The addicted wounded warrior needs your help. You have the knowledge, the interest, and the skill set needed to provide clinical care for former military personnel battling co-occurring post-traumatic stress disorder (PTSD) and addiction.
Whether you are developing a specialized program for the addicted veteran with co-occurring addiction and PTSD or are interested in being a resource to individuals in your established program, there are a few factors to keep in mind. First, you want to be sure that your program and counseling staff have the skills, experience and desire to work with this population. Soldier survivors need to have their story heard. If you or your staff is unable to sit with soldiers and bear witness to their trauma, do not encourage such referrals to your program.
If you are set clinically, then the next step involves getting connected and networking with the community. Let other detox and treatment centers in your area know of your expertise. Include emergency rooms, police departments and crisis intervention teams in your outreach. Contact local veteran’s resource centers and introduce yourself. Be sure that your agency can take Tricare as a payment source, as many retired and active military and family members are covered under Tricare.
I have had addiction counselors confide in me that they are initially reluctant in trying to help the wounded warrior. Their own solemn respect and honor for those who served our country leads them to feel ill-equipped to assist them in getting clean and sober. Yet with alcohol and drug abuse rates running at 80% according to the Army Times, addiction counselors serving members of the military are needed now more than ever.
I assure you that these servicemen and women have survived far worse than any mistakes you or I might make. They are not that fragile. They are warriors.
Research has been limited to what is the most effective treatment for PTSD for the wounded warrior. The most cutting-edge PTSD treatment is not designed for those veterans with co-occurring chemical dependency. Addressing substance abuse falls on a list of symptoms with flashbacks and nightmares in a classic PTSD diagnosis. This same mistake happened 30 years ago in dual diagnosis treatment. Addiction is not a symptom of PTSD or any other mental illness. It is a separate disease process requiring focus in the initial treatment plan. You cannot treat a mental illness if the person meets criteria for substance abuse or dependence.
The four minutes that are allowed in the structured clinical interview in the DSM-5 to ask substance abuse-related questions is woefully insufficient. There is a desperate need for those of us who are trained to do an effective evaluation for substance use, abuse and dependence to help veterans. The importance of understanding how important alcohol has become to someone who cannot sleep because of flashbacks and horrid nightmares, whose only peace is found through the numbing effects of alcohol, cannot be underestimated. They are simply not going to accurately report how much they drink, or be willing to give it up, unless we can offer a different form of symptom relief.
We are experts in treating a frustrating disease with features of denial and self-deception before recovery can occur. Successful treatment takes a seasoned professional who has learned how to weave loving confrontation, education, humor and caring to support the addict/alcoholic who is still suffering. We addiction counselors have the skills to do that.
The alcoholic who has seen combat and is suffering from PTSD has two diseases needing integrated, simultaneous treatment. The old “which came first” is extremely unhelpful. Two diseases are two diseases. Having PTSD does not give someone immunity to addiction.
The remainder of this article will address three aspects of addiction counseling with the wounded warrior. First, it will debunk the myth that you must be a wounded warrior or at least military or ex-military to understand how to help a client with a substance use problem. Second, it will address your already present counseling skills that will be most helpful in reaching the wounded warrior with substance abuse/dependency. Third, it will offer some treatment-specific tips for integrating PTSD treatment with addiction counseling for the veteran client.
Debunking the myth
“Only a warrior survivor can help another survivor.” There will be opportunities for the wounded warrior to find peer/veteran support from other warriors at veteran outreach centers or the Department of Veterans Affairs (VA). The veteran may already know these resources in your community. If you do not know them, you can contact your local or state veteran’s services office.
But some former military service members prefer to have no contact with any other soldiers or anything related to military, especially the VA. They want to close the door on that part of their life, at least for the time being, and return to being a civilian again.
While the VA does offer various tracks of substance abuse treatment provided by veteran and non-veteran counselors, many wounded warriors do not qualify for VA treatment, or don’t want to engage in the drawn-out process of getting qualified or simply don’t want to go to the VA for help. Clients receiving retirement or disability payments from the VA are very guarded over what they want the VA to know about them. Substance abuse treatment, they fear, will jeopardize their financial resources or tarnish their service record.
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