ICARUS Online in the News


At the beginning of the week I was interviewed by a journalist from my local paper the Press and Jornal and talked about the work that me and David Bellamy are doing to help bring change to the military charities sector and also to speed up access to treatment for veterans, uniformed services & their immediate families.

Have a read and please share.

Thanks

https://www.pressandjournal.co.uk/fp/news/aberdeenshire/1438690/turriff-based-ex-marine-sets-up-new-helpline-for-former-military-personnel/

The Importance of Accurate Diagnosis of Post Traumatic Stress.


As a specialist in trauma and Post Traumatic Stress, I read and research constantly for new information and treatment options in order to provide the best possible options for each person I have the fortune of working with.
 
The difficulty can be is that most individuals with PTSD suffer from other mental disorders as well. Studies of the prevalence of PTSD in large samples have found the following mental disorders are most likely to be co-morbid with PTSD:
 
  • Major Depression
  • Substance Use Disorders
  • Dysthymia – persistent mild depression
  • Agoraphobia
  • Obsessive-Compulsive Disorder
  • Generalised Anxiety Disorder
  • Panic Disorder
  • Somatisation Disorder – extreme anxiety about physical symptoms such as pain or fatigue
  • Antisocial Personality Disorder
  • Borderline Personality Disorder
  • Adjustment Disorder
  • Phobias
 
It can be challenging to determine whether overlapping symptoms are best conceptualised as being a part of the PTSD constellation of symptoms or whether they should be attributed to another disorder. Differential diagnosis can be especially difficult when disorders other than PTSD are preceded by exposure to traumatic stress.
 
Despite some symptom overlap between PTSD and other disorders, PTSD has a number of unique features that distinguish it from other disorders. DSM-5 provides specific differential diagnosis guidelines in order to help clinicians assign the most appropriate diagnoses. I know there is much controversy over the DSM, however it is useful to have some form of benchmark to work from.
 
The following elements are useful in distinguishing symptoms of PTSD from symptoms of other disorders:
 
  • PTSD symptoms start or get worse after exposure to a traumatic event.
  • Stimuli reminiscent of traumatic events that activate PTSD symptoms are often pervasive and wide ranging, as opposed to singular or highly specific as in the case of phobias.
 
Disorders other than PTSD may be caused, in part, by exposure to traumatic stress. Although stressor exposure is part of the PTSD diagnostic criteria, PTSD is by no means the only mental disorder that may develop in the wake of trauma exposure. Examples of disorders that may develop after or be exacerbated by trauma exposure include adjustment disorder and phobias. Other highly prevalent disorders, such as depression and panic disorder, may also be potentiated by a traumatic stressor.
 
It is important to look at the guidelines for making a differential diagnosis of PTSD versus other conditions that are commonly associated with traumatic stress exposure. PTSD can be distinguished from these disorders by its defining symptom criteria (i.e., to meet criteria for PTSD, individuals must demonstrate a symptom profile that is consistent with the guidelines for PTSD). Additionally, exposure to traumatic stress is a requirement for a diagnosis of PTSD; in contrast, for disorders such as depression, panic disorder and phobias, although symptoms may be associated with a traumatic event, this is not a requirement.
 
This is why it is important to gather information from varying sources using a variety of methods in order to ensure an accurate diagnosis which will enable the best possible treatment for all symptoms for each individual.

Changes In Treatment Approaches For PTSD


Below is an article taken from the APA website that I find extremely interesting and reassuring that the military is not restricting themselves to CBT and EMDR in treating serving personnel struggling with PTSD.

A psychodynamic treatment for PTSD shows promise for soldiers
March 2012, Vol 43, No. 3
Print version: page 11

PTSD
While cognitive-behavioral therapy remains the most well-researched treatment for post-traumatic stress disorder, it doesn’t help all patients. That’s especially true for service members who have been perpetrators as well as victims of violence, says Russell B. Carr, MD, an Army psychiatrist.
“It’s a much more complicated experience, and they often feel a lot of shame in addition to the usual PTSD symptoms,” he says.

