USA Veteran Population
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  • 1. THE IMPACT OF PTSD ON VETERANS AND THEIR FAMILIES IN DRUG COURT Joseph Madonia, LCSW-R, CASAC Director, Brooklyn Veterans Treatment Court 1
  • 2. Webinar Logistics  Panel  Questions  Raise hand  Tech Difficulties (800) 263-6317 2 2
  • 3. Presenter: Joseph Madonia, LCSW-R, CASAC Director, Brooklyn Treatment Court This webinar was conducted under the auspices of the Bureau of Justice Assistance (BJA) Drug Courts Technical Assistance Project at American University, Washington, D.C. This project was supported by Grant No. 2010 DC-BX-K087-awarded to American University by the Bureau of Justice Assistance.  The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, and the Office for Victims of Crime. Points of view or opinions in this document are those of the authors and do not represent the official position or policies of the U.S. Department of Justice.  33
  • 4. USA Veteran Population - There are currently 23.8 million Veterans in the USA, from all eras - 7.5% of Veterans are women - Approximately 8% of the American population are Veterans VHA Office of Public Health and Environmental Hazards. Aug 2008 4
  • 5. The Impact of PTSD on Veterans and their Families - Since 2011 more than 2 million service members have been deployed to Iraq or Afghanistan - Mental health and substance abuse disorders caused more hospitalization among US troops in 2009 than any other cause. - PTSD occurs in approximately 30% Vietnam veterans VHA Office of Public Health and Environmental Hazards. Aug 2008 5
  • 6. Drug Courts Veteran Treatment Courts Judges Judges Attorneys: DA & Defense Counsel Attorneys: DA & Defense Counsel Substance Abuse Providers Substance Abuse Providers Probation/Case Managers Mental Health Specialists Administrative Staff Veterans’ Health Care Professionals Law Enforcement Officers Veteran Mentors School Reps & Child Protective Services VA Benefit Coordinators (Technical difficulties: 800. 263.6317) 6 6
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  • 8. What is PTSD? Post-Traumatic Stress Disorder (PTSD): Criteria from DSM-IV-TR may include:      Recurrent recollections distressing dreams acting as if the traumatic event were recurring intense psychological distress at exposure to cues or triggers physiological response to the cues or triggers 8
  • 9. PTSD and Associated Factors  avoidant/numbing  hyper-arousal  Lasts more than a month  functional significance 9
  • 10. PTSD & Women Veterans - May have similar situations to male veterans - May also be caused by sexual assault by fellow soldiers - May be reluctant to disclose sexual assault - Combat Operations - Military Sexual Trauma (MST) - Feeling Alone - Worrying about Family (Technical difficulties: 800. 263.6317) 10
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  • 12. Special Issues for Veterans Who are Lesbian & Gay - “Don’t Ask, Don’t Tell” – recently repealed but guidelines are not in place - Stigma and prejudice - Confronted with the same issues as their heterosexual counterparts. 12
  • 13. What is Depression?  Mood disorder  More than “the blues”  Not a personal weakness  May co-occur with PTSD …….Good news! Treatable Illness! 13
  • 14. Depressive Illness Comes in Various Forms - Can occur suddenly - Triggered by stressful experience - Can be one episode, or recurrent - Some people may not be able to function because symptoms are so severe - Can be chronic & doesn't interfere with functioning - Psychotic symptoms can be found in very severe forms of major depression 14
  • 15. Risks Factors for Suicide  History of suicide attempts  History of multiple related losses  Lack of social support  Loss of employment or insurance  Exhaustion of financial resources  Painful and disfiguring physical deterioration  Reliance on public assistance  Co-existing psychiatric problems  Family history of attempted suicide and major depressive disorder 15
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  • 17. Co-Occurring Disorders  Veterans with 1 disorder relating to alcohol and/or other drugs and one or more mental disorders  Veterans may have a number of cooccurring disorders 1. Alcohol dependence & PTSD 2. Opioid dependence and PTSD and depression (Technical difficulties: 800. 263.6317) 17
