PTSD, Addiction Complicate Treatment Options for Veterans

Combat veterans with post-traumatic stress disorder (PTSD) aren’t just haunted by memories of their wartime experiences—they have “a new brain” that complicates treatment. This challenge will be examined during Course 2, “Combat Trauma and Addiction,” from 10:30 am to 12:30 pm today in the Waldorf Room on the third floor of the Hilton Chicago.

“Severe trauma can change your brain like addictions can,” said Larry Ashley, EdS, LCADC, CPGC, who will present the course. “That’s why addictions and PTSD together are so significant. Each one by itself can cause permanent brain change. When they’re together, that heightens the change.”

Dr. Ashley is Addictions Specialist and Mental Health Coordinator at the Department of Educational and Clinical Studies, and Clinical Associate Professor of Addiction Medicine, Department of Internal Medicine, University of Nevada School of Medicine.

PTSD is characterized by three symptom sets—hypervigilance, re-experiencing, and numbing and avoidance—that make it difficult for veterans to readjust to civilian life. Between 35 percent and 75 percent of veterans with PTSD are reported to abuse drugs and alcohol. Combat trauma also can lead to behavioral disorders such as problem gambling, hypersexual behavior, and eating disorders, he said.

Veterans exhibiting hypervigilance startle easily, may have trouble sleeping, and might not trust people.

Re-experiencing isn’t just a bad memory. “You’re there,” Dr. Ashley said. “Your brain has put something back in motion.”

A Vietnam veteran reported that diesel fuel was one of his “triggers” when he came home from war. “I can remember in the summer, driving by a gas station with the windows down, smelling the fuel from the gas station, and that put me right back into Vietnam, right out of the blue,” one veteran told Dr. Ashley.

Combat veterans who experience numbing and avoidance do so as a defense mechanism to block out what they saw during war, but the effects can spill over into daily life, he said, adding.

Veterans have abused substances to deal with the horrors of combat since at least the Civil War, when troops developed morphine addictions. While mental health treatment doesn’t carry the same taboo today as it did after earlier wars, it still can be difficult to successfully treat some veterans. Those veterans “don’t trust the system” and won’t go to the Department of Veterans Affairs for help, Dr. Ashley said, while those still serving in the military may view treatment as a career “kiss of death.”

Medications and counseling can be used to treat veterans with addictions, but Dr. Ashley said his preferred treatment is exposure-based cognitive behavioral therapy.

“We go back, look at some of the events that led up to what’s happening today,” he said. “I believe we have to deal with the past in order to go forward.”