The article Military-related PTSD: A Focus on the Symptomatology and Treatment Approaches by Gregory Garske is an article that discusses how war veterans return home with PTSD and even other disorder, the symptoms and what they go through while experiences PTSD and the treatment process, which is the most important part of a PTSD patient. Combat exposure is not easy for people to encounter. These individual leave home to live in a hostile forgein land, where they sleep with weapons because they can be attacked at any time. Some of them go to war and loose close friends, where they witness the dramatic death through a fire-fight, felt blasts, heard screams or saw their fellow soldier laying helplessly, or getting blown up by an improvised explosive device (IED). “PTSD is also associated with significant functional impairment, including increased risk of somatic symptoms and health disorders, health-related changes in day-to-day functioning, diminished overall well-being and quality of life, psychosocial and interpersonal dysfunction, and occupational impairment” (Garske, 2011). The soldiers’ return home some get PTSD because of what they witnessed, some go through so much emotional guilt creating PSTD. Since the Wars in Iraq and Afghanistan which are also known as Operation Iraqi Freedom and Operation Enduring Freedom, started the PTSD has been a rise, which has been the biggest rise since the Vietnam War. When a person has PTSD it take over the mind and life even though they left war environment behind. They try to forget what happen, but they become numb which causes amnesia, some have disturbing flashbacks that cause them to become unstable, or they horrific nightmare of the event that cause sleepless nights. It is not always easy to put a number on those who have PTSD in the military because not all of them report it because they see it has a something that is going to hold them back in their career as it presented as a disorder. There are two severity levels of PTSD: acute and chronic. In order to be diagnosed with acute PTSD a patient has to have symptoms for at least three months and for chronic the symptoms have to be ongoing for at least six months. There are four types of symptoms for PTSD, they are reliving the event, avoiding situations that remind the person of the event, negative changes in feelings or beliefs and hyperarousal. Today there are two types of medications that are used to treat PTSD; sertraline (Zoloft) and paroxetine (Paxil), which are both supported by the U.S. Food and Drug Administration (FDA). Aside from medications there is also therapy that the soldier goes through; exposure therapy, cognitive therapy and eye movement desensitization and reprocessing. “A specific form of exposure therapy, virtual reality exposure (VRE) therapy, is a human-computer interaction medium in which patients can be immersed in a virtual environment which gives the user a sense of presence, and is proposed to effectively elicit the fear structure and facilitate the emotional processing of fears” (Garnske, 2011). According to Garnske, this therapy may cause improvement but it is not a recovery as it 25% to 45% still fulfill diagnostic criteria for PTSD at the end of treatment. “Cognitive therapy focuses on the trauma-related erroneous automatic thoughts associated with PTSD. Examples of erroneous cognitions include perceiving the world as dangerous, seeing oneself as powerless or inadequate, or feeling guilty for outcomes that could not have been prevented” (Garnske, 2011). Cognitive therapy is way to help the patient work through the event that is causing the symptoms. eye movement desensitization and reprocessing is a controversial treatment that is still under research. “In EMDR, clients are instructed to imagine a painful traumatic memory and associated negative cognitions (such as guilt or shame) while visually focusing on the rapid eye movement of the therapist’s finger” (Friedman, 2006).
When a war veteran returns from war and have experience traumatic events, it is best to start treatment right away for a faster recovery if needed. The best way to treat PTSD is with medication, therapies and support from families and peers. “Although most military personnel returning from recent deployment will readjust successfully, a significant minority will exhibit PTSD or some other psychiatric disorder” (Garnske, 2011). It is important that military personal know the importance of encouraging the support of seeking help when a fellow soldier is suffering from PTSD symptoms. When you hear the percents of soldiers returning home with PTSD they may seem low at 16% but really that it thousands of soldiers. It easy to read the numbers of those who die at war, we can see the injuries, scares or amputies but we can not see their minds and what is going on in there.
