James Vaughns, MS, LPC, CCS, MAC, CACIIJames Vaughns, MS, LPC, CCS, MAC, CACIIWindsor Primous, InternWindsor Primous, Intern

After a trauma (the experience, threat, or witnessing of physical harm, e.g., rape, hurricane), the person who has each of the following key symptoms for over a month, and they result in decreased ability to function (e.g., work, social life): Intrusion (flashbacks, nightmares); Avoidance (not wanting to talk about it or remember.

-DSM-IV Definition-

The symptoms could start after the traumatic event, months or years later. These symptoms are different from those that last for weeks, that cause you great stress or interference.

Bad memories of the traumatic event. You may feel like you are going through the event again. This is called flash backs. Sometimes the triggers are smells, sounds, etc.

Feeling keyed up (hyper arousal) on alert , looking for danger. Know a hyper arousal , it may cause sudden anger or being irritable.

Having a hard time sleeping and trouble concentrating.

10% of men suffer from the results of a sexual trauma.

Boys are more likely than girls to be sexually abused by strangers (authority figure).

Boys and men who have been sexually assaulted are more likely to suffer from PTSD, anxiety disorder and depression.

(Sonkin & Walker, 1998)

Men and Sexual Trauma

This study suggests that there may be a link between PTDS and sexual trauma.

1 in 5 women veteran who seek healthcare services from the VA reported PTSD as a result of sexual trauma.

These women were 8 times more likely to be diagnosed with PTSD as compared to women who did not report these experiences.

Men who were sexually abused report with a diagnosis of PTSD as compared to than those who do not. (Munsey, 2009).

Female Veteran

EmotionalDepressionSelf-blameGuiltShameSuicidal thoughtsAnger****Aggressive behavior****Drugs and Alcohol abuse

Physical SweatingPounding heartRapid breathingFeeling edgyTrouble sleepingMedical problem gets worst

Anger is usually a central feature of a survivor's response to trauma because it is a core component of the survival response in humans.

Anger helps people cope with life's adversities by providing them with increased energy to persist in the face of obstacles.

Uncontrolled, anger can lead to a continued sense of being out of control of oneself and can create multiple problems in the personal lives of those who suffer from PTSD.

One theory of anger and trauma suggests that high levels of anger are related to a natural survival instinct.

Automatic responses of irritability and anger in individuals with PTSD can create serious problems in the workplace and in family life. It can also affect the individuals' feelings about themselves and their roles in society.

*“The compulsion to use despite negative consequences” (e.g., legal, physical, social, psychological). Note that neither amount of use nor physical dependence define substance abuse.

DSM-IV term is “substance use disorder”, with substance abuse a milder form, and substance dependence more severe.

Rates: 35% for men; 18% for women

It is a treatable disorder and “a Brain Disease” (not a moral weakness)

Rates: of clients in substance abuse treatment 12% - 34% have current PTSD. For women, rates are 33%- 59%

For women, typically a history of sexual or physical childhood trauma; for men, combat or crime.

Drugs: No one drug of choice, but PTSD is associated with severe drug use like (cocaine, opioids); “self-medication” in 2out of 3 cases (i.e., PTSD first, then substance abuse).

Other life problems are common: Axis 1 D/O, personality D/O, interpersonal and medical problems, inpatient admissions, low compliance with aftercare, homelessness, domestic violence.

PTSD does not go away with abstinence from substances; and PTSD symptoms are widely reported to become worse with initial abstinence.

Separate treatment systems(mental health Versus substance abuse)

Fragile treatment alliances and multiple crisis are common occurrences.

Treatments are helpful for either d/o alone may be problematic if someone has both disorders,(exposure, twelve step groups, benzodiazepines). Also, some messages in substance abuse treatment maybe problematic: “hitting bottom, confrontation”.

Fear for your safety and always feel on guard

Be very startled when someone surprises you

Feeling numb: Find it hard to express your feelings

You may not have positive or loving feelings toward other people and may stay away from relationships

You may not be interested in activities that you use to enjoy

You may forget parts of your traumatic event or may not talk about it

1.Diversity Issues: In the US, rates of PTSD do not differ by race (Kessler et al.,1995.

