Good Essay On Returning Veterans And Possible Behavioral Health Issues

Veteran Depression Related To Substance Abuse

Veteran Depression Related To Substance Abuse

INTRODUCTION

Even while taking into account the fact that significant share of the veterans, returning from warfare (for instance, Iraq and Afghanistan) do not represent any deviations in their behavior and health condition, as well as the traumatic brain injury has not been experienced by them, each veteran has experienced a period of readjustment (or it is also referred as rehabilitation) within the process of reintegration into life with community, family, and friends.
The juggling of family and military obligations usually takes its place in veteran’s life as one reintegrates into United States civilian life after exposure to combat and living in unfamiliar settings. Such factors may create the fertile background for the different mental and psychological problems for veterans by themselves, as well as their spouses and other members of the family. There is a set of the behaviors, which are vitally important for surviving in a war zone – such as constant state of alertness’ maintaining. Such skills and behaviors have the potential of being transferred into the form of troublesome behaviors in the common civilian life. As the major representation of such behaviors, it is possible to refer to feeling jumpy or edgy as well as being easily startled (US Department Of Veterans Affairs, 2012).
Additional emphasis should be put on the fact that the providers of the health and social services as well as clergy—from the military community or VA, may be considered as the first contacts, which may be sought for assistance by the veterans as well as their family members. That is shy these providers should be aware of the major problems, their specific, typology, and background - for further resolution though the various available means, and evidence-based practice in particular. In the scope of this paper, the intervention for managing the mental disorders depression and the substance abuse among the veterans would be offered while referring to both commonly used and innovative psychological and medical practices.

LITERATURE REVIEW

Those people, who come back from a combat zone, may experience different forms of common stress reactions, involving nightmares, sleeplessness and feelings of rejection, sadness, hopelessness and abandonment. In addition, there is a high probability that the veterans would struggle in terms of concentration and represent the aggressive forms of behavior, such as alcohol, tobacco and drugs use, aggressive driving etc. The durability as well as intensity of such form of behaviors as well as other worrisome behaviors may create the background for indication of more serious problem as well as pose the need for professional approach towards the treatment.

Substance Abuse among the Veterans

There is an insignificant quantity of the reported information, concerning the illicit use of drug and alcohol among veterans. There is one investigation of the VA healthcare user, which reports that more than 11% of the Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans were diagnosed with the SUD (substance use disorder), which implies the drug or alcohol use disorder (or both of them).
In addition, the information, concerning the alcohol use among the veterans, indicates that the alcohol is used by this group of people for self-medication. In accordance with the information, represented by VA, more than 22% of the OEF and OIF veterans, who were diagnosed with the post-traumatic stress disorders, were also diagnosed with substance use disorder (NAMI, 2009).
In accordance with the information, represented within recent nationwide investigation, those, veterans, who are diagnosed with some mental disorders and the PTSD in particular, have represented the higher probability of being prescribed with opioid medication for the set of health conditions, related to pain, in comparison to those veterans, who have not been diagnosed with the mental disorder of any type.
Such veterans have represented the higher risks in terms of the SUDs co-occurring as well as getting the higher quantities of the opioid regimens and refills at the early stages of treatment. In addition, this group of patients has usually taken the opioids for longer timeframes in the scope of their course of treatment. Finally, this patients’ segment was characterized as those, representing the adverse clinical outcomes’ higher risk.
The set of the investigations, conducted in the corresponding field of knowledge, has revealed that the substance misuse and abuse (and alcohol in particular) as well as binge and hazardous drinking, are common for the veterans (these studies were conducted among OEF and OIF veterans). In some cases, the alcohol is consumed by the veterans because they do not ind another way for managing the difficult feelings, associated with their wartime experience, as well as erasing the memories, concerning such type of experience. As an evident example, it is possible to refer to the fact that in some cases, the increased combat exposure, which implies the human trauma and violence among the veterans, may be referred to greater and more frequent quantities of the alcohol use in comparison to the cases, when the veterans were not exposed to such form of combat. (Committee on Identifying Effective Treatments for Gulf War Veterans et al, 2001)
While referring to the depression, as the frequent phenomenon of mental condition, which is faced by the veterans, it is essential to refer to the fact that it is considered to be one of the most expensive as well as frequent mental disorder. The estimated annual cost of such disorder for US is $66 billion per year. More than 14% of the veterans are diagnosed with the condition of depression (NAMI, 2009).
In accordance with the data, represented by NAMI (National Alliance on Mental Illness), in the timeframe of seven years (2000-2007) each third veteran, who has entered VA health care system, was diagnosed with some type of mental disorder and 41% of these veterans were diagnosed with behavioral adjustment or mental disorder. The rate of PTSD was revealed as 20% while 14% of the diagnosed have represented some form of depression.

