Screening for Substance Use Among Veterans with PTSD in the US

Screening for Substance Use Among Veterans with PTSD in the US

Introduction

PTSD cases that are prescribed along with substance use among men and women of honor, veterans, are increasingly becoming rampant as they are more and more becoming prevalent in every state, attracting the attention of many. According to Watkins, Burnam, Kung, and Paddock (2011), post-traumatic dress disorder is a mental disorder often caused by past terrifying events, and its symptoms are but not limited to; nightmares, anxiety, flashbacks and more importantly uncontrollable thoughts about situations or events. It is believed that people with this disorder may have difficulties adjusting, but as time goes by and more specifically, if handled with care, they can overcome the ordeal with ease. Winarski, and Dubus (2004), on the other hand, voices out that substance use entails the act of engaging in drugs or alcohol and other substances such as inhalants, solvents, or cigarettes. To many, screening for substance use among veterans with this disorder is more than mandatory in a bid to ascertain whether all persons experiencing such disorders are culpable of substance use. It is believed that substance use occurs when individuals try to cope with their PTSD condition by drinking heavily or taking drugs. Winarski and Dubus expanding upon their research argued that the recent development of both the psychological and pharmacological interventions in the US aimed at addressing substance use and PTSD yielded the necessary findings even as the country tries to look into the matter with much care.  Research has it that both substance use, as well as PTSD, are chronic conditions that can sometimes co-occur. However, persons with either disorder alone have shown or demonstrated a favorable treatment outcome as compared to those individuals with co-occurring SUD and PTSD (American Psychiatric Association, 2013). This, therefore, implies that screening for substance use among veterans with PTSD would be a good move in as far as fighting PTSD is concerned.

While many people and groups support the status quo claim that screening and assessment of substance use among veterans does not help and therefore not necessary, research, as well as other pieces of evidence from different quarters, proves that screening and assessment is a vital tool in taming the substance use among veterans with PTSD and should always be carried out.

Discussion

Screening and assessment of substance use among a considerable number of veterans have emerged to be an important exercise that has helped a large number of veterans overcome the substance use epidemic. There are several ways that ideally portrays the importance of screening and assessment among veterans. First is that screening and assessment allow for earlier detection on all veterans who are victims of substance abuse. It is needless to point out that earlier detection presumably translates that the veteran can be helped in overcoming this co-occurrence in time without necessarily waiting for it to be chronic. According to Atkins (2014), he explains that earlier detection of any disorder or challenge can be easily contained. Atkins further points out that the early screening by use of the two assessment tools, which are; addiction severity index and the alcohol use identification test, which asses the general status of the veteran and those whose alcohol consumption has become risky respectively, has allowed for earlier detection among veterans. A number of military veterans who recently came from Afghanistan with substance use and PTSD say, for example, were subjected to a screening session using both AUDIT and ASI and the results were that some of the veteran’s substance abuse had barely finished a week (Calhoun et al. 2010). This notably implies that screening can help in earlier detection of substance abuse among veterans with PTSD and, more importantly, since a mild case of substance abuse can respond easily to treatment, unlike a chronic case.

Another important aspect of screening is that screening and assessment help in ascertaining the severity of the substance abuse dependence, which apparently can be key in determining the appropriate care level that should be administered to the veterans. Cukor, Olden, Lee, and Difede, (2010), for example, argues that the presence of high index drugs among veterans literally indicates that the severity level is a bit high or greater as opposed to some low index drugs such as a cigarette and need for specialized or urgent treatment and care. Of great importance to note is that there are various strategies engaged in assessing the level of substance abuse in co-occurrence cases among veterans. The most commonly used assessment tool is the drug abuse screening test, which often allows for a brief identification of individuals with a high level of drug dependence. The brief identification will eventually guide the caregivers or the medical persons in determining the treatment level that fits the level of drug dependence. Alternatively, the Severity Dependence Scale can also be engaged in measuring the severity of the substance abuse, which will give directions on the extent of the abuse and, more specifically, on the level of treatment to be administered. Bowe, and Rosenheck (2015) a psychological researcher, on the other hand, voices out that screening is mainly used to determine the level of drug abuse, which promotes the caregiving exercise as medics will be able to know the extent or severity of the abuse after the screening is done.

