To Honor Our Veterans, Let’s Keep Our Commitments to Them

As an addiction treatment professional, it goes with the territory that we lose people, good people who maybe needed a little more help or time or who simply made a regrettable choice. Veterans are often among those lost to substance abuse and suicide.

 

My first and most devastating loss was of a young Marine, Scott,* who had returned to the US from multiple deployments in Iraq and Afghanistan. He was 23 and handsome, classic good looks – blonde hair, blue eyes, solid chin and impeccable manners. I like working with veterans and active duty military because I have yet to meet one without impeccable manners. When I knew Scott, he was living at a VA facility in California. Scott and I spoke often. He liked to watch me needlepoint. I understood Scott because although we had very different stories, we had both self-medicated our symptoms of post-traumatic stress. We were in a way, kindred spirits.

 

Scott had hoped for a career in the military, but had been wounded during his last deployment and could not continue in military service. He walked with a cane and was clearly in pain. Scott had a wife and a child that was only a few months old. He sought treatment at the VA for alcohol abuse related to post-traumatic stress disorder (PTSD).

 

The last time I saw Scott, he had arrived at the meeting hall earlier than normal. He sat in his usual chair at the end of the first row. He was shaking. I walked up to him right away and asked what was wrong. He told me that he had just come from therapy and was very upset. To treat trauma, the VA often uses exposure therapy. In this type of therapy, the individual recounts, and very often in their mind relives, the most traumatic experience(s) of their lives. Exposure therapy is the “gold-standard” for PTSD treatment, according to the VA.

 

Exposure therapy can be an effective tool for overcoming trauma-related symptoms. For example, if a woman was raped in a park, she may have a fear of going to a park – and this might prevent her from having a full relationship with her young child who likes parks. By reviewing the traumatic event in the park, the woman may be able to become desensitized and recognize that the trauma stems from an event, not from parks.

 

Unfortunately for some, there is no catharsis in reliving the worst moments of their lives. For these individuals, there is no desensitizing that goes on with exposure therapy. In fact, the therapy may exacerbate their PTSD symptoms. Scott did not benefit from exposure therapy. He did not tell his therapist that his PTSD symptoms were worsening. Rather than feeling he was a failure for discontinuing therapy or relapsing on alcohol to relieve his PTSD symptoms, Scott chose suicide as a way out of his pain.

 

Scott died nearly a decade ago. I didn’t know him well, but he was precious and he was pained. I think of him often, particularly on Veterans Day.

 

Could Scott have been saved? I don’t know. The VA certainly does its best. However, the staggering number of veteran suicides, now 20 per day down from 22 per day earlier in the decade, should indicate that we are not doing enough. Our services are either incomplete or inadequate, or not in the right places or veterans cannot or will not use them. Whatever the cause of the deficit, it is our responsibility to keep our promises to our wounded warriors of all types and do a better job of providing re-entry into our communities. We owe them a debt. We need to pay it.

 

*Not his real name.

 

Helping Veterans with PTSD Using Yoga

We have come a long way in our efforts to treat PTSD and other psychological disorders. Some of the best information has come from veterans themselves. For example, after suffering from the 9/11 attack on the Pentagon, Army veteran John Thurman used his experience with yoga to help others, in a program that packs rooms. There are many complementary therapies that have shown great results in treating PTSD and other issues. With the number of veterans in need of these resources, it is important for healthcare professionals to put these resources to greater use.

The Washington Post reports:

Of the 2.3 million American veterans who returned from wars in Iraq and Afghanistan, more than 20 percent suffer from post-traumatic stress disorder, which often includes anxiety, depression, and hypervigilance, which means they feel always on guard.

However, a combination of whole health therapies, including acupuncture, yoga, meditation, and intensive one-on-one psychotherapy are proven to rewire the brain in positive ways and help individuals overcome many psychological disorders, including PTSD. This combination of therapies has been used for over a decade in elite addiction treatment and outstrips the results of pharmaceutical based treatment, without the side effects so many pharmaceutical interventions create. The Washington Post continues:

Experts say that treatment for PTSD with painkillers, antidepressants and psychotherapy often have mixed results. The Veterans Health Administration has launched four pilot programs — including one in Richmond — offering yoga, acupuncture, Qigong, guided imagery and equine therapies, part of an effort to reduce the dependence of tens of thousands on opiate painkillers.