  • 18. Common Substances of Abuse by Veterans  Pain killers such as oxycontin or vicodin  Heroin  Alcohol  Mixtures of pain killers, anti-depressants, anti-anxiety medications (some prescribed, some not) 18
  • 19. TBI: Blast Injuries & Veterans Traumatic Brain Injury (TBI)  Primary: exposure generated by the blast itself  Secondary: results from fragments flying through the air  Tertiary: occurs when a person is thrown into a solid object by the blast  Quaternary: may result from severe blood loss or inhalation of toxic gases (DVBIC.org) 19
  • 20. Behavioral Changes You May See in Court - Impulsivity - Lability - Irritability - Tension/anxiety - Depression - Personality Changes 20
  • 21. Observable Cognitive Limitations That You May See In Court Cognitive impairment Executive functioning  Short term memory loss  Inability to set goals  Short term attention span  Inability to finish tasks  Problems w/comprehension  Inability to self monitor  Difficulties in problem solving  Inability to understand abstract concepts 21
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  • 23. Psychosocial Challenges  Difficulties with job or school  Difficulties with family members, including intimate partners  Use of alcohol or other drugs 23
  • 24. Physical Challenges - Hearing or vision loss - Difficulty with balance - Dysarthria - Seizures - Sleep Disturbances (Technical difficulties: 800. 263.6317) 24
  • 25. Children of Veterans  School challenges  Family stressors  Emotional difficulties 25
  • 26. Marital Challenges Spouses of war veterans commonly experience - Tension - Low self-esteem - Loneliness - Confusion - Loss of control and self-blame - Feelings of heavy burden 26
  • 27. Screening and Assessment Tools in Veteran’s Treatment Court - Assessment tool - PTSD Check List (PCL) - The PCL is a 17-item self-report measure of the 17 DMS-IV symptoms of PTSD. The PCL has a variety of purposes, including: • Screening individuals for PTSD • Diagnosing PTSD • Monitoring symptoms - PCL-M (Military version) - PCL-C (Civilian version) 27
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  • 29. A Trauma Informed Approach In A Veterans Treatment Court  Trauma-informed care is an approach to engage people with histories of trauma that recognizes the presence of trauma symptoms and acknowledges the role that trauma has played in their lives.  Start not by asking “What’s wrong with you?” but rather, “What has happened to you?”  -psycho education  -individual therapy  -Medication management  Courtroom procedures may need to be revisited 29
  • 30. Veteran Treatment Components  Detox/Rehab referral  Residential or Outpatient Program  Mental health Services  Health Services  Benefits Counseling  Vocational Services  Mentoring  Continuing Care 30
  • 31. Evidence-Based PTSD Treatments  Cognitive behavioral therapy • Pharmacotherapy • Group therapy  Seeking Safety (Najavitz et al., 1996)  Prolonged Exposure (PE) therapy: It has four main parts: Education, Breathing, Real world practice, and talking through trauma  Cognitive Processing Therapy (CPT) helps you by giving you a new way to handle these distressing thoughts and to gain an understanding of these events. 31
  • 32. Promising Practice  Eye Movement Desensitization & Reprocessing: EDMR is a therapeutic process which will clear troubling emotions and negative thinking linked to trauma and other painful past experiences  Virtual reality therapy Resource: BJA Technical Assistance project @ American University 32
  • 33. Coming in September Interactive 3 part webinar series Neuroscience of Addiction 33
  • 34. Presenter: Joseph Madonia, LCSW-R, CASAC Director, Brooklyn Treatment Court This webinar was conducted under the auspices of the Bureau of Justice Assistance (BJA) Drug Courts Technical Assistance Project at American University, Washington, D.C. This project was supported by Grant No. 2010 DC-BX-K087-awarded to American University by the Bureau of Justice Assistance.  The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, and the Office for Victims of Crime. Points of view or opinions in this document are those of the authors and do not represent the official position or policies of the U.S. Department of Justice.  34 34
  • 35. Thank You for Participating! Don’t Forget – Please complete the survey for today’s webinar Presenter: Joseph Madonia, LCSW-R, CASAC Organizer - Clyde Frederick – Senior Administrative Technologist 35 35