At the same time, screening and assessment also aid in medical planning and monitoring goals, not to mention matching specific patients to specific care or treatment. The feedback from the assessment or screening may stimulate a change in the caregiving process. If a veteran, for example, has co-occurring substance abuse and PTSD and looks worse off before any screening is done, it can be found out that the substance abuse in the veteran does not look worse after the screening and assessment feedback as earlier thought. This presumable translates that the screening and assessment help medics in planning and matching specific care to specific patients as per the screening and assessment feedback. McCauley (2012), expanding upon is research, explains that by engaging the use of the Level of Care Utilization System tool to asses, plan resources in time, as well as monitoring changes and placements at given times, will help in reducing the level of substance abuse among veterans. It is needless to point out that the assessment tool will allow for all the resources, changes and placements to be made in time which will greatly help in the treatment of both substance use and PTSD independently and it is for this reason that screening is a prudent aspect that should not be downplayed.

In addition, another major advantage of the screening process is that it ideally gives or allows for follow-ups on positive screens at subsequent visits. This actually means that in case of a positive result on substance abuse co-occurrence, the positive screens can be followed up on future subsequent visits. Moreover, this does not apply only to those who test positive after screening but to the negative results too. Negative screens often warrant discussion whereby clinicians or caregivers play a promotional, guiding, and prevention role by advising all veterans whose results were negative to practice abstinence and maintain safe levels of drug use if necessary. Maisto, Carey, Carey, Gordon, and Gleason (2010). points out that results after screening not only help to solve the substance use at the moment but can be used in the future by making reference to the screening results that were obtained earlier. Expanding upon their research, Maisto, Carey, Carey, Gordon, and Gleason (2010) further argues that of all cases that were handled in 2017 in the US regarding substance use in veterans, results were that 30% of the cases handled that looked worse inferred that the patients had tested positive after screening on their previous visits. Much like Maisto, Carey, Carey, Gordon, and Gleason (2010), Abueg, and Fairbank (2012) adds that, to expedite screening of substance use among veterans with PTSD, especially those visiting health care centers, clinicians should mainly practice asking more questions sequentially to ascertain the level of substance use and record them for future reference. However, the best tool that should be engaged, especially for drug abuse is the use of CAGE-AID as it focuses on lifetime use. This will apparently provide the necessary details to be documented, and one can make a revisit on the documents when need be. This, therefore, demonstrates that screening for assessment can be fundamental not only at present but also for future treatments.

Finally, by using the screening assessment tools in a bid to plan and asses the treatment outcomes of substance abuse among veterans with PTSD, clinicians will be able to identify the frequency, history, and the consequences of the co-occurrence of substance use and PTSD among veterans in the US. Sacks and Ries (2005), in their study, argued that screening not only gives the frequency but also promotes the health sector in general in ascertaining the level of consequences that the substance use that co-occurs with PTSD has on veterans. He further voiced out that the best assessment tool that is used is the Addiction severity index, a semi-structured interview that looks into the history and the consequences of substance use among veterans with PTSD. Ideally, higher scores on this ASI presumably translate that the veteran has greater severity lower scores mean lower severity as well. Therefore, veterans with greater severity, as indicated by the ASI, will be offered more comprehensive care as opposed to those with lower scores, and this demonstrates why screening for assessment is an important activity that should not be overlooked.

Conclusion

As of the above discussion, it goes unnoticed that screening is a fundamental exercise that should not be downplayed in as far as taming substance abuse among veterans with PTSD is concerned. The above discussion illustrates that screening for substance use using exposure-based approaches such as ASI effective. Nonetheless, there exist substantial gaps in whether this approach can be used together with other therapies so as to promote the effectiveness of these tools further. In a nutshell, in as much as the screening for substance abuse among veterans with PTSD can sometimes have some shortcomings, such as too many questions that can make patients feel uncomfortable, it is worth affirming that the benefits of screening always outweigh its shortcomings. Therefore, the US government should roll out plans that will help promote the screening approaches in a bid to more fully achieve the exact and reliable results that will guide the caregivers or clinicians in administering treatment to the veterans.

References

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