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SAMHSA’s Award-Winning Newsletter
September/October 2008, Volume 16, Number 5 

Treating War’s Signature Injury

Traumatic brain injury (TBI), the signature injury of the conflicts in Iraq and Afghanistan, presents new challenges for clinicians and researchers.

Conference speakers at a breakout session on TBI and post-traumatic stress disorder (PTSD) said that many service members who survive explosive attacks have both conditions.

traumatic brain injury, post-traumatic stress disorder

“The symptoms of the two overlap, which complicates diagnosis,” said Matthew Friedman, M.D., Ph.D., Executive Director of the National Center on PTSD at the Department of Veterans Affairs (VA). “The issue is not whether we can diagnose either or both conditions, because we can. The issue is what to do therapeutically when both conditions co-occur, as they often do,” he said.

Another complicating factor is that the injuries caused by the pressure wave of blasts from insurgents’ homemade bombs and improvised explosive devices (IEDs) differ from those on which much of the existing TBI literature is based—mainly results of auto accidents and athletic injuries, said Maxine Krengel, Ph.D. Dr. Krengel is a clinical neuropsychologist in the Veterans Integrated Services Network of the VA. “This is a very, very complex situation that presents many issues together,” she said.

Specifically, for example, Kevlar helmets only do so much to protect the brain’s soft tissue, which is vulnerable both to flying shrapnel and to the powerful percussive wave of a blast.

Effective psychotherapeutic treatments exist for PTSD, panelists agreed, especially cognitive behavioral therapy (CBT) and exposure therapy (see Definitions). Medications are also effective in dealing with symptoms, although symptoms may return when medication is stopped. They include “seeing stars,” headaches, blurred vision, increased sensitivity to lights and sounds, and feeling dizzy or nauseated.

“Research suggests that psychotherapy can be successful; however, further research is needed,” Dr. Friedman emphasized. “There’s concern that TBI may impair the capacity for either cognitive therapy or the emotional processing in exposure therapy; however, that is only a concern, not a proven fact,” he said. “We need to test how well PTSD/mild TBI patients can use CBT. It’s possible that most patients can benefit from these treatments.”

For example, in Australia successful CBT trials with motor vehicle accident survivors with PTSD/TBI have shown great promise.

Currently, no drugs have current FDA approval for TBI, although some appear to show benefit, Dr. Friedman added. “This is a clinical challenge,” he said. Only additional research can resolve these clinical issues, Dr. Krengel and Dr. Friedman agreed.

For more on TBI and PTSD, visit the VA’s National Center on PTSD.


Traumatic brain injury. A blow or jolt to the head or a penetrating head injury that disrupts the function of the brain.

Exposure therapy. Psychotherapy that involves repeated real, visualized, or simulated exposure to a traumatic memory to help the patient control feelings and thoughts about the trauma.


Grant Awards Announced

SAMHSA recently announced grant awards for programs related to children's mental health, suicide, drug-free communities, and others.

Grant Awards Update

  National Survey on Drug Use  
  and Health  

Youth Substance Use Declines

From the National Survey on Drug Use and Health, new national data show a drop in illicit drug use among youth and an increase in adult prescription drug misuse.

image of part of a bar chart

Drugs and Youth: Chart Shows 2002 to 2007 Data

Marijuana, cocaine—changes in use of selected illicit drugs among youth, 2002 versus 2007.

logo for National Alcohol and Drug Addiction Recovery Month

Recovery Month Testimonials

Two people relate their personal stories of addiction, recovery, and hope.

  Mental Health  
photo of a hand holding a pen to paper

Making Mental Health Services Accessible

Can primary care doctors help with mental health problems? New strategies to overcome barriers associated with reimbursement.

the letter i depicted as an icon representing a friend to lean on

Pros and Cons of Self-Disclosure

What are the risks and benefits of revealing a mental health problem to friends or coworkers?

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Bullying: Starting the Conversation

Bullies are out there—SAMHSA resources can help parents and educators address the problem.

  Substance Abuse  
photo of people sitting in a circle

Mutual Support Groups: Fact Sheet for Providers

What do you know about mutual support groups? Providers can help connect clients with groups that help people achieve recovery.

photo of a sign reading “Repeated Admissions Start Line Here”

First-Time Versus Repeat Admissions

New SAMHSA data reveal characteristics of first-time and repeat admissions to substance abuse treatment.

SAMHSA’s National Registry of Evidence-based Programs and Practices

Registry Posts 100th Evidence-Based Practice

NREPP reaches a milestone—find out how the Registry can link communities to interventions specific to their needs.

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