While doctors say the highly addictive drugs can help in the short term, they also can be harmful and often require another round of prescription pills to counteract side effects that can include insomnia, constipation, bone pain, anxiety and depression.

There is growing research evidence that whole health therapies work in ways that medications do not.

In a recent study published in the Journal of Traumatic Stress, researchers say that they found scientific support that yoga can decrease stress and help move people away from negative and traumatic thoughts. The study was also the first of its kind to provide scientific support for the benefits of yoga’s breathing techniques for PTSD patients.

Not only should the VA continue with pilot studies of holistic therapies, but evidence should be taken from related fields, such as addiction treatment, where these therapies have been used for years with great success. Our veterans need more help and they need it right away. Yoga, meditation and other holistic therapies have few if any side effects. Let’s give veterans access to these treatments to improve their lives and those of their families.

Can You Thrive After Childhood Trauma?

Recovery from traumatic events is never easy. However, humans are amazingly adaptable. Unfortunately, survival does not mean thriving. A person can survive traumatic events and be scarred for the rest of their life. Trauma affects children particularly profoundly. Children do not just get over trauma; they live with the consequences for a lifetime.

Children adapt so they can cope, but if they are emotionally overwhelmed, their brain goes into survival mode, which changes the way it grows and develops. An early traumatic experience has a profound effect on the way in which a child’s brain forms and functions. A brain that grows in response to a perceived threat is in overdrive and senses threat everywhere. Stress causes the brain to work too hard, too often, for too long. This creates a foundation for psychological distress and mental illness later in life.

Studies over the past 40 years found children who have been through abuse or extreme stress have higher rates of depression, anxiety and other mental and physical problems than other children do. Nevertheless, few scientists have attempted to understand the biology of what was occurring in the brains of these traumatized children. A growing, international field of study revolves around the ways early experience becomes embedded in the body and brain, and how those embedded traits change the brain’s function.

Charles Nelson is a researcher at Harvard’s Center for the Developing Child, who believes the notion of early brain plasticity is particularly compelling. He claims:

“By plasticity, we simply mean the brain’s ability to be molded by experience. And we have an expression that plasticity cuts both ways, meaning that if it is a good experience, it is probably good for the brain. But if it’s a bad experience, it may be bad for the brain.”

Nelson found that children who grew up neglected had less electrical activity in the brain and smaller brains overall than their peers; they had lost brain cells as well as the connections between those cells. This damage was present for a lifetime.

If certain healthful experiences do not happen, like appropriate nurturing or boundary setting, the brain does not know how to wire itself. There are many theories on how positive and negative experiences rewire the brain.  It is a mystery how some people withstand profound early adversity and seem to come out just fine, while others continue to suffer. Is there something neurological that allows for this difference or is the difference environmental? We know that with the right long term therapy, kindness and support, children can often change their brain function and life-outcomes.

There is growing empirical support for the efficacy of trauma focused cognitive behavior training (CBT) in decreasing psychological symptomology in abused or neglected children. Major components of trauma-focused cognitive behavioral therapy (CBT) for children and adolescents are exposure, cognitive processing and reframing, stress management, and parental treatment. Evidence now supports the success of many alternative and holistic treatment methods also.

Treating childhood and adolescent trauma can prevent or decrease the likelihood of developing future mental health conditions. Left untreated, brain dysfunction can eventually lead many to self-medicate with drugs and alcohol, risking addiction, depression and possibly suicide. Seek professional advice if you or a close family member have experienced a difficult situation or event. Recovery is possible with some effort and the correct help.

Does MDMA Have Psychotherapeutic Potential?

Methylenedioxymethamphetamine (MDMA) is also known as “ecstasy” because of the ecstatic feelings it produces in those who use it. While many dismiss the drug as a dangerous substance, some scientists claim it may have positive therapeutic uses with little risk of harm when used under proper supervision.