For the past six years, Carr has been working with soldiers who haven’t responded to cognitive-behavioral therapy, and he’s developed a new treatment rooted in intersubjective systems theory. This modern take on psychoanalysis pioneered by Robert Stolorow, PhD, posits that the heart of trauma is shame and isolation.
Carr’s therapy, described in the October 2011 issue of Psychoanalytic Psychology, has shown promise helping soldiers who haven’t responded to CBT by addressing the existential dread dredged up by trauma, and the feeling that their entire world has lost meaning. Though Carr’s goals are ambitious, his intervention is relatively short—requiring twice-weekly sessions for up to three months. As a result, the therapist must clearly define goals, keep conversations on track and quickly establish rapport with clients, Carr found.

Short-term therapy—which is typical of CBT, but less common with psychoanalytic approaches—is often the only option in military settings, he says.
“In the military, there is frequently the situation where a patient or therapist is leaving soon,” says Carr. “It’s a transient population, and it limits the length of time we have to work together.”

A key part of intersubjective therapy is helping clients put their feelings around traumatic experiences into words. These feelings aren’t always negative. One patient described in the article found he enjoyed the smell of burning human flesh, and was later horrified and ashamed of his initial reaction. By expressing empathy and not rejecting the soldier, Carr helped the soldier process the experience and reconnect with the civilian world.

Convincing soldiers that a therapist—as well as friends and family—can understand a little of what they are going through lessens their PTSD symptoms, Carr found. In some cases, soldiers even learn from the experience, he says. “Recognizing the fragility of life, you can refocus on what’s important to you, and not waste time on things that aren’t.”
—S. Dingfelder

PTSD Treatment Research Project


As you may well know, I am a therapist, coach and trainer based up in the North east of Scotland and run a private clinic that specialises in trauma and PTSD. I have worked with people from all walks of life and helped them move beyond the PTSD and onto a happy and satisfying life again. PTSD is not restricted to purely the military, it affects anyone that has experienced one or more traumatic events regardless of who you are or what you do and the great thing is that it does not have to last forever, there are ways to resolve the trauma and live a normal life. It is through retraining your brain to process these memories differently that dissolves the physical and psychological symptoms that are caused by the psychological injury that results from the traumatic event/s.

I am now in the final stages of designing a PTSD Research Project up in Aberdeenshire to document the treatment method that I have been developing based on the outstanding work of various leaders in the fields of psychology, psychotherapy, NLP and Neuroscience. My ultimate aim is to have the project independently assessed and use the evidence to generate funding locally in order that the project can then be replicated around the region and help as many people as possible.

I am now starting to look for volunteers for this project and keen for a wide spectrum of volunteers from military and civilian populations. I am very keen for volunteers from all emergency services, however, if you or someone you know would like to participate and receive free treatment for existing PTSD, this needs to have been diagnosed, and I will need your permission to discuss this with your GP and mental health professional if you are currently in their care.

Please email me at simon@simonmaryan.com to arrange an initial meeting to assess whether your participation is beneficial for you or if there are any contraindications that could exclude you from the project.

I will update again when the project is ready to start and provide dates etc.

Simon

Why We Are The Way We Are. The good and the bad of conditioned response.


It’s 4am and I’m awake again at the sound of the car door closing outside the window. My instincts are kicking in with my body and mind ready to respond in the blink of an eye and as I look around the room I realise I’m not in Baghdad or Kabul, Portharcourt or Baiji or anywhere else that is a threat, I’m on my own sofa in the living room of my own house.
My heart is racing as I struggle between two realities not completely sure which one to chose and not always knowing which one I prefer. It’s hard to step away from the chaos, fear and excitement that comes with combat, as crazy as it sounds it can feel more reassuring for a while than the quiet of a so called normal life with a host of new uncertainties that are alien and in their own way just as scary at times.

We were trained for years to respond to threats with a highly calculated, swift and utterly devastating level of aggression and violence on the battlefield, and to be able to turn that aggression down like a dimmer switch. It’s a hard skill to learn and one of many that never leaves you, and like so many it gets confused in the civilian life that we all end up in at some point.

When your brain is so used to high speed threat assessment it is easy for mistakes to be made in the civvy world because we feel constantly under threat as we navigate our new environment and unsure of the new rules of engagement. Sometimes we’re not sure who the enemy is and ironically, particularly in the early days, we are our own enemy. Our mind is struggling to cope, half knowing we can’t respond the way we do but not knowing any other way yet, until we learn what’s acceptable in this new world. And this takes time. Not something given up lightly in a frantically fast and ruthless world that we live in because time is a commodity, it’s precious and people and business hold onto it like it was a newborn child at times, protecting it with every ounce of strength they have.

