Co-Occurring Disorders in Veterans and Military Service Members
Screening, Assessment, and Treatment Models for Veterans and Service Members
Veterans and service members benefit from integrated screening and assessments for co-occurring mental and substance use disorders. The purpose of integrated screening is to detect the likelihood that an individual has a co-occurring disorder. Integrated assessments allow practitioners to gather comprehensive information to determine a diagnosis and formulate a treatment plan. Integrated screening and assessment utilize a multidimensional, biopsychosocial approach including screening tools, diagnostic interviews, and clinical diagnoses.
There are a variety of screening tools for identifying veterans and service members at-risk for co-occurring disorders. Examples include:
- K6 and K10 psychological distress scales for serious psychological distress (SPD, an overall indicator of nonspecific psychological distress);
- Post Traumatic Stress Disorder (PTSD) Checklist (PCL), PTSD Checklist-Military (PCL-M), and Primary Care PTSD Screen (PC-PTSD) for post-traumatic stress disorders;
- Patient Health Questionnaire (PHQ) for mental disorders;
- Center for Epidemiological Studies Depression Inventory (CES-D) for depression;
- Generalized Anxiety Disorder (GAD-7) scale for generalized anxiety disorder;
- American Drug and Alcohol Survey (ADAS) and Brief Addiction Monitor (BAM) for substance use disorders; and
- Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) for alcohol use disorder.
Treatment of co-occurring disorders among veterans and service members is a relatively new field of study, and more research is required to identify the relative effectiveness of treatment models. Treatment models for veterans and service members have focused almost exclusively on co-occurring PTSD and substance use disorders. More research is required on treating the co-occurrence of substance use and non-PTSD mental disorders.
Examples of treatment models that have shown positive results for veterans and service members with co-occurring mental and substance use disorders include the following:
- Cognitive Behavioral Therapy for PTSD in Addiction Programs. This model consisting of 8-12 sessions of PTSD therapy adapted for substance use disorder settings, including cognitive restructuring and breathing retraining.
- Concurrent Treatment of PTSD and Cocaine Dependence. This 16-session model combines existing treatments that have shown efficacy for PTSD and substance use disorders, including psychoeducation on the interrelationship between PTSD and cocaine dependence, and in vivo and imaginal exposure.
- Transcend. This 12-week partial hospitalization model designed for combat veterans with PTSD and a substance use disorder is comprised of 6 weeks of skills development followed by 6 weeks of trauma processing. It combines cognitive behavioral therapy, constructivist, psychodynamic, and 12-step models.
- Substance Dependence Posttraumatic Stress Disorder Therapy. Also known as Assisted Recovery from Trauma and Substances, this a 5-month, twice-weekly, two-phase model focusing first on addiction, then on trauma. The model combines existing therapies that were already established as effective for PTSD and substance use disorders separately. For example, cognitive behavioral therapy for substance use and stress-inoculation training for PTSD.
- Seeking Safety. This widely studied treatment model for co-occurring PTSD and substance use disorders is a cognitive-behavioral, relapse prevention group approach.
Regardless of the treatment model selected, individuals with co-occurring disorders should be served by practitioners who are trained to treat their diagnosed disorders. Individuals with co-occurring disorders should be empowered to seek appropriate care by being informed about what types of services to expect, the benefits of those treatments, and how to evaluate whether they are receiving the best possible care.
Resources and Links
Report of (VA) Consensus Conference: Practice Recommendations for Treatment of Veterans with Comorbid Substance Abuse and PTSD
Summary of proceedings and recommendations of VA representatives on treating veterans with co-occurring PTSD and substance use disorders.
Invisible Wounds of War: Summary and Recommendations for Addressing Psychological and Cognitive Injuries
Study of post-traumatic stress disorder, major depression, and traumatic brain injury among U.S. troops deployed for Operations Enduring Freedom and Operation Iraqi Freedom (OEF/OIF).