2.Substance Abuse: Hispanics & African Americans have lower rates than Caucasians; Native Americans have higher rates than Caucasians. Rates of abuse increase with acculturation. Some cultures have protective factors (religion, kinship).

3.It is important to respect cultural differences and tailor treatment to be sensitive to historical prejudices. Also, terms such as “trauma, PTSD and substance abuse” may be interpreted differently based on culture.

Treat both disorders at the same time, also clients prefer this mode of treatment(One Stop Shopping)

Decide how to treat PTSD in context of active substance abuse.

OPTIONS: Type 1: Focus on “present only”(coping skills, psycho education, educate about symptoms) {safest approach, widely recommended} Type 2: Focus on past only(tell trauma story){high risk; works for some clients} Type 3:Focus on both past/present

A present-focused therapy to help clients (male & female) attain safety from PTSD and substance abuse.

25 topics that can be conducted in any order:Interpersonal topicsCognitive topicsBehavioral topicsOther topicsDesigned for flexible use

SafetyIntegratedA focus on ideals4 content areasAttention to therapist processesAdditional features: Trauma details not part of group therapyIdentify meaning of substance use in context of PTSDOptimistic, help clients obtain more treatment

InhibitionImpulsivityAggressionSexual DeviationPassive; IndifferenceParanoiaIrritability

Improvement tends not to occur after 2 years.No established drug treatment for affective disorder, anxiety or psychosisPsychotherapyBehavioral modification

Poor outcomes after TBI shorten length of stays in both inpatient medical setting payers points to lack of sufficient evidence-based research as a primary reason for coverage denial of medical-necessary treatment.

Cognitive RehabilitationCritical therapyAvailable to active dutyNot accessible to medical retirees under TRICARE

Vocational rehabilitation is available for service members diagnosed with PTSD, TBI, and other related illnesses

VA treats employment as a goal of rehabilitation

VA declares many retirees ineligible for vocational rehabilitation

Department of Defense and the Department of Veterans Affairs has improved the quality and speed of care for service members and veterans with TBI.

Access to local and specialized treatment remains limited.

H.R. 667 & S.262 Traumatic Brain Injury Family Caregivers Personal Attendant Training, Certification and Compensation Program makes respite care available to caregivers of persons with cognitive disabilities as physical disabilities.

TBI is a blow or jolt to the head that can temporarily or permanently diminish a person’s physical abilities, impairs cognitive skills, and interfere with emotional and behavioral well being.

TBI outcomes depend on the location and the extent of the neurological damage; ranges good recovery to death.

Thinking and reasoningUnderstanding wordsRemembering thingsPaying attentionSolving problemsThinking abstractly

TalkingBehavingWalking and other physical activitiesSeeing and/or hearingLearning

A traumatic brain injury can change how a person acts, moves, and thinks. It can cause changes in the brain, such as:

The term TBI is not for a person who is born with a brain injury. It not a term for a brain injuries that happen during birth.

Personnel who are exposed to loud noise, like a loud cannon or a bomb/grenade going off around you. Prolonged exposed can cause this TBI affect.

Memory lossConcentration and attention problemsSlow learningDifficulty with planning and reasoningPoor judgmentDepressionAnxietyImpulsivityAggressionThoughts of suicide

It is very important that returning soldiers, airman, marines and navy members get thoroughly checked out before returning to society.

Everyone who is returning wants to get home as soon as possible and when asked will deny any problems, especially those of a psychological nature.

**YOU ARE NOT INSANE IF YOU ASK FOR HELP**

Make sure you tell doctors everything you think or feel may be wrong with you.Get a copy of your medical and dental records.Get copies of every evaluation you participated in on purpose or accidentally.Medical records seem to get lost or burned in fires, or other catastrophes.You will need these records if and when your service time is questioned.Lastly, when you do need them, never, ever, give the VA your original medical records; copies only, and keep your records in a safe place.

GET CHECKED OUT BEFORE YOU GO HOME!

Munsey, Christopher. (2009, September) Women and War, Monitor Staff, Monitor on Psychology, Volume 40, N0.8.

Sonkin, Danial J., Walker, Lenore E. A. (1998) Wounded Boys, Heroic Men: A Mann’s guide to Recovering from child abuse