It is a very emotional time when military families are faced with the stress of a deployment. Deployment consists of five stages; pre-deployment, deployment, sustainment, and redeployment and post deployment. Some people may think that the hardest part would be the actual deployment until the family member returns but sometimes the hardest part can be the post deployment and readjusting the lifestyle that was there before the deployment. Truth be told though, people change and grown and routines are made. The soldiers abroad and the families at home create a new routine and some-what live different lives during deployment so after deployment when the soldier returns home, there is an adjustment process. Some times soldiers return home healthy and safe, some return home with psychological problems, some with pshysical problems and some do not return home at all either as result of death or becoming a prison of war (POW). Either way, there is going to be post deployment process when the brigade that your soldier was in returns home and sometimes this process is easy some time there are difficult issues that arise causing emotional distress that can lead to other problems. Not properly addressing these problems can lead to more challenges.
The article ” Working with Military Families Through Deployment and Beyond” by Julie Anne Laser and Paul M Stephens is about helping military families through deployments and the challenges that follow. Pre-deployment should consist of being close, doing things as a family, spending time together. And while those things are highly important it is also important to make sure all the family affairs are in order so that the soldier feels confindent that the family is prepared for the departure as well as the family members who are staying. Some families deal with the soldier separating themselves from them because they believe it will make the leaving process easier. During deployment things can become very stressful for both the soldier and the family. Each having their own roles need to know how they can help one another being so far. The soldier can show emotional support with encouragement for example, “you’re doing a great job”, “I love you” etc. The family also needs to show support by not worrying the soldier over small things, they need to know that things are okay back home. Children also deal with deployment in their own way, depending on the age. Younger children may change the way they eat and sleep and cry a lot. School aged children may become rebellious and whine a lot. Teenagers may become irritable, do drugs, act disobidient towards the parent at home. Some children understand and do not act out in negative manner, but either way parents and even teachers need to be aware and know how to treat the situation and know of what resources are available for contact. Post deployment is when the soldier returns home and there is a reunion for the families. “Prior to rejoining their family, service members must go through physical and mental exams, but some issues may not be reported or visible at this time” (Laser & Stephens, 2010). During this time the soldier returns to their home, and if there is problems this is when they will be noticed. Problems could include; mixed emotions in family roles, PTSD, alcohol abuse, physical impairment issues and even communication problems. Before the soldier comes home, the family and the soldier are informed of what to expect, what can occur and how to seek help if needed. The help in is therapy form, the therapy helps for both the family understanding where the soldiers problems are coming from and how they need to be addressed as well as informing the soldier of where the family lies and how these problems are occurring. Problems that arise after deployment and lack of knowing how to properly address the problem are; domestic violence, divorce, suicide and substance abuse. Being aware of the process and how to address issues and would to contact for help is key. There are different forms of therapy depending on the problems; individual therapy, family therapy and couples therapy. “Understanding the issues that face military families prior to deployment, during deployment and post deployment are crucial for providing appropriate clinical services. With a better understanding of the issues facing military families, better mental health services can be provided” (Laser & Stephens, 2010). Seeking help from professionals when in need, is the proper solution rather then letting the problem get worse.
The article Evidence-Based Screening, Diagnosis, and Treatment of Substance Use Disorders Among Veterans and Military Service Personnel by Hawkins, Grossbard, Benbow, Nacev and Kiviahan discusses substance abuse, screening and diagnosis for SUD. “Substance use disorders (SUDs) are among the most common and costly conditions in veterans and active duty military personnel, adversely affecting their health and occupational and personal functioning” (Grossbard, Benbow, Nacev & Kiviahan, 2012). Like many people in our society, there are many military personal members who also suffer from SUD. The military has a zero tolerance for substance abuse so when the chain of command becomes aware of the problem, they take the necessary actions of starting them in a substance abuse program, more then likely they will be discharged from the military as well the policy was first taken in 1982. Substance abuse can mean many different substances like tobacco, street drugs, medical drugs and alcohol. In order to determine unhealthy alcohol use the Alcohol Use Disorders Identification Test Consumption Questions (AUDIT-C) is used. The scoring point system varies depending between males and females. Drug abuse is detected through a Urinalysis (UA). UA’s are conducted when needed, sparatically and on certain