Being conditioned into who we are has many advantages in both worlds. We are fiercely loyal, we have a work ethic that is second to none, we are extremely adaptable, learn fast and want to learn, we are highly disciplined, fantastic team players and very capable of getting the job done on our own when need be. We make great leaders because we have been trained and led by great men and when the shit hits the fan, there is no one else you would rather have by your side.

So when you meet or know someone who is struggling with their own mind as they work to come to terms with physical and/or psychological injuries from their time in the military, please share some of that precious time, allow them a little more of it and some space to come to terms with their new world.

And for you my brothers, when there is no need to brace yourself as the tailgate lowers and there are no more doors to kick in, no more need to try and squeeze yourself into the tiniest rut in the ground as the dirt kicks up all around you, when there are no more explosions that vibrate every organ in your body leaving you deaf, nauseous and disoriented and there is nothing left but deafening silence.

Remember that when the faces come rushing at you in those quiet moments, when you least expect them, with your heart racing as you check your exits and for people who are a threat, it is just your mind and the way you’ve been conditioned to be. Remember the simple things, remember to breathe, and as you breathe in clench your fists and as you breathe out open your hands and flex your fingers till they strain and imaging that you push those faces further away with every breath out. Keep doing this until those faces drift and fade into the distance and when they’re gone relax your hands at your sides and let that complete relaxation in your hands and forearms to flow all the way up to your shoulders, up your neck and into your head and face, then let that relaxation flow all the way down your upper body, through your hips, down your legs into your feet and all the way down to the ends of your toes. Remembering to breathe slowly as you do this.

You may well find this takes a bit of practice, as crazy as this sounds, but we all do it from time to time, we forget to breathe when we are stressed, under pressure and we tense up. So when you catch yourself tensing up like this, even if there are no faces to push away, just practice it like any other skill you’ve learned and create a new conditioned response when you feel stressed and threatened on any way.

Just as in the military and on operations we have each others back, well I have your back now. If you need to speak to clear your mind and get things off your chest then get in touch with me either on Facebook or my email, simon@simonmaryan.com and we can arrange a time to chat. We need to look out for each other just as much in this civvy world as we did in the military and sometimes more so. Despite retiring from that old world we will always be that band of brothers and that loyalty does not need to fade because we are not side by side physically anymore, technology has seen to that and made the world a much smaller place. So let’s take advantage of that and keep each other safe.

On that note ladies and gentlemen spoofers, I believe I am done.
Simon Maryan

Per Mare Per Terram

Life Design


For a long time I thought I was happy with my job, I was doing what I’d set to do in joining the Royal Marines. I worked with like-minded people, got paid to stay exceptionally fit, got fed four times a day and was provided with a roof over my head. The trade-off was that I was expected to do what I was told do whether I liked it or not and, some of the things I was asked to do I really didn’t like. However I was still happy living my dream.

Or so I thought.

Continue reading Life Design

Hypnosis and the Brain – Body Connection


I found this article on research at Stanford University School of Medicine that has identified three specific areas of the brain that are altered by hypnosis. It goes on to explain how effective hypnosis can be in using our minds to control our perception and our bodies and also, that there is a brain-body connection that helps the brain process and control what’s going on in the body.

So many benefits to using hypnosis to your advantage.

http://med.stanford.edu/news/all-news/2016/07/study-identifies-brain-areas-altered-during-hypnotic-trances.html

Key to Your Mind.001

A Day In the Life of a Dad With Combat Related PTSD


img_0257

I have spoken to and worked with many serving military personnel and veterans with PTSD and have heard some horrific stories that match some of my own. I never ask for any content of stories and just allow them to tell me what they need to say out loud, in their own way.

There are surprisingly innocuous triggers for flash backs, which is one of the many frustrating aspects of PTSD. Those who suffer with it find themselves getting lost in a flash back from minor little daily events that have no apparent connection to anything they have experienced. This recollection is from someone with PTSD and will hopefully go someway to help you understand what PTSD sufferers can be going through on a daily basis.

