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We, as social workers are and will be increasingly needed
to address the needs of returning combat veterans, especially from Iraq and Afghanistan. We will be focusing on the most affected,
displaying adjustment disorders to traumatic brain injury to severe PTSD. Granted many vets are able to adjust and re-acclimate
into society. However, many suffer from dual diagnoses, i.e. alcohol/drug addiction and PTSD. As we also know, trauma also
sets off past traumas, further complicating our task. Therefore, social workers must be adequately informed, trained and empowered
so they may address the needs and provide new ways to care for returning combat veterans. We must know the resources of the
VA and other services available.
I just attended a class at the NASW Florida state conference emphasizing the need
for social workers, whether at the VA, in government services or in private practice (especially through referral services),
to be knowledgeable to provide service for our returning armed forces. There are currently more than one million military
troops who have been deployed in support of operations Enduring Freedom and Iraqi Freedom. Many are returning disabled, unemployable
and who have multiple psychological issues. Due to PTSD, many experience recurrent and intrusive distressing memories, flashbacks,
sounds, explosions and traumatic images. Recurring nightmares, extreme physical reactivity such as a racing pulse and sweating,
intense stress and fear set off by triggers, detachment and numbing, feelings of being estranged from others, a sense of a
fore-shortened future, avoidance, exaggerated startle response, irritability and anger, sleep disturbance, hypervigilence
and survivors guilt may exist. Suicidal ideation is not uncommon. As the news reports, there have been many suicides in Iraq!
The soldiers own risk factors such as poor social support, past life stressors, adverse childhood events and prior traumas
may intensify the risk for PTSD as well as multiple tours of duty.
The number one stressor bringing the Vet in
for help is the threat of divorce or separation. A therapist can identify the soldier's pain, medical problems, feelings
of emptiness and estrangement, anger and rage causing destructive behaviors and the fear of losing control. One Vet, having
intense nightmares, got up often at night to check locked doors and to see that his gun was in place! Another Vet reported
putting crickets in his closet to recreate familiar noise to sleep at night. However, the crickets got loose and spread throughout
the house, causing the wife to demand their capture! A soldier is afraid to go into the market because he cannot see the outside.
These are examples of hyperarousal.
A soldier operates by the principle, "If you are not 100% in control,
you will die!" They live by the fight or flight syndrome! Their pupils dilate, their body prepares and they are hypervigilant.
The New England Journal of Medicine studying returning soldiers reports 16% of the service men studied suffered from mental
health issues, especially PTSD. The surgeon general reports a study showed that after 3 to 4 months post discharge, 30% have
a diagnosis of stress related mental health issues. Research also shows a high rate of co-morbid condition with PTSD and SUD(substance
abuse disorder). 75% of combat veterans with lifetime of PTSD will also have a SUD diagnosis. Adrenaline rush from war is
often duplicated by dangerously speeding one's car or intensely playing computer games with violence. PTSD and SUD diagnoses
show these patients to have higher rates of Axis II disorders. Clinicians must reassure clients that they are listening and
"memories can't hurt you as you are now safe." Utilize breathing exercises for adrenaline issues and discourage
self-medicating practices. Resistant Vets may refuse needed medication/referrals and may isolate themselves or act out.
TBI (traumatic brain injury) is the signature injury of Iraq, often hard to diagnose, is invisible and symptoms
may be similar to PTSD. TBI is typically caused by a blow or jolt to the head or a penetrating head injury. 7,000 Americans
in peacetime who are in service are diagnosed with TBI yearly! In prior conflicts, TBI was present in 14-20% of surviving
combat casualties. A soldier reported falling off a stack of bricks to avoid sniper fire and broke his leg and hit his head.
Months later, he was diagnosed with TBI! TBI is not a mental health diagnosis and needs a neurological evaluation before treatment.
Powerful shockwaves of rapid air pressure, flying debris and explosions are examples of causes of TBI. Defense and Veterans
Brain Injury Center at 800-870-9244 or at www.DVBI.org is a good resource.
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