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Veterans' Health: Beyond PTSD and Traumatic Brain Injury

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Over the past decade, the Department of Veterans Affairs and Department of Defense have expanded their efforts to meet the mental health needs of our service men and women. In particular, a better understanding of post-traumatic stress and traumatic brain injury (TBI) has led to major changes in how the healthcare community addresses veterans' needs.

But the intense focus on PTSD and brain injuries can mask deeper, more complex problems. Beyond the physical and psychological trauma lies an inextricably linked group of behavioral and physical health issues -- drug and alcohol addiction, chronic pain and depressive disorders. They're all serious medical conditions, and too often they're overlooked or untreated.

Alcohol abuse is the most prevalent problem among U.S. military personnel and one that poses a significant health risk, according to the National Institute on Drug Abuse (NIDA). Twenty-seven percent of Army soldiers screened three to four months after returning from deployment in Iraq met criteria for alcohol abuse, according to an April 2011 study. Alcohol abuse puts these vets at increased risk for other harmful behaviors such as drunk driving, drug use and suicide.

Veterans often self-medicate with alcohol or drugs to push down the painful memories, fight insomnia and dull the physical pain. Those serving in Iraq and Afghanistan also face multiple deployments and less "dwell" time at home to recuperate and reconnect with their communities and families.

Today, chronic pain is a leading cause of disability among military personnel. While TBI and concussive brain injuries capture today's headlines, other combat wounds and "wear-and-tear" injuries from heavy equipment and grueling patrols still account for a majority of disability cases. That in turn has sparked a wave of prescription-medication addiction among vets -- the unintended consequence of modern medicine's reliance on powerful narcotics to manage both acute and chronic pain.

The military has slowly begun to recognize the value of alternative, non-narcotic therapies for pain management. A May 2010 report by the Pain Management Task Force makes numerous recommendations for alternative therapies in conjunction with pain physicians such as acupuncture, chiropractic care, massage and occupational therapy. Realistically, though, all of these therapies require long-term commitment and support -- hence the beckoning "quick fix" of the prescription pad.

Undiagnosed and untreated PTSD and TBI are in many cases accompanied by depressive disorders, which can be as crippling as the physical wounds a veteran may bear. Depression, moodiness, lethargy and sleeplessness all play a part in these conditions. Without treatment, many veterans self-medicate to seek the mental peace and quiet they find so elusive.

The government and VA have begun to address these complex issues. Under General Peter W. Chiarelli, the Army has made significant strides in preventive measures, programs and support for our troops and how best to address brain injuries. A recent study, "Army 2020: Generating Health and Discipline in the Force Ahead of the Strategic Reset Report 2012," lays out a comprehensive analysis of the behavioral and physical health needs of our troops.

But like PTSD and TBI, depression and addiction must be treated as serious medical conditions, not bad choices or moral weaknesses. Veterans Healing Initiative has been working to expand the number of dual-diagnosis programs specifically dedicated to veterans' care.

VHI identifies programs that have excellent clinical addiction and trauma programs, and works with them to create veteran treatment tracks. These grants from VHI help to provide treatment for veterans who lack VA benefits or would otherwise go without care. We know these treatment models can be highly effective and save lives. However, comprehensive treatment can be expensive, and often requires long-term residential care.

Countless veterans have suffered for decades with PTSD, pain and addiction, afraid to ask for help. Whether they served in Vietnam, Desert Storm or Iraq, these veterans need compassion and comprehensive treatment for these serious wounds. There's no quick fix, but there is help. And hope.

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