Veterans

In our pursuit to provide information and resources to addictions professionals, IPDA is launching a resource on our website that will feature topic specific forums. The goal of these forums is to provide as much one-stop-shopping as possible for addictions professionals who need the most up-to-date, quality resources on specialized populations.

As a small token of the deep appreciation we feel for our country's veterans, I have chosen to launch our new section in time for Veteran's Day and have our inaugural topic focus on the particular needs of veterans who are being treated for substance use disorders. Early in the year I had the privilege of meeting with some of our veterans who are now in recovery. As they opened up about their experiences, it became clear to me that IPDA could play a vital role in helping addictions professionals better understand the specialized needs of our veterans. With the help of leaders in the field who are experienced in veteran's issues, we have begun to compile the valuable resources listed below. Thank you to all of our veterans! We hope these resources will help the service men and women who are struggling with addiction.

As we go forward, we will continue to add topics and information to this section of our website so that it will become a valuable tool for addictions professionals when they are searching for resources on a specific topic or want to post questions to other professionals on those topics. Stay tuned for other topics soon to come!

Michelle Cleary

NeATTC Veteran's Newsletter

Achilles in Vietnam by Jonathan Shay
Odysseus in America by Jonathan Shay
On Killing by Lt. Col Dave Grossman
On Combat by Lt. Col Dave Grossman
Post Traumatic stress Disorder: A Complete treatment Guide by Aphrodite Matsakis
I Can't Get Over It by Aphrodite Matsaki

Battle Scars: Treating Combat Veterans in the Therapeutic Community

by Carol Davidson, LMSW, CASAC

Walter Reed Army Medical Center is renowned as “the clinical center of gravity” within American military medicine. Their own slogan proudly proclaims “we provide warrior care.” Wounded soldiers like Senior Airman Brian Kolfage, who suffered the loss of his right arm and both legs in a mortar attack at the Balad Army Base in Iraq last year, can count on receiving expert care and rehabilitation, delivered by world class professionals. The courage displayed by our young soldiers is unparalleled, both as warriors, and as veterans who face the immeasurable challenges associated with healing the catastrophic wounds of combat.

The wonders of technology and modern medicine saved Kolfage's life. He has already undergone 16 separate surgeries, and his days now are devoted to rehabilitation as he re-learns to negotiate the simplest tasks of living. Standing tall on his new, high-tech prosthetics, he recently married his hometown sweetheart, and is already lining up a civilian job. His extraordinary, optimism, courage and determination bode well for his ability to rebuild his life.

Post Traumatic Stress Disorder is a war wound that can be as devastating as any physical injury. Psychological battle scars are not readily visible, and there are no reconstructive surgeries or grafts or prosthetics with which to treat them. The complex matrix of prolonged exposure to life and death level stressors and the resulting impact upon physiological, neurochemical, cognitive, emotional, and spiritual systems within human beings often results in a chronic, debilitating condition that generates as much pain, despair, and dysfunction as the most dramatic physical injuries.

No one goes to war and returns completely unscathed. Veterans have always exhibited the PTSD symptoms which were referred to as “battle fatigue” or “shell shock.” The availability of information concerning the mental health status of troops currently deployed in the War on Terror is, however, unprecedented. A landmark study published in the New England Journal of Medicine (July 2004) by researchers Charles Hoge, M.D. et al, concluded that some 15 to 17 percent of combat troops returning from Iraq met the criteria for major depression, generalized anxiety disorder, or PTSD. The Iraqi combat zone contains many significant factors, including urban guerilla warfare, the lack of a clearly identifiable enemy, the prevalence of terrorist activity within “safe” zones, extended tours of duty, adverse physical conditions in the theatre of operations, and unrelenting psychological stress which may influence the prevalence of PTSD.

Like the brilliant clinicians at Walter Reed, military experts in trauma treatment will provide valuable services for our veterans. Nonetheless, we can anticipate that the coming years will produce an influx of combat veterans into various systems within the health and human services field, and particularly into the realm of chemical dependency treatment. The rate of co-morbidity with respect to PTSD and substance abuse is estimated to be as high as 89%, due primarily to efforts to self medicate unmanageable symptoms. The biology of addiction and the biology of trauma within the brain's limbic system both cause neurochemical changes which exacerbate one another and potentially trigger an endlessly repeating cycle of dysfunction.

The Samaritan Village Veterans Program, a small therapeutic community program in Manhattan, has been treating combat veterans since 1996. Clinical lessons learned through experience with veterans of the Korean and Vietnam wars, Grenada, Panama, Lebanon, Somalia, and The Gulf War have coalesced into a unique treatment protocol that draws on best practice from the therapeutic community model, dual diagnosis treatment, and an unmistakable veterans persona that is all its own. Chemical dependency and PTSD are treated simultaneously in a safe, structured, nurturing environment where the natural camaraderie among veterans forms the foundation for the “family” concept of the therapeutic community. The treatment of traumatized veterans involves some specific clinical distinctions. What might be perceived as a cleansing emotional catharsis in a generic treatment setting, for example, might actually be a dangerous abreaction which will trigger self-injurious behavior in the combat veteran. Likewise, the use of confrontation is modified to avoid retraumatization or activation of survival-based aggressive responses. Staff must build upon their expertise in chemical dependency treatment to develop acuity in managing the cycles of hyperarousal and numbing that are characteristic of PTSD.

Skillfully facilitated, the core concepts of the therapeutic community environment provide a safe haven for combat veterans to engage in the grieving, reframing, skills-building, and emotional homecoming that will form the basis for a lifetime of sobriety and the careful construction of a meaningful and satisfying life. In the months and years to come, our returning veterans will look to the chemical dependency treatment field for the hope and healing that they need and deserve. It will be incumbent upon our professional community to continue to develop the knowledge and skills required to fulfill this critical mission.

Carol Davidson is the Program Director of the Veterans Program at Samaritan Village, Inc.

Veteran's and Substance Abuse Discussion Forum