Post Traumatic Stress Disorder and Substance Abuse Counseling - Research Paper Example

Post Traumatic Stress Disorder and Substance Abuse Counseling Joseph Williams Liberty HSCO 509 Military personnel, having toconfront various combat situations involving death, injury and mutilation to human body, constantly undergo stress in their lives. Even on their return from active duty, memories of these traumatic events keep haunting them and, as a result, their stress levels persist. Thus, post-traumatic stress disorder (PTSD) remains a common problem among the combatant military personnel even after their retirement. Most of these military personnel do not have adequate coping skills to overcome the negative impacts of the traumatic events they have undergone while in active combatant service. Thus, to erase the haunting memories and to seek solace from the constant stress, they turn to alcohol, drugs or other substance abuse. This paper seeks to evaluate the problem of PTSD among combatant military personnel and to gain an understanding of how it affects their post service life. It will also investigate the negative consequences of this syndrome, including the higher propensity towards substance abuse and addiction as a means of escape in lieu of healthy coping. The paper, further, will explore various aspects relating to treatment of such military personnel who suffer from PTSD. In addition, it will elaborate on various interventions, with a specific focus on tactics to be used in counseling, to inculcate better coping skills in affected individuals. Post Traumatic Stress Disorder and Substance Abuse Counseling Introduction: Psychological distress can occur in people after they witness traumatic events such as accidents, natural calamities, terrorist attacks and plane crashes in which death or physical injury is caused. Such incidents may have long lasting impact on their mental status and their memories of the event may cause them trauma that sometimes last throughout their lives. Death of a close relative or injury or physical abuse that a person sustain can also cause trauma. On the other hand, while physical injury is often a causative element of trauma, it is not essential for its occurrence. Prolonged psychological abuse or having to live in extreme poverty conditions can also cause trauma. Post Traumatic Stress Disorder (PTSD) can be perceived as an “anxiety disorder” and it manifests in terms of characteristic symptoms as a consequence of a traumatic event and patients constantly attempt to “avoid triggers to revive” memories of such events (Vitzthum et al, 2009, p.1). Evidence suggests that while almost all humans sustain traumas in some or the other stage of their lives, only “8%” of those who suffer trauma “develop PTSD” (p.2). A person’s vulnerability to PTSD depends usually on the interaction of his or her “mental and biological predispositions” and early childhood traumatic experiences as well as the severity of the traumatic event (p.2). Symptoms of the problem include “pessimistic cognitive schemas” and constant and uncontrolled recollections of the event as well as a tendency to avoid triggers of the traumatic incident (p.2). The patients may also manifest enhanced levels of arousal, anger or agitation, and they usually tend to rely on “substance abuse” to overcome the problems related to their mental status (p.2). Military personnel on combat duty remain exposed to traumatic events, and they are most likely to have the problem of PTSD even after they return from the scene of action and they remain vulnerable to substance abuse to escape the haunting memories. PTSD in Combatant Military Personnel: Military personnel, by virtue of the nature of their duties, often remain exposed to risks of traumatic events such as death, physical injuries, rape and torture in the field of their vocation. The constant exposure to these events may cause extreme mental agony for them, which, over a period of time, may contribute to the development of PTSD in them. The report of a study sponsored by the Department of Defense identifies PTSD and the associated medical problems as “daunting” and finds that “all aspects” of the military personnel’s life are affected by this mental health issue (Treatment for Post Traumatic Disorder, 2012, p.365). It is also relevant that in most cases, military personnel stay away from their families and often they are unable to meet the family commitments. This can cause frustration and mental stress in them, which negatively impacts their psyche. Many studies suggest that action in military deployment areas has a direct correlation to psychological status and the mental problem in soldiers “increases after deployment” (Brancu et al, 2011, p.54). They further find that “10% to 25%” of military personnel have the problem of PTSD, which is significantly greater than the prevalence among the civilian population (p.54). PTSD in the recent days has become the “most common psychiatric condition” under which the American military veterans are seeking financial assistance from the government (p.78). Evidence suggests that military personnel that are engaged in peace keeping operations (PKOs) often encounter atrocities or become “targets of hostility” of the same people whom they protect (p.79). This can cause frustration to them and the resultant psychological stress may contribute to problems such as PTSD. Research studies from the US find that “15-17%” of US military personnel deployed on active operational duties in Iraq or Afghanistan have manifested symptoms of either PTSD or acute stress and both these conditions have been identified as factors that impair “occupational effectiveness” (Frappel-Cooke, 2010, p.645). On the other hand, evidence emerging from the research studies in the UK indicates a substantially lower prevalence of PTSD at “4-7%” in their military personnel