days. Substance abuse can be the result of many things but in the military there are a few main factors that be at cause for substance abuse; divorce, financial issues, family issues,stress at the work place, peer pressure, PTSD and post deployments. While substance abuse can be caused those factors there are also other issues that can be caused by substance abuse; divorce, job loss and suicide. Once the drug abuse is recognized through the proper screening then, proper treatment process needs to take place in order for the military member to over come the dependency. “Providers should consider the patients willingness to engage in treatment as well as the patients treatment goals and preferences and evaluate how their strengths, limitations and presenting problems will affect the treatment process and outcomes” (Grossbard, Benbow, Nacev & Kiviahan, 2012). With military personal the concern and issue becomes a challenge when the military member is deployed and therefore they will have to be evacuated. Depending on the severity of the substance abuse, will determine where the soldier can be treated. Some can be treated in a general facility, those who have more sever cases need to be treated with speciality case in where they can receive psychosocial intervention. According to Grossbard, Benbow, Nacev and Kiviahan, 2012 the following table lists services available from the Veterans Affair (VA) in patients with SUD: 1) Medically supervised withdrawal management(2) Co-ordinated and intensive substance use treatment required toestablish early remission from SUD, which includes either (a) Intensive Outpatient services >3 hours/day >3 days per week, or (b) Mental health residential rehabilitation treatment program that specializes in SUD services(3) At least 2 empirically supported psychosocial interventions,including motivational enhancement therapy, cognitive behavioraltherapy for relapse prevention, 12-step facilitation counseling,contingency management and SUD-focused behavioral couplescounseling or family therapy.(4) Evidence-based pharmacotherapy for alcohol dependence andpharmacotherapy for opioid dependence with approved,appropriately regulated opioid agonists delivered in either anapproved opioid treatment program or office-based Buprenorphinetreatment.(5) Long-term management for substance use conditions andcoexisting psychiatric and medical conditions.(6) Evidence-based pharmacotherapy and psychosocial interventions for co-occurring mental health conditions There are a few evidence based medications that are also used in the treatment process; acamprostate, naltrex one or disulfiram. “Because of the high prevalence of co-occurring PTSD and SUD and a recommendation from the National Quality Forum to coordinate the care of both SUD and mantel health conditions, the VA increased efforts to better integrate the treatment of SUD and co-occurring psychiatric disorders” (Grossbard, Benbow, Nacev & Kiviahan, 2012). When it person is diagnosed with SUD it is more likely that they also have issues with their family or even some peers, during the recovery process it is important that they come to rest with these issues and get the proper support from family and peers. Having support will be beneficial in a successful recovery, there is also counseling available for the patient and whoever they are having relationship problems with. Although everyone who has an SUD civilian or military personal should receive proper help, the military has is limitations. For example, when a soldier receives care, it is not private, all the soldiers peers and chain of command will know about the issue and it will follow the soldier on paper through out their career. Since there is a zero tolerance policy, if a soldier gets caught they will be discharged from the military and that is not what many soldiers want so they may not seek help for these reasons.
While everyone faces their own issues military or civilian, military members and their families live different lives where they follow everyday laws as well as military laws and standards. The encounter and deal with challenges everyday that most people could not handle like deployments, while some of these issues cause more problems like PTSD and substance abuse there is also many positive factors about the military that many people also do not see for example the pride of serving your country, financial security, the health benefits and a military family that is made up of bonds you create with other soldiers and their families. Families need to be aware of resources that are available for the overall deployment process. War veterans, their peers and family members need to be aware of PTSD symptoms and who is at risk so that they can treated as soon as possible. Any of sign of substance abuse needs to be reported for accurate and fast treatment, even when the soldier does not want to receive help. There are many beneficial resources available to the military and their families, they just need to be educated on what is out there and who to contact.
1.Garske, G. G. (2011). Military-related PTSD: A focus on the symptomatology and treatment approaches. Journal of Rehabilitation,77(4), 31-36. Retrieved from http://search.proquest.com/docview/900728851?accountid=32521
2.Friedman, M. J. (2006). Posttraumatic stress disorder among military returnees from Afghanistan and Iraq. American Journal of Psychiatry, 63(4), 586- 593.
3.Hawkins, E.J. Grossbard, J., Benow, J., Nacev, V., & Kiviahan, D. R. (2012). Evidence- Based Screening, Diagnosis, and Treatmetn of Substance Use Disorders Amoung Veterans and Military Service Personel. Military Medicine , 29- 38.
4.Laser, J. A., & Stephens, P. M. (2011). Working with military families through deployment and beyond. Clinical Social Work Journal, 39(1), 28-38. doi:http://dx.doi.org/10.1007/s10615-010-0310-5