With less than 10 percent of those struggling with addiction receiving help, it is not practical to believe that we can deliver individual treatment to all in need. Your feedback has helped me realize I need to clarify this section of my lecture – thank you. Instead, we must evolve a public health approach to the problem that includes a continuum of services, where individual therapy may be reserved for those with the greatest need. A recent journal article by Alan Kazdin (watch his video here) titled Rebooting Psychotherapy Research and Practice to Reduce the Burden of Mental Illness speaks to this issue.

At the same time, an individualized approach to intervention still makes sense. Even if you share similar experiences with others (like your time in Iraq), we know that how you respond to those experiences is unique to you, and influenced by many factors including your genetics, early life experiences, coping skills, and degree of resiliency. As a result, intervention will be optimized when it is individualized for your needs.

Drinking (as well as other addictions) are an adaptive response to what you and others have been through – extreme and abnormal life events. Such experiences are overwhelming, and for many, will lead to PTSD. Addictions are a way to self-medicate the symptoms and there should be no shame in seeing them for what they are. For those who avoid addiction, very often untreated PTSD leads to a life of more trauma, or what we call trauma reenactment. It is a painful life and can lead to many ongoing struggles with depression, anxiety relationships challenges, and sleep problems. Fortunately, treatment, when done right, can help immensely.

Your experiences with your family (and others who have not experienced war in Iraq) also makes sense to me. To survive, you had to make split second decisions, life and death decisions, and spending time considering a list of options most likely would have gotten you killed. As you say, in the military you learn to act – just get it done – and act fast. Life is fairly black and white. But back home life is really many shades of gray. Intimate relationships are perhaps the best example of shades of gray, and it is not surprising that many who come back from Iraq report that relationships are among their most significant challenges. The relational skills that work in the military unfortunately don’t serve you well at home. Add to the mix untreated PTSD and addiction problems, and finding “normal” at home seems all but impossible. But it’s not. With the right kind of treatment it is possible to successfully deal with the PTSD symptoms, overcome addiction, and acquire the skills and developmental capacities necessary to succeed in relationships throughout life (marriage, work, school, raising kids). Remember, the primary theme running through my addiction talk is that addictions are about relationships. In many ways, PTSD is also about relationships.

To recap, your reactions to war are a normal response to a very extreme and abnormal situation. Left untreated, PTSD and addiction will wreak havoc on your life. Treatment works when done right. The 5 Actions framework discussed in class and on this site, is what I believe to be the best way forward. Know that I am always available to chat about how best to implement it and thanks again for taking the time to write.

Seems like there is just as many ways to help, as there are ways to get hooked on drugs. From watching your videos and your lecture in our class I see the course you’re trying to head down. Individual assessment and treatment, not the cookie cutter approach with group therapy, but designated for an individual. I believe the good an individual patient approach can bring; making yourself available for them when they’re in dire need. Showing them how to break those relapse triggers because they know when they happen. I see the down side as well, but this is just from someone outside of a health major and not familiar with these methods from the counselors’ side so don’t be offended. An individual approach would take longer and make you less available to others. Plus, would it not take more of your time in and around the office?

Understanding addiction, for me, is difficult because I wasn’t addicted to drugs, but of course that doesn’t exclude the use of OTC and alcoholic beverages. Addiction can take many forms, as you of course know…from actual substances taken to (what I believe) behavioral, attitudes and actions (PSTD). I’ll explain; I am a returning veteran from Iraq. I had my fair share of PSTD and related problems with this. Not the same as others I feel, no night sweats, no drugs use (excluding alcohol, I’ll get to that), no beating of my wife, family or dog. I coped with the fact I was in a bad place doing things I was suppose to do…another day at the work place, if you want to think of it like that. We didn’t get in the amount of trouble other units would, but I can tell you we did get our fair share of unwanted indirect fire, which made it a whole different hell (never knowing when the next one will drop).
When we came back, my unit had more deaths and injuries (including families destroyed) than we had in Iraq. Behavioral differences were something we had to deal with. People not understanding why we were there, even family members questioning reasons we why we had to go. No worries were on my end, most of these situations just rolled off my back…or so I thought.
I dealt with my experiences with drinking, heavily to binging, but ask anyone in the military and they’ll tell you the same thing. We had little to no counseling and lots of down time; more money in our bank accounts than we knew what to do with so we went out to do what we missed out on for the past year. What I hear these days from friends still in the service. The counseling has gotten better and more directed towards those that need it.
My behavior around friends was nothing different. I got to choose the people I hung around. Their personalities mirrored mine, but when I’m around family my personality changes from one no different than Mr. Hyde. I’m not saying I tear off my clothes and go rampaging around the city hurting people, oh no, but I become short tempered, moody, ill mannered, quiet, irritable, snippy at times, complete opposite of what I am in public or to others. The sort of quick-tempered and short-fused people in my unit or service and whom I became accustomed to. I compensated with drinking, heavily, to keep that person at bay. I’m emotionally dull when it comes to being in person with my family. You will see this with many Veteran soldiers and service members returning, but this is normal for those who went through serious or life changing moments together. Now, I work with family members and when a job or task is needed. They like to give options on how either they or I would like it to be done, instead of the “just get it done” mentality of the military. Options are sometimes overrated.
Hearing your speech about how you like to give a one on one approach and how each person is different and can’t be helped, at times, with group therapy made me think. If that would of worked for me…hearing those who were like me in the past would of made thing a little easier. I feel the trigger was and is my family, and that is why I mentioned earlier I think there are behavioral/emotional addictions because I have no idea why I do these things and it’s becoming a nasty habit…hope this all made sense.

You can watch my film here…
http://www.snagfilms.com/films/title/cracked_not_broken

paul

pp

J