Links between PTSD, substance abuse explored

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Kelly Kennedy – Army Times – January 7,
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At a two-day conference for civilian and military researchers, doctors produced one idea after another for treating and preventing substance abuse in service members with post-traumatic stress disorder.

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As the ideas bounced from person to person, they tried to tie them together in ways that could make sense in a military setting: They must be accessible to many people at once, they must be cheap, they must be proven, and they must be easy.

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And they must be immediate.

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About 20 percent of service members say they’ve had a few drinks and then driven a vehicle, Richard Keller, a researcher for the U.S. Army Battlemind behavioral health program, said at the conference, sponsored by the National Institute on Drug Abuise.

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The drinking, he said, also leads to domestic violence and fights, “particularly with our younger crowd.”

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The military also is seeing 20 suicides per 100,000 people.

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“Every Brigade Combat Team commander can expect one suicide per year,” Keller said.

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Research has shown that alcohol can contribute to suicides because it makes people impulsive.

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Roger Roffman, professor at the school of social work at the University of Washington, talked about an intervention that’s not as invasive as checking into a substance abuse program – in fact, it doesn’t even force a person to change, only to take a look at his or her habits.

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He said the “check-up” isn’t necessarily for people who are in denial about alcohol or other substance abuse, but they are in “profound struggle with themselves,” and they don’t have a desire to change.

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With a check-up, they would go in for an assessment to talk about how much they drink, as well as a physical exam, but without actually seeking treatment. They would go for a second visit to get feedback about the assessment.

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But rather than being told they have a problem, Roffman said they might learn how much everyone else drinks on average in comparison. Roffman said that simple intervention can reduce drinking by about 30 percent without actual treatment because people can change their patterns on their own.

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This concept also has been found effective for other risky behaviors that could flow from the onset of PTSD, including abusive behavior or risky sexual habits.

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Barbara Gerbert, professor in the behavioral sciences dvision at the University of California, San Francisco, talked about her research using a “video doctor.”

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A patient sits at a laptop and answers questions presented by a “doctor” on the screen. Whatever the person answers on the keyboard determines what the “doctor” asks next, and then the video doctor gives the patients feedback based on the answers.

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Gerbert said live doctors may not always have time or even the ability to ask personal questions that can affect a person’s health. However, she said the answers could inform the real doctor about what to do next. Her research showed that people were more likely to answer questions from a “video doctor” than from a real doctor – even if they knew a real doctor would see the answers later.

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“As appointments are getting shorter and shorter, we need something to augment the clinicians,” she said.

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Magdalena Naylor, professor in the department of psychiatry at the University of Vermont College of Medicine, talked about a comparable intervention, only with an automated voice by phone.

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Instead of answering on a computer keyboard, the patient answers yes or no questions on a telephone keypad. This has been found effective for people experiencing major depression, obsessive-compulsive disorder and eating disorders.

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However, Naylor said people needed feedback at least once a month for it to work.

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Keller talked about the Army’s Battlemind behavioral health training program, now in use by all the services as well as the State Department and some foreign militaries.

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Keller said he is also working with sheriffs and police associations about getting the training to reservists returning from Iraq or Afghanistan.
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The Battlemind Web site gets 20,000 hits a day, he said, and a new module is being created for providers, adding to those already in place for service members, families and leaders.

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Military leaders must, he said, promote existing programs, health assessments and better sleep management, especially while deployed, Keller said.

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“We are our own worst people when it comes to getting behavioral health while we’re out there,” he said, referring to a strong stigma attached to those who seek help. “We’re actually recognizing you cannot go into a war environment and not have some price to pay.”

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Army Col. Charles Milliken, chief of the department of behavioral biology at the Walter Reed Army Institute of Research, said the military actually has had complaints from people saying they hear the same questions over and over about mental health issues from their primary care physicians. “They get tired of hearing the same questions every single time,” he said. “ ‘Do they want us to have PTSD?’ ”

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He said programs like the video doctor and the phone technology might make assessments more accessible and more complete.

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