deployed on active duty in “conflict zones” (p.645). Thus, the study contends that while traumatic events act as causatives for PTSD, other factors such as prior instances of psychological problems as well as “repeated traumatic exposures” also enhances the risk for the development of the problem (p.645). In a study conducted by Greenberg et al (2008), involving 1245 military personnel who have been deployed on various missions between 1991 and 2000, the researchers conclude that aspects of “age or gender” do not influence one’s vulnerability to PTSD (p.81). On the other hand, they find that married personnel as well as those who serve as officers do report “less PTSD symptoms” and also that people who manifest more symptoms of PTSD usually leave the force (p.81). Once they return from active duty and enter civilian life, it will compound their problems because they may be feeling lonely and unable to mix freely with the civilian population. Vitzthum et al (2009) classify the traumatic events into two categories such as “Type I Traumata,” which encompasses a single instance, and “Type II Traumata” including continuous or repetitive incidents (p.1). PTSD develops when the traumatic event dilutes the person’s ability to cope with the emotions that stem out of witnessing the incident, which may include actual death of another individual or any “serious physical injury, rape” or becoming a hostage being experienced by the person (p.1). The authors further contend that conflicts in combat zones often cause “significant prolonged mental illness” to the serving personnel in various armed forces as they have to constantly deal with traumatic situations (p.2). All these circumstances can cause severe mental stress to the people involved and sometimes their mental capabilities to sustain the shock of the event may snap, which causes the psychological problems. Similarly, in Type II cases, even the tougher military personnel who have had to witness traumatic events continually during operations in the field may also lose their ability to withstand the shock and thus manifest the symptoms of PTSD. In this context, it becomes relevant that memories of traumatic events may haunt a person again and again in his or her life, which makes them re-live the experience and this can constitute high stress in them. Substance Abuse in Military Personnel as a Result of PTSD: It is a commonly accepted notion that people who undergo mental distress usually turn to drug, alcohol or other substance use to escape from their problems. In this context, a study by Pare (2011) finds that persons suffering from PTSD have “80% higher risk” of exposure to other mental health issues including substance abuse (p.5). The study further endorses that PTSD is more likely to occur in retired war veterans than in serving military personnel. Since the veterans may not usually have any engagement, they are more likely to indulge in drinking or substance abuse to escape their memories about the traumatic events they encountered while in active military service. Williamson and Mulhall (2009) contend that PTSD and other mental health problems can encourage substance abuse in military personnel and such people often do not get the “treatment they need” (p.9). The authors further point to evidence, which suggests that out of the 12% cases of alcohol abuse among military personnel, only 0.2% have been “referred to treatment” (p.9). This suggests that a majority of the military personnel who have the problem of PTSD and the associated issue of drug or substance abuse do not receive any treatment. Thus, these personnel will continue to seek solace in increased amount of drinking or drug components and this will increase their mental problem. Drug dependence will naturally increase when these veteran return from active duty and remain idle during their retired life without having to do any specific work, and often haunted by the memories of the traumas. The US military practices a policy of “zero tolerance for drug use” and, therefore, most of the military personnel desist from taking any drugs as has been evidenced during the past two decades (Substance Abuse in Military, 2013, p.1). The stringent drug policies in the military has apparently contributed to the reduction in the use of drugs and the rate of drug use in the force is only “2.3 percent” as compared to the civilian rate of “12 percent” (p.1). However, obviously, the drug consuming population in the military may be those who have served in combat zones and suffered PTSD. Personnel who have served time on combat zones have to undergo stress at a higher level than that of the personnel serving on peace zones. Thus, combatants are more likely to run the risk of PTSD and substance abuse than those serving in non-combatant zones. On the other hand, most of the military personnel consider heavy drinking as a “right of passage” or as a part of their professional culture and when confronted with stress, they may indulge in excessive drinking as a route of escape (Eggleston et al, 2009, p.54). In this context, it becomes relevant that personnel on combatant duty become stressed due to the fact that they remain exposed to traumatic events such as explosions, deaths, rapes and physical injuries. This will lead them to turn to alcohol abuse for escaping the traumatic memories. Current Intervention Methods: Military personnel, who are considered as strong and tough than the general population, need to maintain the cutting edge of their physical and mental competence to be effective in their role of protecting the security of the nation. Similarly, mental health and happiness are inevitable conditions for individuals to perform their duties well. Thus, problems such a PTSD in military personnel need to be recognized and addressed immediately with suitable means of intervention so that they can function