Substance Abuse and Veterans

Substance abuse is an ugly word among some.  But, it is a reality our veterans and military service members are facing.  Many of these veterans don't realize they are abusing the drug(s) just from the fact that they are struggling with PTSD and/or pain.  These situations should be handled delicately and there are many programs that will assist in the recovery process.  The first step is not denying the situation which is easier said than done.  Just remember this...the quote for the day:

"From this day to the ending of the world, but we in it shall be remembered - We few, we happy few, we band of brothers. For he who sheds his blood today with me shall be my brother" - Henry V, William Shakespeare.

...in other words, you are not alone.



First the facts.  They might help put things into perspective:

• Prescription drug abuse doubled inbetween 2002 and 2005.  It tripled in 2005 to 2008.
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• 27% of military service members who returned from a deployment meet the criteria of alcoholism, but it is suspected that these numbers are considerably low since this is only reported numbers.
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• 30% of all suicides that were reported among active duty military were associated with alcohol from 2003 to 2009.
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• More than 45% of non-fatal suicide attempts of military personnel had alcohol involved.
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• The younger the soldier, the more chances of alcohol abuse is occurring.  (My personal note: I believe this is due to the frontal lobe not being fully developed and more susceptible to considerable changes from trauma exposure and/or head trauma).

The VA is very cryptic of what veterans are facing when in comes to substance abuse.  But here is the known facts:

• If you were injured in war, you are more susceptible to substance abuse.
• If you suffered a head injury, you are more susceptible.
• If you suffer from PTSD, you are more susceptible.
• If you are under the age of 30, you are more susceptible.
• If you are a chronic pain patient, you are more susceptible.
• Military recently back from deployment are more susceptible.
• Military previously deployed and facing another deployment are more susceptible.

Basically, it is a vicious cycle and many veterans have experienced this.  The military has also stated that over 50% of soldiers returning from war are participating in binge drinking, it's probably much more than that.  The reality is that this occurs within the military culture as it is....before deployment and after deployment is when it increases dramatically.  My word of advice, just be safe.  I can't tell you how many times I had to stick someone with an IV because they drank way too much, usually right before deployments.

What is hard is for others to understand why substance abuse occurs so much within the military and veteran community.  To drown the pain, memories, etc.  Everyone has a reason.  These are the facts to these "uses":

• Alcohol is a depressant.  
• It makes the memories worse.
• Prolonged, excessive alcohol exposure generates a painful small fiber peripheral neuropathy, the most common neurologic complication associated with alcoholism
• Withdrawals from chronic alcohol exposure will create more pain.
• Alcohol with prescription drugs increases the effects of the drug that can cause the inability to wake up, internal bleeding, and liver failure.
• When alcohol reduces the pain, it has reached an excessive amount that can induce the previous facts listed.

Because of the issues with abusing prescription medication, it has made it nearly impossible to get these drugs within the VA and military.  This can be a problem for those who really need the medication to function daily.  But, I have seen how easily it is to start abusing the medication once you receive them and how often overdoses occur.  For chronic pain patients, here are my tips on how to prevent substance abuse:

• Build a relationship with a local pharmacist.  The VA and the military have been known to prescribe medication that are deadly mixed together.  Talking to your pharmacist about medications prescribed can ease the apprehension of taking multiple medications and confirm that you are getting the adequate care you deserve.
• If the pain medication isn't work, try to contact your doctor about your concerns.  The VA and military providers are sometimes hard to get to so you may want to talk to your pharmacist again, call a nurse on staff, or ask another medical professional.  Worse case scenario, if the pain is unbearable, go to the VA Emergency Room.  They will straighten things out until you can see your provider.  DO NOT take more than prescribed!
• If you begin to build a tolerance to a medication you are taking, talk to your provider.  Physical therapy, another drug, or any other service might be available to help.
• Keep track of what you are taking, when, and how much.  If someone lives with you, ask them to help with this process.  I know asking for help is a horrible feeling sometimes, but it is better than overdosing!
• Try to see an occupational therapist if you haven't already.  Occupational therapist have many great tools, tricks, and advice on how to keep the pain a minimum.  They are all about YOU and helping you live an independent life.  
• Keep track of how many drinks you have.  It's okay to have the occasional drink but you will be surprised how you forget how much you drink within a week.  Keep track of this and reflect if this is "normal".  Having a psychologists or a peer mentor reflect with you will help.  The first step is overcoming denial.