According to researchers, in the early 1970s a small group of therapists and researchers began to explore the potential of MDMA and its therapeutic use. MDMA encouraged the experience of emotions by reducing the fear response to perceived emotional threats. When used under controlled, therapeutic conditions, there were no direct observable harmful physical effects. For example, MDMA-assisted therapy helped trauma survivors delve into the root of their problematic memories; they experienced a healing catharsis, and subsequently functioned more efficiently and happily.

Then the 1980s saw a change from the therapeutic use of the drug to recreational use. In May 1986, after almost two years of hearings, a judge recommended that MDMA be placed in Schedule III. He made three basic findings: that MDMA had a low potential for abuse; that it had an accepted medical use; that there was an acceptable level of safety for use under medical supervision. Despite the ruling, the DEA administrator placed MDMA into Schedule I.

Formal therapeutic use and human research of MDMA has been deterred by its Schedule I status. Though the FDA claims that its refusal to permit experimentation is based on concern for the health of volunteers, this comes after millions of doses of MDMA were previously taken in the United States. Past literature does not contain one case of an individual suffering neurological symptoms linked to MDMA-related brain damage when the drug was administered in controlled, therapeutic settings.

In Switzerland, psychiatrists have used MDMA successfully in hundreds of cases in recent years. They have used it to help individuals uncover painful childhood memories and experiences that had been repressed; to decrease fear and defensiveness; to increase communication and empathy with one’s spouse; to get through traumatic experiences such as rape and incest; to live with the pain of cancer; and to resolve oneself to dying.

Dr. Michael Mithoefer, a Charleston, South Carolina, psychiatrist who works under the umbrella of the Multidisciplinary Association for Psychedelic Studies is conducting a new study on the effectiveness of using MDMA in combination with psychotherapy to treat PTSD, to allow patients to reflect on their trauma with emotional clarity.

He showed in a 2010 study that 83% of PTSD patients treated with MDMA-assisted psychotherapy showed marked improvement, compared to 25% of those treated with psychotherapy alone. A follow-up study found that the majority of those treated with the assistance of MDMA remained symptom-free two years later, demonstrating the treatment possibility of long-term efficacy.

Dr. Mithoefer said of the participants in the 2010 study,

“They were neither overwhelmed by emotion nor numbed from it. It is not just that people get blissed out. The psychotherapy is still difficult and can still be painful, but they have a sense that they can do it.”

While there are certainly promising indications of the medical possibilities of using MDMA, there remains difficulty in human testing of Schedule 1 drugs. Scientists are divided about MDMA’s safety. Until scientists can provide the FDA evidence to change the drug’s classification, future medical research will be slow in coming.

There are some serious health risks when taking any illicit drug for recreational use. The MDMA sold on the streets today is usually some mysterious chemical substance that often contains no MDMA at all. Confiscated drugs over a recent two-year period, showed only 13 % contained even a small amount of MDMA. Risk from unknown drug combinations is not worth the danger, nor is it wise to use any illegal drug.

That said, there is evidence once again that drugs like MDMA may have important psychotherapeutic uses when given in controlled medical settings. These drugs should be studied for their possible therapeutic effects.

Can Psilocybin Mushrooms Help Cure Mental Illness?

Advocates of hallucinogens claim that substances that alter the conscious may be a key to treating mental illness and can be more effective than some prescription drugs. There has been a resurgence of interest in psychedelic research in the last few years with promising results. However, treatments using restricted Schedule 1 drugs like psilocybin are legal only for limited research at this time.

Dr. David E. Nichols, psychedelic research expert and co-founder of The Heffter Research Institute, explains:

“We have been able to accomplish so much in such a relatively short time. Psilocybin, the psychoactive compound in magic mushrooms, is proving a prodigious treatment for anxiety, depression, addiction, and one study even found it might lead to neurogenesis, or the regrowth of brain cells.”

This is great news for the hopeful development of successful new treatment options for common mental health issues. What is the evidence supporting such claims? Here is a list of recent studies.