Depression and its symptomatic

The clinical depression is the severe medical disease which exceeds the traditionally-attributed conditions of temporarily feeling blue or sad. Such form of this disease implies the disturbances in concentration, mood, interests, level of activity, sleep, social lifestyle and behavior as well as the appetite of the individual (which, in turn, makes its negative impact on the overall health condition of such person). Even if it is considered by the experts in medicine that there is a set of possible options for treating the depression, there are still the cases when it is transferred into the form of life-long condition, when the illness re-occurrences are alternated by insignificant periods of wellness.
The major symptoms of depression represent the next issue to be discussed in the scope of this section. It is essential to note that the commencement of the major depressions’ first episode may not be obviously noted in the case if it is mild or gradual. The significant change from the individual’s and functioning behavior before the illness occurrence is characteristically represented by the symptoms of major depression. These symptoms may be represented in the following sequence:

The mood condition, which is constantly sad or when the individual is persistently irritable;

Clear changes in the overall condition of the patient and in energy, appetite and sleep in particular;
Individual faces with some difficulties in one’s cognitive activity: thinking, remembering and concentrating;
Agitation or physical slowing;
The activities, which were previously enjoyed by an individual, do not interest him or her anymore;
Feelings of worthlessness, guilt, emptiness and hopelessness;
Periodical considerations about one’s death or suicide;
Persistent physical symptoms, which cannot be addressed by the traditional form of treatment - such as digestive disorders, headaches and chronic pain.
In the same manner as in majority of investigations, dedicated to depression, in the case of veterans, females represent the higher rate of depression in comparison to males. This indicator is not impacted by the form of service. Women represent almost twice higher rate of drug and alcohol consumption(NAMI, 2009). In accordance with the study, conducted by Hourani et al (2012), that there are increased risk factors among female veterans for suffering from both depression and PTSD.
In the investigation, which was conducted among 100,000 returning veterans, more than one quarter of them have been diagnosed with the mental disease or the problem of behavioral adjustment. In this case, no correlation was revealed between the diagnosis and gender of the veterans. At the same time, it was revealed that the higher rate of PTSD was represented by the older veterans, who have come from the reserve units and National Guard, while the higher rate of mental disorders was revealed among the young veterans, who were among the active-duty personnel. In addition, in the timeframe of the first year after the mental disorder is diagnosed, almost 60 % of the patients lack the psychiatric care or get it in minimal quantities (NAMI, 2009).
After conducting an investigation in the area of the alcohol use among military members and returning veterans, Saxon. (2011) has put an emphasis on the fact that there is a need of paying additional emphasis to this common problem among the younger cohorts of this target audience, since there is an option of preventing the disability and worsening impairment in the case of issuing the timely intervention.
It is estimated by the experts that in the case if early intervention is not issued to the specific subgroups of combat veterans, significant quantity of such patients would be not treated furthermore, as well as would experience a durable episode of depression (up to several months). In addition, there is a high risk that such form of depression would repeat during the life span. Such mental condition leaves the veterans under the risk of relationship and economic problems, as well as would poses the risk for excess substance use, which, in turn, has the potential of making the harmful effect for their overall health condition.
The last issue to be discussed in this section is the main reasons and causes of depression among the veterans. Psychiatrists consider that the roots of depression occurrence may be found in environmental, psychological, and biological environmental factors. In addition, it was firmly established by the set of scientific investigations that major depression is a medical and biological illness of an individual as well as the family history of the illness increases the risk for the depression development in multiple times (NAMI, 2009).
In the scope of the question, concerning the risk factor for the veterans, it is essential to outline the following information. It was revealed by the scientific investigations, that the probability of the suicide among US veterans is significantly higher in comparison to the representatives of general population. For instance, there is a correlation between the age of an individual (fellow citizen) and the increased rates of suicide risk occurrence, while in the cases with veterans, it is possible to observe controversy trend - the maximal risk of suicide may be attributed to the young veterans.
In accordance with the findings of Bryan et al (2013) and Hourani et al (2012), there is no direct interrelation between the combat exposure and suicide risk, but at the same time, the combat exposure is associated with the various representations of depression as well as post-traumatic stress disorder (PTSD), which , in turn, have direct interrelation with the risks of the suicide occurrence among the veterans. Thus, the vulnerability of the veterans, to suicide risk may be increased by the combat among other factors of the risk –such as substance abuse.
The major approaches towards testing the depression may be represented in the following way. First of all, even if the major depression is referred as the devastating illness, there is a set of the possible options for its effective and successful treatment. Up to 90 percent of the individuals, who had such diagnosis, may be treated and afterwards, return to their usual and preferred life style. There are different healing options, available for such cases, and the type of treatment, which is chosen by the physician, is mainly dependent on the patterns of illness represented by an individual as well as on its severity on the current stage.
In the scope of the next chapter the intervention plan for the veterans’ treatment would be represented as it related to the depression and substance abuse among this group of people.