For family members:

• Do not yell, get angry, start the name calling game, or frustrated at your family member.  This causes abuse to happen more frequently and can be deadly.  Be understanding.
• Show your support and concern.  But, don't be too pushy.  Do research and talk to someone who is experienced in substance abuse within veterans. 
• Reflect on why your family member/friend is doing this.  There are plenty of valid reasons.  The key is to understand why they are doing it.  That way you know what they need to get help for.
• Offer your family member/friend to have a guy's/girl's night out with others that deployed with them or other veterans.  They feel comfortable talking about what they went through with others who have "been there and done that".  You would be surprised how much it helps talking to other veterans and just hanging out with them.
• The biggest thing you can do for your veteran is support them.  They are going to have to realize for themselves their problems and how to overcome them. 

If you think really hard, you know why you are abusing prescription drugs or other substances.  This is when the "overcoming denial" is essential.  Realize what the problem is, and seek out help to overcome it.  You are not alone in this.  Find resources, talk to people you trust, and overcome.  One thing that got me through the recovery of my injures at Brooks Army Medical Center was what my father (retired Vietnam veteran) always told me and still does to this day.....Adapt and Overcome.  Repeat it to yourself and it will help. 

Here are the following resources to find help or more information about substance abuse of veterans:

VA Substance Abuse Programs
Wounded Warrior Project - they have many programs that are listed and phone numbers are available to contact different departments for wounded warrior project alumni, family members, or more information to join.  A few different programs they offer is peer support, therapy in certain areas, and information for other resources.
Substance Abuse and Mental Heath Service Administration - Military/Veteran Programs

Other sources are listed on the side of this blog that can further assist in overcoming this situation.  I will post more programs if I come across them.  Comments, questions, cuss words???

Veterans Be Aware of the Privacy Breech On EBenifits

Some of you may have noticed the "down for maintenance" again on eBenifits that has popped it's ugly head again as it does multiple times a month.  This time, it is due to a privacy breech where other veterans were able to see personal information such as social security numbers, bank routing numbers, claims, medical conditions, etc of other veterans.  The news article is very interesting on the details of these findings and what was done to finally shut it down.  Veterans should be on alert for any possible repercussions on this breech and watch for any updates of the investigation.

Short Clip of Civil War Soldier's PTSD

This short clip is from the documentary "Wartorn 1861 - 2010".  It shows the progression of PTSD through the letters and accounts of a soldier during the Civil War. 

Facebook Community Page

Here is the Facebook Community Page.  Feel free to like the page and participate.  If you have any  questions you want to ask anonymously, message me and I will post it. 

Courage To Fight The Battle's Facebook Page

Traumatic Brain Injury (TBI) Facts

I am going to try something new.  I will be posting on my Facebook community page one inspiring quote everyday.  Todays is the following:

"It takes nothing to stand in a crowd. It takes everything to stand alone." - Hans F Hansen

At least I will try to do it everyday with my memory loss which comes to our topic of the day....Traumatic Brain Injury otherwise known as TBI.

TBI occurs with a blunt force trauma to the head, jolt, or any other impact.  Not everyone who has suffered a concussion develops TBI.  It can occur during a car accident, blow to the head, impact sport, explosion, etc.  The severity may range from mild to severe depending on the severity of the concussion and symptoms in the months proceeding.

Mild TBI (MTBI)

• Shows normal brain anatomy during MRIs and CT Scans
• Blasts are a significant cause of many military related MTBI
• Symptoms lasts longer in adults due to the less plasticity of the brain (the ability for the brain to recoup to "back to normal" and "rewire" appropriately).
• Symptoms are apparent for days, weeks, months, or even years.
• Symtoms are listed under the following four categories: physical, cognitive, emotional, and sleep.
• Concussions fall under the category of a brief loss of consciousness or disorientation for up to 30 minutes.

Here are the following symptoms for MTBI....