efficiently in their assigned roles. Studies suggest that addressing the psychological problems in military personnel is highly significant to preserve their “dignity and career” and they recommend psycho or stress education as an effective strategy of secondary intervention for redressing the problem in combatant military personnel (Greenberg et al, 2009, p.20). This strategy aims at improving the affected person’s resilience by either preventing or mitigating the “effects of exposure” to traumatic events and this method has been endorsed as productive by institutions such as the Royal College of Psychiatrists in the UK as well as World Health Organization (p.20). However, it transpires that unless the military personnel who receive such psychological briefings perceive them “as being useful” these exercises cannot fetch the intended benefits (p.23). Similarly, Siddique (2013) suggests that some of the current methods of intervention such as psychological debriefings are “neither overly beneficial nor harmful” (p.118). The author further argues that Trauma-Focused Cognitive Behavioral Therapy (TFCBT) will be an effective “first-line treatment” for the patients suffering from PTSD or acute stress disorder (ASD) (p.118). On the other hand, a possibility exists that soldiers deployed in combat zones may perceive threat to their lives even if there is not real threat to their lives in the forward area where they remain on duty. Such risk perceptions may also increase the level of stress and the resultant problems including PTSD. It however transpires that present intervention strategies do not cater for solutions to address this problem. Researchers such as Frappel-Cooke et al (2010) find that the Trauma Risk Management (TRiM) can “benefit psychological health” of personnel deployed in conflict zones (p.649). The authors further argue that social support from peers and family can alleviate the negative impacts of PTSD but point to other research evidence, which contend that social support “acts as a buffer” for the development of PTSD (p.645). The study further emphasizes on a hesitation on the part of military personnel to accept professional help, while they are more comfortable seek the support of informal sources such as peers. Thus, the authors support the view that trained peers will find better acceptance among affected military personnel and hence, offering support through this system will be more effective. In conclusion to their investigation, they endorse that military personnel, who receive active social support have been found to have “lower levels” of mental distress (p.649). They further conclude that a proper social support system, whether it is incorporated along with TRiM or otherwise, will have beneficial outcomes for military personnel deployed in “high-threat environments” (p.649). The study by Vitzthum et al also points to the hesitation on the part of soldiers to seek help when they have mental problems, due to the fear of being “stigmatized” and it (Vitzthum et al, 2009, p.3). The authors further refer to other studies, which find that US soldiers that served in Iraq and Afghanistan have demonstrated hesitation to seek help for psychological problem because of their fear of stigmatization and “endangering their careers” (p.3). This study, while agreeing to the validity of peer and family support, further postulates virtual therapy, which encompasses “computer animated scenarios” that are set in the zones of conflict, as an effective preventive and therapeutic measure (p.3). Strategies for Intervention Including Counseling: Research evidence suggests that many of the current intervention strategies including preoperational stress debriefings lack efficacy and researchers have been unable to draw “firm conclusions” especially in the context of reducing mental distress in personnel serving in armed forces (Interventions, 2013, p.90). With the presence of PTSD as a rampant problem in military personnel, it becomes necessary to develop effective intervention strategies so that the mental health of the sentinels of the nation can be salvaged. The research study by Greenberg et al (2011) proposes TRiM as an effective strategy for addressing the issue and the researchers argue that it can be highly beneficial “method of supplementing” informal group support systems that exist in many organizations, whose members to not favor enlisting of professional services (p.188). In this context, it becomes relevant that many of the earlier studies considered during this research have pointed to a hesitation on the part of military personnel to enlist the services of professional healthcare workers and that they rather feel comfortable with informal sources such as family members and peers. Besides, the stigma attached to mental health problems will make them hesitant to seek treatment. On the other hand, they also harbor an apprehension that mental health problems may affect their career prospects as individuals with such problems may not be usually considered for promotions and career advancement. Thus preempts them from enlisting professional help to address their mental health problems. However, if their colleagues or other relatives are the ones who counsel or help them overcome the problem, they are more likely to be more comfortable with the treatment. Thus, TRiM can be highly useful to people who rather prefer not to work with professional healthcare personnel. On the other hand, the UK armed forces use the decompression process, whereby troops that return from active deployment go through unwinding through the “post-operational stress management” system (Jones et al, 2011, p.102). The aforesaid study, conducted among 11304 personnel, finds that TRiM has been also found useful in “stigma reduction” (p.104). Similarly, the study finds that Third Location Decompression (TLD) can be