Continue reading A Day In the Life of a Dad With Combat Related PTSD

PTSD and Hypnosis


Over the last year I have been conducting my own meta-analysis of the efficacy of hypnosis in the treatment of a wide variety of different conditions (47 in total) as you can see below.

Hypnosis Research Articles

With my area of expertise being PTSD and Trauma, I could not miss an opportunity to dig deeper into this field and as with all the other subjects, I found that hypnosis either outperformed other modalities or greatly enhanced their performance in the treatment of the illnesses and conditions listed in my research. The papers and articles referenced in the links are available for you to read at your leisure and make your own conclusions, however, in the course of my research I have reinforced and deepened my understanding and belief that hypnosis is a hugely powerful form of treatment for so many afflictions of the human mind, body and spirit.

Study 1: Hypnosis and Combat-Related Post Traumatic Stress Insomnia (Hypnosis As Effective or Better Than Ambien)

Hypnotherapy in the Treatment of Chronic Combat-Related PTSD Patients Suffering From Insomnia: A Randomised, Zolpidem-Controlled Clinical Trial

http://www.medecine.ups-tlse.fr/du_diu/fichiers/ametepe/1212/PTSD_et_Insomnie.pdf
http://www.tandfonline.com/doi/abs/10.1080/00207140802039672

Results: Those in the study given hypnotherapy had improvement in all sleep variables assessed: quality of sleep, total sleep time, number of awakenings during the night, ability to concentrate upon awakening and morning sleepiness. The hypnotherapy group had better quality of sleep, better concentration, and lower sleepiness than the group that received Zolpidem (a prescription insomnia medication sold under brand names such as Ambien). The hypnotherapy group and the group given Zolpidem had equal levels of improvement for total sleep time and number of awakenings.

Notes: This study evaluated the benefits of add-on hypnotherapy in patients with chronic PTSD who were suffering with chronic difficulties in initiating and maintaining sleep, night terrors, and nightmares. Thirty-two PTSD combat veteran patients treated by SSRI antidepressants and supportive psychotherapy were randomised to 2 groups: 15 patients in the first group received Zolpidem 10 mg nightly for 14 nights, and 17 patients in the hypnotherapy group were treated by symptom-oriented hypnotherapy, twice-a-week 1.5-hour sessions for 2 weeks. The hypnotherapy included age regression where participants imagined returning to earlier periods in which normal restorative sleep was present (for example, an exhausting day of games with friends during childhood). All patients completed the Stanford Hypnotic Susceptibility Scale, Form C, Beck Depression Inventory, Impact of Event Scale, and Visual Subjective Sleep Quality Questionnaire before and after treatment.

International Journal of Clinical and Experimental Hypnosis, Vol. 56, Issue 3, 2008
By: Eitan Abramowitz, Yoram Borak, Irit Ben-Avit et Haim Y. Knobler, Israel Defense Forces, Mental Health Department, Israel

Study 2: Hypnosis for PTSD in Children Traumatized by Death of Close Relatives
Hypnotic Treatment of PTSD in Children Who Have Complicated Bereavement.

http://www.asch.net/portals/0/journallibrary/articles/ajch-48/iglesias.pdf

Results: Following the single session hypnosis, the mother reported significant improvements in her son’s skin with noticeable changes in itching, irritation, and swelling. The dermatologist was impressed with the child’s recent progress. According to the mother, at follow up, her daughter was feeling increasing relief from the abdominal discomfort. She was no longer debilitated by pain, which had narrowed her range of activities. Follow-up a month later was conducted by phone with the mother and she reported that both children had recovered completely from the debilitating somatisation (that is, the production of recurrent and multiple medical symptoms with no discernible organic cause) features. The children were no longer demonstrating intrusive morbid ideations of the course of their father’s death and were no longer experiencing obsessive preoccupations over the degree of terror and agony their father must have endured during the course of the traumatic events that led up to his death. The mother indicated that at this juncture both children were also able to reminisce about happy times with their father. The mother at this follow-up also reported the restart of grief in both children and assured us that her family would offer comfort for their mourning. (Note—It was suspected that the traumatisation/PTSD had been interfering with the children’s ability to complete normal grieving and move on, so this was a good sign.)