INTERVENTIONS FOR PREVENTION AND TREATMENT

OF THE SUBSTANCE ABUSE AND DEPRESSION AMONG VETERANS
Brief description of the interventions
Intervention 1 Medication
It was indicated by the set of various investigations, that there is an option of altering the imbalances of the neurotransmitters – such as dopamine, serotonin and norepinephrine while using the antidepressants. In majority of cases, the initial effect of using the antidepressants is reached within two to four weeks, while for reaching the full effect, 6-12 months are needed.
Both veterans and their family members should be aware of the fact that there is a need of being cautious in the timeframe of the early stages of medical treatment. The major reason for this need is that the normal levels of energy as well as the ability for taking the actions often returns before improvement of the mood. (Lydecker et al, 2010).

Intervention 1 Psychotherapy

The depression as well as the mental disorders may be treated while using the set of the types of the psychotherapy – for instance, the interpersonal therapy (IPT) and cognitive-behavioral therapy (CBT). It was indicated by the scientific investigations that the depression of mild to moderate form may be effectively treated with either of the therapies, mentioned above, if they are used alone (Committee on Identifying Effective Treatments for Gulf War Veterans et al, 2001).

Relevance of the Interventions

After conducting an investigation of the Clinical Outcomes of an Integrated Treatment for Substance Use Disorders and Depression, Lydecker et al, (2010) have made a statement that the making the early response as well as providing the veterans with proper treatment on depression and substance abuse has the potential of predicting the long-tern outcomes. From the other hand, there is a direct interrelation between the poor initial treatment of addiction was followed by the short term improvement, while afterwards, increases in substance use have taken their place.
That is why it was suggested by the scholars that there is a need of issuing additional therapeutic efforts for those, who were dually diagnosed with poor response for initial treatment. As an evident example, it is possible to refer to the fact that adding the component for the motivational enhancement to the therapy has the potential of increasing the readiness of the veterans to change substance behavior,
Tate et al., (2008) has made a claim that there is an alternative option - focusing on the social and environmental context of the individuals, who have early poor responses.
Finally, the treatment of the depression while using the means of psychotherapy, has represented its effectiveness both in young adults and elderly patients. At the same time, premature stopping of using the medication is done by significant share of the elderly patients and such trend in turn, leads the inconsistent recovery
The study, conducted by Lydecker et al (2010) has revealed that 73 % of those veterans, who have been provided with the proper medication or psychotherapeutic treatment (while being dependent on at least one substance), have represented the following immediate results – the criteria of current alcohol or drug dependence was not met by 73% of participants of the study, who have also managed depression disorder and in one year, this index has decreased to 65% (the veterans with no depression diagnosis) and dropped to 78% of the veterans with no substance dependence.
That is why combination of medication psychotherapy ma be referred as effective approaches towards the substance abuse and depression treatment, but the additional emphasis of the care services’ providers should be attuned both to symptoms and signs of the mental disorders as well as substance use among veterans. For instance, these problems, may be not discussed by the veterans if they are not asked about these aspects of their life. In addition, some of such veterans may be afraid of the negative impact, made by such information and factsheet of their life on their further career; for addressing this concern ,it was claimed by Hourani et al (2012) that there is an option of making the positive impact on the overall mental condition as well as motivate the veteran to be engaged into discussions, by the means of spirituality, which, in turn, were claimed to make the protective effect for depression and PTSD.

