Rising to the Challenge of Treating OEF/OIF Veterans with Co-occurring PTSD and Substance Abuse
Rising to the Challenge of Treating OEF/OIF Veterans with Co-occurring PTSD and Substance Abuse
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DOI：
10.1080/00377310903115473
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发表时间：
2009-01-01
影响因子：
1
通讯作者：
Bernhardt, Alan
中科院分区：
文献类型：
--
作者：
Bernhardt, Alan
本文回顾了持久自由行动/伊拉克自由行动（OEF/OIF）退伍军人报告心理健康和药物滥用问题的相对较高的发病率的数据，以及一些可能导致他们参与治疗率较低的感知障碍。患有创伤后应激障碍（PTSD）和物质使用障碍（SUD）的退伍军人的治疗结果通常比单独患有PTSD或物质滥用的退伍军人差。沿着描述了VA医疗中心提供的几种循证个体治疗方法，以及他们如何将物质滥用与PTSD的关系概念化。讨论了在专门方案中对PTSD和药物滥用者进行顺序治疗的问题，特别是要求退伍军人在进入PTSD治疗前一个月或更长时间内完全无药物和酒精的做法。几个综合治疗方案描述沿着与支持其有效性的证据的简要总结。退伍军人事务部最近的一些政策变化，预示着未来的PTSD/SUD治疗的描述。年轻和年长的退伍军人之间的差异被引用沿着他们对治疗的影响。关于如何更好地参与和保留OEF/OIF退伍军人与创伤后应激障碍/SUD治疗的建议，连同其实施的例子。作者的结论是，为了应对治疗这一困难人群的挑战，有必要调整治疗以满足他们的需求，而不是要求他们适应可能不太适合的治疗。
This article reviews data on the relatively high incidence of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans reporting mental health and substance abuse problems, and some perceived barriers that may account for low rates of their engaging in treatment. Treatment outcomes for veterans with co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) are generally poorer than for those with PTSD or substance abuse alone. Several evidence-based individual therapy approaches offered by VA Medical Centers are described along with how they conceptualize the relationship of substance abuse to PTSD. Problems with sequential treatment for persons with PTSD and substance abuse in specialized programs are discussed, including notably the practice of requiring veterans to be completely drug and alcohol free for a month or longer prior to entering PTSD treatment. Several integrated treatment programs are described along with a brief summary of evidence supporting their effectiveness. Some recent policy changes from the Department of Veterans Affairs that bode well for the future of PTSD/SUD treatment are described. Differences between younger and older veterans were cited along with their implications for treatment. Recommendations regarding how to better engage and retain OEF/OIF veterans with PTSD/SUD in treatment are presented together with examples of their implementation. The author concludes that to rise to the challenge of treating this difficult population it is necessary to adapt treatment to meet their needs rather than requiring them to adapt to therapies that may not be a good fit.