Notes: This paper reports on two cases where children were suffering from Post Traumatic Stress Disorder (PTSD) as a result of the traumatic death of close relatives in rural Guatemala. The normal grieving process had been inhibited due to the horrific nature of these deaths and the children’s grief had become a pathological psychiatric disorder. Both children were only treated with a single session of hypnosis involving the Hypnotic Trauma Narrative (a protocol the authors developed specifically to help children deal with situations like this). There was a follow-up one week later and again after two months when the authors noted that the children’s symptoms had cleared and they were now beginning to grieve in a normal fashion.

The hypnotic induction consisted of simply asking the children to close their eyes. The following “Hypnotic Trauma Narrative” was then used: You’re old enough to know that when you look through telescope things that are far away look much closer. Important events in our lives can also be viewed as though you were looking through a telescope that brought them close to you. When you do that, you gain access to even the minutest details of the image that you are examining. At that point, you could see more than you need to see and could become stuck with certain images and unable to let them go. This can be overwhelming because the details that you seem stuck on are upsetting and hurtful. There is an alternative—you can turn the telescope around and view the same picture form the wide lens and then things can seem very, very far away. When that happens, you may not realise it, but many details of the image that you are examining get lost and are no longer available. Events that take place in life can be examined from either end of the telescope…. Now, I ask that you see yourself looking through the wide lens of a telescope at events that have taken place in your life, that need to be viewed from a less painful perspective, so that you can be well again. Look through the eye of your mind into the wide end of the telescope. This offers you the ability to see things in a far away, far away, far away space, place, and time.

By placing them far away, you’re able to see them in a more manageable fashion and elements of that image that used to upset you, are no longer so noticeable. Of course, horrible events in our lives do not simply disappear, but with the passage of time the details of the painful event get blurry, you start forgetting, and your mind makes room for current memories. Your mind is also capable of giving you a picture of yourself a week from today, a month from today, three months from today, and even a year from today…It’s fun to be able to look ahead and to get a glimpse of what our lives will be like in the future. As we now look ahead…. and I wonder if you are able to project ahead a week…. I wonder if you can move ahead a month or two or three, and I wonder if you are old enough to be able to see a year into the future. As you look ahead, no matter how far into the future, you find yourself able to accept all of the happy memories that you have not given yourself the opportunity to enjoy. As you put everything that is painful in its proper perspective, you grow and strengthen inside, as well as outside, and you become more mature and older. Also, any complaints that your body has been voicing that are no longer necessary can quietly follow in the same direction as the images that you are looking at through the wide lens of the telescope. As these complaints become a thing of the distant past, never to trouble you again, you become well and able to move ahead with the assignments that are appropriate for someone your age.

Am J Clin Hypn. 2005 Oct-2006 Jan;48(2-3):183-9
By: A. Iglesias, Virginia Commonwealth University

Study 3: Hypnosis for “Complex Trauma” PTSD (such as from childhood abuse, sexual assault, and domestic violence)
Hypnosis For Complex Trauma Survivors: Four Case Studies

http://bscw.rediris.es/pub/bscw.cgi/d4438997/Poon-Hypnosis_complex_trauma_survivors.pdf

Results: Data from self-reports, observation and objective measures indicate a significant reduction in the trauma symptoms of these four subjects after hypnosis treatment.
Notes: This report describes the use of hypnosis to help four Chinese woman who were suffering from complex trauma. Two were victims of sexual abuse when they were children, the third had been raped and the fourth had been repeatedly battered by her husband. The hypnotic treatment involved three steps: “stabilisation, trauma processing, and integration.” Hypnosis was first used to help stabilise the victims. Then age regression techniques were used to help them to remember the traumatic events that led to their condition (and to begin to distance themselves from these memories). Finally, hypnosis was used to help them integrate and consolidate the gains they had made. When their treatment was finished they were all assessed by various self-reported and objective measurements. These all indicated that they experienced a significant reduction in their symptoms as a direct result of this hypnotic treatment. One key thing to note is that the researchers comment that adequate rapport and explanation about hypnosis must be provided before clients feel comfortable to use the tool, especially in survivors of childhood abuse who tend not to trust people easily.

