Rodney JS Deaton MD JD Clinical Director Substance Abuse Treatment Section Richard L Roudebush VA Medical Center Associate Professor of Clinical Psychiatry Indiana University School of Medicine ID: 709991
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Combat Trauma, Substance Dependence, and Treatment Providers: Understanding What We’ll Never Fully Understand
Rodney J.S. Deaton, MD, JD
Clinical Director, Substance Abuse Treatment Section, Richard L
Roudebush
VA Medical Center
Associate Professor of Clinical Psychiatry, Indiana University School of MedicineSlide2
The National Institute on Drug Abuse (NIDA)
“Prescription drug abuse doubled among US military personnel from 2002 to 2005 and almost tripled from 2005 to 2008.”
“Army soldiers screened 3 to 4 months after returning from deployment to Iraq showed that 27 percent met criteria for alcohol abuse and were at increased risk for related harmful behaviors (e.g., drinking and driving, using illicit drugs).”
“Drug or alcohol abuse . . . was involved in 30 percent of the Army’s suicide deaths from 2003 to 2009 and in more than 45 percent of non-fatal suicide attempts from 2005 to 2009.”Slide3
Goals
Workable Model for to Use in Individual and Group Settings
A “Provocative” EncouragementSlide4
What Doesn’t Work
“Silo” Treatment
“Business as Usual” Trauma Treatment (i.e., Combat Trauma = Other Trauma)Slide5
Seeking Safety
Najavits
, Lisa M.
Seeking Safety: A Treatment Manual for PTSD and Substance Abuse
Developing Specific Skills of Emotional Regulation
So That
More Trauma-Focused Work Can ProceedSlide6
Judith Herman’s Model of Trauma Treatment
Phase of Safety
Phase of Mourning
Phase of Re-ConnectionSlide7
The Advantage
From the beginning
, the veteran is urged to see combat PTSD and substance use disorders as inextricably linkedSlide8
The Recurring Message
You
nev
er
n
eed to use
s
ubstances to cope. There is
always
a better (in the long run) alternativeSlide9
Description of Course
Twenty-Four Related, Yet Independent Units
Focus on Safety (Strength? Principles?)
Strong
F
ocus on Case (Self) ManagementSlide10
CAVEATSSlide11
Harm Reduction:
Abstinence as Goal,
Not
as Pre-
RequisiteSlide12
Relapse = Trigger for More Focused Interventions,
NOT
Bump-Up of Care LevelSlide13
“Cookbook Therapy”--and Safety from Emotional Overload
(for
both
veteran and clinician)Slide14
Summary
Self-Medication Meets Biological SubstrateSlide15
Issues with Combat Trauma/Military Culture
Do
YOU
Have What It Takes?Slide16
Types of Trauma
Acts of God
Acts of Others
Acts of SelfSlide17
Volunteers in Time of War:
Honor and IntensitySlide18
Love, Rage—and Horrific Excitement
Dare
You
Look Inward?Slide19
Personality and Personality “Disorders”
Entitlement and the Ubiquity of Shame
“Posttraumatic Identity”Slide20
“Readiness”
Can Your Prescribers “Hack It”?
Are You Physically Ready?
Are You Worthy of Respect? or the Art of Managing the HystericalSlide21
On Street Hustlers, Rebellious Rakes, and Good-Old Country BoysSlide22
Further Resources
www.seekingsafety.org
Van Winkle, Clint.
Soft Spots: A Marine’s Memoir of Combat and Post Traumatic Stress
Disorder
Johnson, James D.
Combat Trauma: A Personal Look at Long-Term
Consequences
Shay, Jonathan.
Achilles in Vietnam.