• Physical
• Headache
• Nausea
• Balance Problems
• Vomiting
• Dizziness
• Visual Problems
• Fatigue
• Sensitivity to light
• Sensitivity to sound
• Numbness/Tingling
• Dazed
• Cognitive
• Feeling foggy
• Feeling slowed down
• Difficulty concentrating
• Memory problems
• Forgetful of recent conversations or information
• Repeats questions
• Answers questions receptively and/or slowly
• Emotional
• Irritability
• Sadness
• More emotional
• Nervous
• Sleep
• Drowsiness
• Sleeping less than usual
• Sleeping more than usual
• Trouble falling asleep

As you can see, MTBI can easily be confused with PTSD with many of the correlating symptoms.  But, military patients MTBI typically are more susceptible to PTSD.  There are different types of testing used both in the civilian sector and during military theater to distinguish if a patient is showing signs of MTBI early.  But it is still more common for TBI to be diagnosed well after the trauma as occurred due to the patient not recognizing the symptoms or the inability for anyone to diagnosis until well after the concussion occurred.

Severe TBI

• Closed - movement of the brain within the skull
• Open - gunshot wound, penetration, etc.
• Loss of consciousness for at least six hours (my personal note: this is debatable due to many different cases that have no involvement of loss of consciousness but significant symptoms so keep that in mind)

Symptoms of Severe TBI

• Physical
• Paralysis
• Partial or complete loss of vision
• Weakness of eye muscles
• Double vision
• Problems judging distance
• Involuntary eye movement
• Intolerance to light
• Decreased or loss of all hearing
• Loss or diminished sense of smell
• Loss or diminished sense of taste
• Ringing in ears
• Increased sensitivity to sounds
• Chronic pain
• Control of bowel and/or bladder
• Loss of stamina
• Appetite changes
• Regulation of body temperature
• Menstrual difficulties
• Difficulties determining limb movement, touch, and temperature
• Slurred speech
• Speaking very fast or very slow
• Problems writing (may be either physical or cognitive)
• Problems speaking and being understood
• Cognitive
• Problems reading
• Difficulty with concentration
• Memory Issues
• Distractibility and attention problems
• Confusion
• Impulsiveness
• Language processing problems
• Not understanding what is being said
• Seizures
• Emotional
• Dependent behaviors
• Depression
• Emotional ability
• Irritability
• Aggression
• Interests and personality changes
• Sleep
• Trouble falling asleep
• Insomnia
• Irregular sleep patterns

I know I jumped from mild to severe TBI symptoms.  I did this purely because moderate TBI does not have a typical lists of symptoms.  It is known to be the "in-between" of mild and severe.  The concussion typically lasts from 20 minutes to 6 hours in cases of moderate TBI.  Keep in mind,  there is not much known about TBI and it is still a developing disorder.  MRIs and CAT scans can determine severe TBI in some cases, but many cases it cannot diagnose TBI.  The brain is a large organ of vessels, nerves, and sensitive to every stimuli it receives.  If a blow to the head is received or even a serious traumatic event has been witnessed, the brain "rewires" itself in some cases to survive.  We do not have the advanced technology to delve deep into the brain to evaluate if there have been changes to the functionality to determine if a person has TBI.  That is why specialists who are familiar with this disorder is essential to diagnose a patient properly and begin the treatment process.  Many specialists are involved with TBI.  The following is a lists I have compiled to explain what each role of each specialists is:

• Psychiatrists - to administer drugs as needed to calm the cognitive symptoms such as depression, mood swings, etc.
• Occupational Therapists - to help an individual learn to live with the disabilities that may have been sustained.  This includes relearning how to handle everyday life for those with memory loss.
• Physical therapists - helps with regaining balance during walking, movement, and any other injuries sustained.
• Speech and language pathologist - improves communication skills and speech
• Neurologists - frequently checks on the cognitive functions of the patients and any changes that may have occurred.
• Psychologists - Works through any emotional issues as well as any cognitive therapy.

This is just a basic lists of typical needs for TBI patients but depending on the symptoms involved, other specialists may be needed.  One cognitive therapy I have found extremely helpful that can be done at home is called Luminosity.com   I have used this for PTSD and TBI cases.  I have yet to have nothing but success with this site.  Some "games" are free but if you want the full experience, they have a few affordable plans.  It is worth a look if you are interested in helping memory problems and cognition.  I will post the link to the side of the blog as well so it will only be a click away.  