Am J Clin Hypn. 2009 Jan;51(3):263-71
By: Maggie Wai-ling Poon, Clinical Psychologist, Social Welfare Dept. Hong Kong

Study 4: Hypnosis for PTSD in Immigrants who Escaped to America After Being Tortured, Raped and Abused
Indirect Ego-Strengthening in Treating PTSD in Immigrants from Central America.

http://www.readcube.com/articles/10.1002/ch.227?locale=en

Results: This report focuses on the limitations of conventional therapy to help these individuals and it presents two ego-strengthening techniques involving indirect hypnosis that have proved helpful in treating this population.

Notes: As a result of civil war in Central America many refugees escaped to America suffering from PTSD as a result of being tortured, raped and abused.
Contemporary Hypnosis Vol. 18(3):135-144

By: G. Gafner, S. Benson, Southern Arizona Veterans Affairs Health Care System, Tucson Arizona; Progressive Insurance Employee Assistance Program, Temple, Arizona

Please feel free to comment and discuss the findings and any experience you have had either personally with PTSD and Trauma or in treating people who are struggling with it, as I would love to hear about different experiences and view points.

A Look At the Link Between PTSD and Substance Abuse


Post Traumatic Stress is an extremely emotionally debilitating state resulting in intense anxiety, intrusive memories and vivid flashbacks that interfere with daily life.

Often individuals with Post Traumatic Stress turn to drugs and/or alcohol as a way to numb their emotional and psychological pain or to gain some measure of control in their lives. Unfortunately, chronic substance abuse creates a complicated Dual Diagnosis through the co-existence of a serious psychiatric disorder and an addictive disorder. Recovering from this Dual Diagnosis requires a careful exploration of the causes of Post Traumatic Stress, combined with treatment for drug or alcohol addiction.

What Is Post-Traumatic Stress Disorder?

PTSD is a condition in which an individual experiences extremely high levels of stress and/or anxiety after witnessing or being involved in a traumatic event in which physical or psychological trauma that leaves the individual feeling powerless and out of control can lead to PTSD. The most common causes of the condition include:
• Military combat
• Violent assault
• Natural disasters
• Sexual assault
• Childhood abuse

The nightmares and flashbacks experienced with PTSD tend to be based around incidents that have never been fully resolved in the individual’s psyche. For example, a soldier who survived an ambush and his friends and colleagues died may well have flashbacks related to that incident as a way to work through unresolved guilt, anger and fear. A child who felt powerless while being sexually abused by an older relative might develop and grow up living with constant intrusive feelings of helplessness, guilt and revenge.
In women, sexual abuse is one of the most common causes of PTSD and addiction. Combat is another common reason for PTSD, especially in men and this will only continue to increase as a result of Iraq and Afghanistan. In Vietnam veterans seeking treatment for PTSD, between 60 and 80 percent also require treatment for substance abuse and in the UK veterans of the Falklands and Northern Ireland are now displaying signs and symptoms of PTSD, with a growing number living homeless and committing suicide. Many are struggling with alcohol and drug addictions that complicate their situation further. Veterans of WWII never received any form of treatment and still suffer 70 years on.

Symptoms of PTSD include nightmares, flashbacks, avoidance of situations, thoughts and anything related to the event, severe anxiety, sleeplessness, aggressive behaviour and often severe and aggressive mood swings. These symptoms can strike the individual at any time, mainly when that person is reminded of the events in question and this doesn’t have to be consciously reminded.

People who meet the diagnostic criteria for PTSD and substance abuse often experience other serious disorders, such as:

  • Depression
  • Mood disorders
  • Panic/anxiety attacks
  • Attention deficit disorder
  • Chronic pain
  • Chronic illness such as diabetes, liver disease or high blood pressure

The symptoms of PTSD can be divided into three main categories:

  • re-experiencing the traumatic incident
  • avoiding experiences that evoke memories of the incident
  • symptoms of hyper-arousal, such as irritability, anger or extreme anxiety. People who experience these symptoms for at least one month can potentially be diagnosed with PTSD. Alcoholism and drug abuse fall into the category of avoidance symptoms, as the person may use these substances to avoid intrusive/traumatic memories or to numb fear.

When alcohol or drugs are used to cope with PTSD symptoms, the symptoms become more severe. As a central nervous system depressant, alcohol worsens depression and anxiety and disrupts normal sleep patterns. Under the influence of alcohol, someone with PTSD is more likely to engage in risk-taking behaviour, such as driving under the influence, or to become aggressive and/or violent towards other people.