used as an effective method of intervention if integrated as “part of a natural homecoming process” (p.106). From the literature reviewed during the course of this study, it transpires that stigmatization and hesitation to seek help stem chiefly due to the lack of awareness and education on the part of military personnel about the problem. Thus, their counseling on return from the zone of conflict must focus on the concept of educating them about the seriousness of the issue and also about the options available for treatment. Therefore, the future strategies need to focus on resolving these concerns so that appropriate treatment can be extended to military personnel based on their needs. In this context, it becomes relevant that the study by Hunt et al (2013) further confirm the validity of TRiM, which is “correctly focused” on the military personnel with the “highest levels of exposure” to traumatic events (p.554). Thus, future strategies based on TRiM and adequate counseling to the returning military personnel can bring positive outcomes for them. Some studies suggest that “internet and teleconferencing based interventions” have high potential in the treatment of PTSD and if coupled with pharmacological supplements such as D-cyclocerine, the problem shall be contained to a great extent (Cukor et al, 2009, p.1). Similarly, they also contend that exposure therapy, in conjunction with “increasing distress tolerance,” can be effective in the treatment of the problem. On the other hand, authors such as McLay et al (2011) propose virtual reality (VR) based therapy, which incorporates prolonged exposure to simulated situations to desensitize the military personnel, to “more likely improve” their mental status (p.228). It also transpires that in some cases, military personnel in the forward areas of actively wrongly harbor the notion of threat to their lives even in if there is no such real threats. Such wrong perceptions increase the element of stress in them, which will contribute to mental health issues such as PTSD. This needs to be addressed either through the process of debriefing or counseling to the personnel before, during and after deployment. On the other hand, military veterans after their return from service usually spend time without a job and living on their pension or other financial assistance. Such individuals, who often remain jobless, usually resort to drinking or substance abuse as a pastime or to escape their mental anguish due to the recollection of the memories of the traumatic events they may have endured during their active duty. Such individuals also do not mix freely with the mainstream civilian population as they may not find common interests among these groups. Thus, overall, they lead a secluded life and are often cut off from the community, which further complicates their social life and make them turn to alcohol or drug abuse as a means of escape from their anguish. Therefore, strategies for addressing the mental health problems in military veterans, including PTSD, need to consider the social life of these personnel. Similarly, the mental health status as well as social support system of individual war veterans differs considerably and, therefore, a uniform intervention may not be appropriate to all. Thus, the interventions strategies must take into account the individual circumstances of each veteran and be designed according to the needs of their unique cases. The preventive measures may also consider group counseling, family and social support etc, which rather focus on providing a conducive environment for the veterans, so that their mental concerns and anguish can be alleviated to a reasonable extent. Conclusion: Evidence emerging from the literature reviewed during the course of this study reveals that PTSD is a major mental health problem not only in serving military personnel but also in retired veterans. While serving military personnel remain at the risk of experiencing traumatic events in the conflict zones, retired veteran remain often experience the recollection of memories of the traumatic events they encountered during their active duty. Most of them, to escape the haunting memories in the conflict zone, turn to alcohol or other substance abuse. This trend may especially be rampantly present in war veterans than in serving personnel. Most of the current intervention strategies have been found useful in addressing the problem of PTSD and other types of mental distress in military personnel. However, these intervention methods are highly generic and are being applied uniformly among all the populations rather designing strategies that can address the unique needs of individual cases. On the other hand, many studies identify a hesitation on the part of military personnel to seek help due to fear of stigmatization or impediments to career prospects. However, methods like TRiM and TLD have been found to be effective strategies for those who are willing to take treatment and to develop coping skills. Many studies also point to the fact that lack of awareness and education acts as barriers in the treatment of the problem. Similarly, evidence also points to a lack of proper social and family support to the military veterans, who often feel secluded from the main stream society. Proper and regular counseling can be highly useful in creating awareness in the military personnel and such sessions will encourage them to seek treatment as well as help nourishing appropriate coping skills in them. Therefore, the future strategies need to focus on extending proper awareness and education in the serving personnel as well as retired veterans. Similarly, integrating TRiM and TLD into the management of PTSD along with counseling using peer group or family members will also can be more productive in treating the problem. 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