Returning Vets, Families in Need of Interventions: Substance Abuse Emerging as Top Concern

Article excerpt

WASHINGTON -- Combat conditions in Iraq and Afghanistan that foster posttraumatic stress disorder are creating a need for interventions among returning veterans to prevent substance abuse that can emerge as a coping mechanism, according to mental health experts.

Substance abuse, and alcohol in particular, has been closely associated with combat throughout history, said Terence Keane, Ph.D., director of the behavioral science division at the National Center for Posttraumatic Stress Disorder at the VA Boston Healthcare System.

As far back as the era of the Iliad and the Odyssey--both tales of recovery from war--alcohol has been described as both a palliative and a damaging therapy, said Dr. Keane, who spoke at the Association for Medical Education and Research in Substance Abuse annual meeting, which was also sponsored by Brown Medical School.

Combat is a known stressor with about 15% of Vietnam War veterans still experiencing PTSD 30 years after that conflict officially ended. Vietnam veterans account for some 500,000 current PTSD cases in the United States, Dr. Keane said.

Studies have estimated that 15%-30% of veterans of Iraq and Afghanistan have mental health issues, including PTSD. Almost 2 million people have been deployed to those two theaters; there have been more than 4,500 deaths and 35,000 injuries. About 164,000 personnel are currently deployed, according to John Rodolico, Ph.D., of the psychology department at Harvard Medical School, Boston, and a former U.S. marine who spoke at the AMERSA meeting.

Dr. Keane and a colleague, D.H. Barlow, proposed an etiologic model of the many factors that contribute to the condition, which was published as a chapter in Mr. Barlow's book "Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic" (New York: Guilford, 2002).

The model posits that a genetic vulnerability combined with a biologic vulnerability in the face of trauma creates an alarm, which then turns into a kind of permanent alarm in the face of new traumas. The anxious apprehension that an event will happen again leads to adverse coping mechanisms such as drinking and drug taking.

Specific aspects of the Iraq and Afghanistan conflicts and the makeup of the current military personnel are contributing to an increase of PTSD cases, said Dr. Keane and Dr. Rodolico.

Half the military personnel are reservists, which means that they return to the civilian world instead of a military base, where they might be met with more understanding of their combat experiences.

Soldiers in the Iraq and Afghanistan conflicts have multiple tours of duty. …