  1. In a study by Dr. Michael Bogenschutz, at the University of New Mexico, researchers gave psilocybin-assisted therapy to 10 volunteers with alcohol dependence. Drinking decreased significantly beginning in the second month of treatment, after psilocybin was administered, and improvement remained significant for an additional six months of follow-up.
  2. A study by Dr. Matthew Johnson at Johns Hopkins, administered psilocybin within a 15-week smoking cessation treatment. Participants were 15 healthy smokers with a mean of six previous lifetime quit attempts who were smoking an average of 19 cigarettes per day for 31 years. Measures of smoking behavior showed that 12 of the 15 participants (80%) were no longer smoking at six-month follow-up.
  3. In a study at the Imperial College London, scientists found psilocybin reduced blood flow to the cingulate cortex, the region of the brain responsible for extreme thoughts or behavior.

These few, small studies indicate that psilocybin could produce great results. Much more research involving larger groups will be needed to conclusively prove the positive benefits of the therapeutic use of hallucinogens, particularly psilocybin. Three phase drug studies with FDA approval will also have to be completed before these types of drugs can be removed from the list of substances with no medical purpose. Safety and quality control are always important and will also need much more research.

The problem is that pharmaceutical companies are not interested in researching an inexpensive substance that has been around for a long time. There is no money to be made with a non-patentable drug that is given only once or twice in a lifetime.There is the sad dilemma. Research of hallucinogens at this time is primarily done by non-profit organizations. Fortunately holistic approaches are becoming acceptable in main-stream science today, and hopefully enlightened medical scientists will prevail over profit-seeking.

PTSD Basics

You have probably heard of Post-Traumatic Stress Disorder (PTSD), but may not know much about it. PTSD affects not only returning war veterans traumatized by military service, but many people who are exposed to terrorism, violence and natural disasters, shattering their sense of trust and safety.

After a traumatic event, everyone experiences some stress symptoms. These are normal reactions to abnormal events. However, these symptoms gradually lift after a short time of days or weeks as emotions are processed.  With PTSD, the symptoms do not decrease and may even become worse over time because the psychological shock. This can disrupt work and home life causing misery and making it difficult to function on a daily basis.

Look at a few facts about PTSD in the USA:

  1. About seven or eight out of every 100 people (or 7-8% of the population) will have PTSD at some point in their lives. Children and adolescents can also have PTSD.
  2. About 5.2 million adults have PTSD during a given year. This is only a small portion of those who have gone through a trauma.
  3. Women are more likely than men to develop PTSD. About 10% of women develop PTSD sometime in their lives compared with 5% of men.

Negative changes in beliefs and feelings of unease and distrust can be a result of ongoing symptoms, along with guilt, shame, substance abuse and suicide. Extreme and prolonged threat to personal safety increases the risk of developing PTSD and human-inflicted traumas tend to be more damaging than impersonal accidents or natural disasters.

It is important to recognize the symptoms of PTSD and start treatment as soon as possible to prevent escalating problems and improve the ability to function in everyday life. While everyone experiences PTSD differently, there are three main types of symptoms:

  1. Re-experiencing the traumatic event: flashbacks, nightmares, upsetting memories causing distress, intense physical reactions (e.g. nausea, sweating, pounding heart).
  2. Avoidance and numbing: not seeking help to avoid talking or thinking about the event, loss of interest in activities, feeling detached and emotionally numb, avoiding certain activities, a sense of a limited future. 
  3. Increased anxiety and emotional arousal: irritability, anger outbursts, sleep problems, difficulty concentrating, startled by loud noises, feeling jumpy or jittery, hyper-vigilance.

Treatment will help relieve symptoms, offering an outlet for suppressed emotions by processing those emotions and sensations. This release can help the individual gain back a sense of control over their life by helping them learn to cope with the memories and feelings they experienced.

There are several options available for good treatment of PTSD. One or more may be used as people may respond better to a combination of therapies. Learning about the different choices can help with making the decision to start a treatment plan.

For therapy to work, it is very important to find the right trained therapist who makes the individual feel comfortable and safe. Fear or anxiety about the treatment itself can prevent success; trust and comfort are an important part of being able to feel understood. PTSD is a serious psychological disorder that needs to be addressed for better health.