For now, here's the link for Luminosity.

I hope this posting has been helping in understanding the facts of TBI.  If you think that you or someone you know suffers with TBI, please schedule an appointment with your primary care provider to get evaluated.  

Suicide Rates Among Veterans

This is not a subject that anyone wants to talk about.  But, the reality is that suicide rates among veterans are spiraling out of control.

According to CNN, one veteran commits suicide every 65 minutes.  That is 22 veterans a day.  Now, it is being brought to light how there are more veterans not being reported under these statistics.  Certain states, 29 to be exact, do not reveal this information such as California and Texas.  It is hard to imagine how many veterans are resorting to suicide thinking about the large populations in just those two states alone.  Homeless, family reporting, deaths due to recklessness, and the lack of formal reporting also contribute to these inaccurate statistics.  Here are some facts this article points out about the seriousness of this issue:
*30% of veterans have thought about committed suicide
*1 out of every five suicides is a veteran.
*Female veteran suicide numbers are the most inaccurate.
*45% of veterans know another veteran of the Iraqi and/or Afghanistan war that attempted suicide.

Another article came out in the past few days and contained even more raw numbers.  TIME reported on the data recently released stating that young veteran suicide rates have increased at 44% in the past 2 years.  Female veterans spiked to 11% during the same 2 years.  These statistics have the VA suicide prevention teams on alert, especially when the numbers are climbing at an alarming rate...well over the number of military members who have died in combat.

What changes will these statistics bring?  We will only know when the time comes.  Which means hurry up and wait...even with these staggering numbers.  Posted on the side of the blog is some of the many programs that are available to veterans and family members, including the Vet Crisis line.  They are continuously available for any calls (and even chat or text message) from veterans thinking about committing suicide or family concerned about their loved ones.  Please do not hesitate using that free resource.  From personal experience, I wish the service members and veterans I knew that committed suicide made a phone call to talk to someone before making their decision to end their life.  I am also posting a free resource for mental healthcare for veterans and families that served after 9/11.  Please share any resource information you may have experienced or have knowledge of.  It may help another veteran or family member in their search to fight this battle on the homefront.

My personal note...it angers me that with over 8,000 veterans committing suicide a year nothing is being done.  You survive battle, but no one will help you survive when you get home.  The battle continues even on the homefront.  Thoughts, comments, cuss words?

CNN Investigations Report: Hospital Delays Are Killing America's War Veterans

http://www.cnn.com/2013/11/19/health/veterans-dying-health-care-delays/

This does not surprise me. Personally, I have recently fought for the past year for seeing a doctor about problems with my left eye since my last concussion. Two weeks ago, I started losing sight in that eye and the sensitivity to light was excruciating. I went to my clinic, called multiple times, and went to the regional VA office. Nothing was done. I ended up having to pay out of pocket for an eye specialist referred to me through a civilian emergency room and a neurologist. Not to mention multiple testing only to tell me that it is going to get worse and there is no treatment available. But, even without the daunting news of possible complete blindness, I cannot be more thankful for such caring physicians who are persistent. They even contacted the VA for me and was told that my vision loss wasn't "their problem". What are your experiences with VA healthcare? I know all of us have multiple stories and advice we can give to others how to handle these situations. What changes do you think would make your experience better? Let me know what you think of this news report.

What Is PTSD?

This may seem redundant to some people but I want to go over the basic details of what PTSD (Post-Traummatic Stress Disorder) is.  It is important to know what it is according to medical diagnosis instead of by word of mouth.  PTSD is diagnosed by a psychologist or psychiatrist.  If a primary care provider suspects PTSD, he or she should give a referral to a mental health care provider.  How PTSD is diagnosed is using the Diagnostics and Statistics Manual, more commonly referred as the DSM-5.  This manual is updated approximately every ten years.  The fifth volume, the most current, was published in 2013.  In this manual, PTSD has added additional criteria for being diagnosed with this disorder.  Here is the breakdown:

Criteria A: Stessor

The person was exposed to a trauma which may include abuse, violence, death, life threatening situation, and/or serious injury.  At least one of the following is required:

1. Direct exposure

2. Witnessing, in person.

3. Indirectly, by learning a close relative or friend was exposed to a trauma.  If the event involved an actual or threatened death, it must have been violent or accidental.

4. Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies, or pictures.


Criteria B: Intrusion Symptoms

The traumatic event is re-experienced persistently.  One of the following is required:

1. Recurrent, intrusive, and involuntary memories.

2. Traumatic nightmares.

3. Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness.   (my personal note: this symptom is also associated with feeling like in a "fog" or feeling "cloudy headed".  Memory loss is also associated with this symptom)

4. Intense and/or prolong distress after exposure to traumatic reminders (my personal note: this is often associated with "triggers".  An example of this would be the backfire of a vehicle, fireworks, movies, conversations, etc.  Anything associated with the trauma.).

5. Marked physiological reactivity after the exposure of a trauma related stimuli (my personal note: The following are examples of this symptom: hitting the ground "cover", flinching, shaking, etc.)


Criteria C: Avoidance

Persistent effortful avoidance of distressing trauma-related stimuli after the event.  One of the following is required:

1. Trauma related thoughts or feelings.

2. Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).

(My personal note: Criteria C is listed more complicated than it really is.  If the person is avoiding anything that reminds them of the traumatic even or even if they think it may remind them, the person meets the requirement.)


Criteria D: Negative Alterations in Cognitions and Mood

Negative alterations in cognitions and mood that began or worsened after the traumatic event.  Two of the following are required:

1. Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol, or drugs).

2. Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., "I am bad," "The world is completely dangerous").

3. Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences.

4. Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt, or shame).

5. Markedly diminished interest in (pre-traumatic) significant activities.

6. Feeling alienated from others (e.g., detachment or estrangement).

7. Constricted affect: persistent inability to experience positive emotions.


Criteria E: Alterations in Arousal and Reactivity

Trauma related alterations in arousal and reactivity that began or worsened after the traumatic event.  Two of the following are required:

1. Irritability or aggressive behavior.

2. Self-destructive or reckless behavior.

3. Hypervigilance 

4. Exaggerated startled response (my personal note: this goes hand in hand with the Criteria B:Intrusive Symptoms, number 4.)

5. Problems with concentration.

6. Sleep disturbances (my personal note: this also goes hand in hand with Criteria B: Intrusive Symptoms, number 2.  This can also be associated with Criteria C: Avoidance if the person has insomnia due to avoiding nightmares).


Criteria F: Duration

Persistence of symptoms in Criteria B, C, D, and E for more than one month.  (my personal note: There is no time frame when the symptoms might present themselves.  It may be immediately after the trauma or decades afterward.)


Criteria G: Functional Significance

Significant symptom-related distress or functional impairment (e.g., social, occupational). (my personal note: This can also include the inability to socially interact with friends, impacting family functioning, impact at work, inability to handle crowds, etc.  This portion is typically hard for the person with PTSD to recognize since it becomes routine to function this way).


Criteria H: Exclusion 

Disturbance is not due to medications, substance abuse, or any other illness.



Dissociative Symptoms:

In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:

1. Depersonalization: experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or one were in a dream).
2. Derealization: experience of unreality, distance, or distortion (e.g., "things are not real").

Delayed Expression:
Full diagnosis is not met until at least six months after the trauma, although onset of symptoms may appear immediately.


There are other types of PTSD but they have not been accepted into the DSM-V.  More on that soon....  Please comment with any questions you may have or comments.

Intro To This Blog

I created this blog to help veterans, spouses, military, etc in understanding PTSD, Veteran Affairs, TBI, and any other topic that someone may want information on.  Along with understanding comes the reality of how serious the situation has become for veterans to receive the proper healthcare they deserve.  I am not a pompous jerk that claims to know what PTSD is and never have experienced it.  Nor am I just someone who wants to talk about a random subject they don't know to gain a feeling of importance.  I am a disabled veteran, Wounded Warrior Project Alumni, chronic pain patient diagnosed with PTSD, a veteran undergoing testing for TBI, prior combat medic, and a psychology student because of all these experiences.  I hate labels but that is the best way to explain how I "get it".  This blog is not about me...it's about you.  So, whatever you may want me enlighten on in a future posting, email me.  If you need to talk, email.  If you want more resources, contact me too.  I will make another posting later today but I will leave you to this....Never give up.  Have the courage to fight this battle at the homefront.