Posttraumatic Stress Disorder and Substance Use Disorders

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Combat Stress What Everyone in a Congregation
Needs to Know 20081102 Ver. 3.2
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This presentation covers the basic issues facing
veterans recently returned from combat and the
people who interact with them.
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The Typical Timeline

• A returning servicemembers experience most often
  follows this pattern
• 2 weeks to a month The Honeymoon is when the
  servicemember, family, friends and co-workers are
  living in an unrealistic state of gratitude and
  potential problems can be easily overlooked.

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The Typical Timeline, cont.

• A month to 2 or 3 In the Readjustment, the
  Honeymoon ends and grappling with the reality of
  the new situations and relationships creates a
  new normal pattern of life for the
  servicemember and those around him/her. Some
  friction and conflicts are inevitable in the
  phase.

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The Typical Timeline, cont.

• After about 3 months The New Normal the
  phase when readjustment has completed and, except
  in cases where there are significant stress
  disorder issues, this will be the new life
  situation that will be normal for the
  servicemember, family, friends, and co-workers.

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When there are stress disorder issues

• The Typical Timeline will not occur
• Signs and symptoms of stress disorders will
  become noticeable
• It is vital that people around the servicemember
  know the signs and what to do

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A definition of psychological trauma from combat
stress

• There has been exposure to an event in which
  both of the following were present
• 1. The person experienced, witnessed, or was
  confronted with an event or events that involved
  actual or threatened death or serious injury, or
  a credible threat them.

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• 2. The persons response involved intense
  fear, helplessness or horror
• Adapted from The Diagnostic and Statistical
  Manual of Mental Disorders, 4th Edition--Text
  Revision, 2000, published by the American
  Psychiatric Association

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Military personnel who have served in Iraq,
Afghanistan, and other recent US military
operations may have experiences that meet these
criteria. This includes returning Reserve and
National Guard personnel as well as those
recently discharged from active duty.
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Only a relatively small percentage of returning
veterans will have full PTSD which requires
major treatment or counselingbut lower levels of
symptoms may occur. Here are the symptoms that
may be present. If a veteran exhibits several of
these, PTSD or a related problem may be present
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• Nightmares
• Flashbacks (vivid total awareness)
• Intrusive memories (less intense than flashbacks)
• Cue-related distress (gunshot type sounds may
  cause the victim to drop flat on the ground, for
  instance)

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• Physiological reactivity following the presence
  of reminders (increased heart rate, sweating,
  the shakes, etc.)
• Sexual dysfunction (unusual decrease or increase)
• Sleep disturbance/restlessness (especially the
  inability to achieve consistent restful sleep)

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• Emotional estrangement from loved ones
• Emotional numbing that prevents the interactions
  that were normal before
• Decreased interest in pleasurable or usual
  activities such as hobbies or outside interests
• Psychogenic amnesia (blanking out some of the
  traumatic events)

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• Hyperstartle/Hypervigilance (oversensitivity
  extreme jumpiness)
• Extreme irritability or anger outbursts
• Decreased concentration
• Increase in use of alcohol or other drugs
• Mixing alcohol with prescription pain or mood
  altering medications

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• There is a possibility of PTSD if several of
  these symptoms
• Occur one month or more after leaving the
  combat stress environment
• Last more than one month
• Interfere with normal functioning in
  family, work or other important life activities

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It is NORMAL for veterans to experience some
symptoms of stress disorders. For most people,
these will be relatively few and will begin to
diminish within a month or so after return from
the combat environment and the symptoms will not
significantly interfere with normal daily life.
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PTSD Other Stress-caused issues
It is very important to remember that a vet may
have some stress disorder problems and not have
full PTSD. As the next slide shows, there a many
complex variables in stress disorders.
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Stress that produces chronic problems can be

• Lower intensity, longer duration
• Carried over from previous settings and multiple
  deployments
• Increased by declining health, emotional status,
  and spiritual condition
• Be stressful one time and not the previous or
  next time The Battle that causes the main
  problems may be the first, last or middle one or
  a combination

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And another concern

• There is a condition called mild traumatic brain
  injury (mTBI).
• A blow to the head (even wearing a helmet) or the
  trauma from an explosion can cause a concussion
  and an mTBI even if the person did not become
  unconscious.

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• An mTBI may produce some of the same signs and
  symptoms as PTSD or another stress disorder.
• Only a skilled clinician can determine exactly
  what is causing a person to have symptoms and a
  number of medical tests may be required.

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The Bottom Line is If there has been any
significant, long-enduring change in the vets
behavior or personality from before combat to
after, and if that change interferes with normal
life functioning, then, the possibility of a
stress disorder should be investigated.
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• What are the appropriate responses?
• Pray for peace and healing for the veterans and
  their loved ones.
• Tell the veteran that you know you cannot really
  understand what they have experienced but that
  you want to do what you can to help.
• Encourage the veteran to contact a combat stress
  specialty clinic or program.

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Please do not be discouraged by this bit of
information It has documented that veterans
often cannot really communicate about their
traumatic experiences with people who have not
been there. Vets can talk to other combat
vets, but it may be quite difficult for them to
have similar conversations with non-vets.
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So it is best to contact mental health
professionals or clinics that are experienced in
dealing with combat veterans. This is because
the symptoms of combat stress disorders often
mimic other disorders. An experienced combat
stress counselor can sort this out most
effectively. The next two slides give some
excellent resources to contact
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• Resources
• The mental health service at any Veterans
  Hospital or Vet Centerfind them on the Internet
  at
• www1.va.gov/directory
• MilitaryOneSource
• 1 800 342-9647
• www.militaryonesource.com

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If the previous resources are not accessible

• try contacting the military hospital behavioral
  health clinic or the office of the base chaplain
  at the nearest military installation. Ask them
  if they can provide referral to a nearby combat
  stress assistance program.
• A directory to all US military bases can be found
  at
• www.military.com
• Just click on Military Bases found in the middle
  of the listings on the left side.

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In summary, we know that combat stress disorders

• Need not be full PTSD to be a problem
• Can be minimized by early recognition
• Have symptoms that most people can recognize if
  they know what to look for
• Should be referred to counselors and groups
  dealing specifically with combat stress

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Another excellent resource

• The Web site www.battlemind.com has an excellent
  interactive video program on stress disorders.
  There are also downloadable resources for
  veterans, family/friends, and leaders.
• This site is highly recommended.

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Contact information

• This presentation was prepared by
• The Rev. Dr. Michael T. McEwen, a recently
  retired Army Chaplain (Lt. Col.), using materials
  he originally developed while he was on the
  faculty of the US Army Medical Center and School.
  He may be contacted at
• michael.mcewen_at_us.army.mil