IMPLICATIONS OF THE CURRENT STATE OF KNOWLEDGE ON YOUR FUTURE PRACTICE IN THIS AREA

After conducting an investigation in the area of the depression occurrence among the veterans as well as its relation to the substance abuse among this group of people, the following important points of specific knowledge were gained by me.
Among the most common and generally accepted approaches towards the major depression treatment, I have noted the following as promising and effective: various types of psychotherapy; use of prescribed medicines, and the electroconvulsive therapy (ECT). Additional emphasis should be put on the usefulness of the light therapy in the case if the depression of such individual may be characterized by the seasonal component. In the case if the traditional options of depression treatment (listed above), are ineffective, there are the options of using the transcranial magnetic stimulation (TMS). Such approach is refereed as an effective one both in the case if it is used alone or combined with other existing treatment options and tools.
In addition I have discovered that one of the major success factors for the depression treatment is attributed to the support and education of the peers and family members. Finally, the healthy lifestyle has represented the increased effectiveness of all approaches listed above.

References

Bryan, C. J., Hernandez, A.M., Allison, S., Clemans, T. (2013) “Combat Exposure and Suicide Risk in Two Samples of Military Personnel” Journal of Clinical Psychology 69(1), 64-77.
Committee on Identifying Effective Treatments for Gulf War Veterans, Health Problems, Board on Health Promotion and Disease Prevention, Institute of Medicine (2001) Gulf War Veterans:: Treating Symptoms and Syndromes. National Academies Press
Hourani, L.L., Williams, J., Forman-Hoffman, V., Lane, M.E., Weimer, B, and Bray, R. M. (2012) “Influence of Spirituality on Depression, Posttraumatic Stress Disorder, and Suicidality in Active Duty Military Personnel” Depression Research and Treatment Volume 2012 (2012), Article ID 425463, 
Lydecker, K.P. Tate, S.R. Cummins, K. M., McQuaid, J., Granholm, E., and Brown, S. A. (2010) “Clinical Outcomes of an Integrated Treatment for Depression and Substance Use Disorders”. Psychol Addict Behav. 2010 Sep; 24(3): 453–465.
NAMI (2009) Depression. Retrieved from: http://www2.nami.org/Template.cfm?Section=Depression&Template=/ContentManagement/ContentDisplay.cfm&ContentID=87942
SAMHSA (2012) Behavioral Health Issues Among Afghanistan and Iraq U.S. War Veterans. Retrieved from: http://store.samhsa.gov/shin/content/SMA12-4670/SMA12-4670.pdf
Saxon, A. J. (2011) “Returning Veterans with Addictions” Psychiatric times online journal . Retrieved from: http://www.psychiatrictimes.com/military-mental-health/returning-veterans-addictions
Tate, S.R., Wu, J., McQuaid, J.R., Cummins, K. Shriver, C., Krenek, M., Brown, S.A. (2008) “Substance dependence and depression comorbidity: Role of self-efficacy and life stress in sustaining abstinence”. Psychology of Addictive Behaviors. 2008;22:47–57 in Lydecker, K.P. Tate, S.R. Cummins, K. M., McQuaid, J., Granholm, E., and Brown, S. A. (2010) “Clinical Outcomes of an Integrated Treatment for Depression and Substance Use Disorders”. Psychol Addict Behav. 2010 Sep; 24(3): 453–465.
US Department Of Veterans Affairs (2012) Guide to VA Mental Health Services For Veterans & Families. Retrieved from: http ://www.mentalhealth.va.gov/docs/MHG_English.pdf