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Treating Combat Veterans in TCs
From: TCA NEWS 2005 Spring Edition

The wonders of technology and modern medicine can save a veteran’s life. Many of our returning soldiers receive multiple surgeries, and fill their days devoted to rehabilitation as they re-learn to negotiate the simplest tasks of living. Many of our veterans are standing tall on new, high-tech prosthetics, reuniting with their families and lining up a civilian job. Their extraordinary optimism, courage and determination bode well for our veterans’ ability to rebuild their lives.

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 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.

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 which may influence the prevalence of PTSD,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. 

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.

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.