This is a significant reason why PTSD and substance abuse often lead to legal problems, incarceration, poverty, broken homes and chronic unemployment. Getting the right treatment for this Dual Diagnosis early on can make the difference between an individual leading a satisfying, healthy life, or, losing their relationship, their job, home etc.

PTSD and Addiction
Symptoms or PTSD can be extremely real, vivid and distressing and because they place such a huge amount of stress on the person, many people with PTSD feel unable to cope and turn to drugs or alcohol as a means of escaping a distressing, altered reality. Self-medication has led to very high percentages of PTSD suffers with alcohol dependence (over 50 percent) and drug dependence (over 30 percent).

A large part of the cycle is the endorphin withdrawal process, which plays a large part in the use of alcohol or drugs to control the symptoms of PTSD. When a person experiences a traumatic event, their brain produces endorphins — neurotransmitters that reduce pain and create a sense of well-being — as a way of coping with the stress of the experience. When that experience is over, their body experiences an endorphin withdrawal, which is very similar and has the same symptoms as the withdrawal from drugs or alcohol:
• Anxiety
• Depression
• Emotional distress
• Physical pain
• Increased cravings for alcohol or drugs

According to Alcohol Research & Health, many with PTSD will turn to alcohol as a means of replacing the feelings brought on by the brain’s naturally produced endorphins. However, the positive effects of alcohol are only temporary.

With an increased use of alcohol, the person can become chemically dependent on the drug and as such will need more alcohol or drugs to continue to produce those numbing effects that temporarily relieve their symptoms. Eventually, dependence can turn into addiction, which is characterised by compulsive use of the substance, tolerance to the drug and an insistence on abusing the drug in spite of its devastating effects. The use of alcohol to numb PTSD symptoms leads to a vicious cycle. Drinking alcohol worsens the fear and anxiety of PTSD, which leads to the release of endorphins. As the effects of the endorphins subside, the individual needs more alcohol to escape the nightmares and flashbacks of PTSD. Anti-addiction medications like naltrexone, an opioid antagonist, can block the positive effects of alcohol, breaking this destructive cycle. Naltrexone, buprenorphine, acamprosate and other anti-addiction drugs can be used in the treatment of PTSD and substance abuse to reduce the overwhelming cravings that lead to relapse.
Hypnosis has also proven highly effective in the treatment of PTSD in enabling a person to relax, calm their body and mind, remove cravings, strengthen ego and build confidence, as well as deal with traumatic memories.

Finding Specialised Treatment

Recovering from a Dual Diagnosis of PTSD and an addictive disorder demands intensive support from psychiatric and/or psychological professionals, family members and peers. People who are struggling with PTSD and a substance use disorder can be reluctant to seek treatment or even admit that they need it in the first instance. Many who experience PTSD live with intense guilt and shame caused as a result of the traumatic event and their addictive behaviour may be adding to their guilt, making it even harder to reach out and ask for help.

Once they enter a treatment programme, they may have trouble finding the motivation to use their recovery resources at their disposal unless they have support and encouragement from an integrated treatment team.

Those with a Dual Diagnosis such as PTSD and drug addiction need to work with mental health professionals and addiction experts who understand their special needs. Conventional rehab facilities are likely to be ill equipped to deal with the intense psychological problems brought on by PTSD and equally, a psychiatric facility may not have the counselling and detox programmes available that the individual needs in order to successfully overcome the addiction. What the Dual Diagnosis patient needs is integrated care, where recovery resources are centralised in a single facility, and all the professionals on the treatment team have dealt extensively with Dual Diagnoses in the past.

An integrated treatment plan for PTSD and substance abuse needs to include:

  • Individual psychotherapy/hypnotherapy to teach the client how to recognise and deal with their triggers that lead them towards substance abuse
  • Counselling sessions with other clients struggling with PTSD and substance abuse/addictive disorder
  • Couples/Family therapy and counselling to help strengthen and rebuild relationships and educate family members about the condition and how they can help
  • Help clients build their own support network outside of therapy
  • Discuss medication options as a last resort to get them through the initial early stages if their condition and symptoms are severe

Sources:

http://www.hawaii.edu/hivandaids/The%20Role%20of%20Uncontrollable%20Trauma%20in%20the%20Development%20of%20PTSD%20and%20Alcohol%20Addiction.pdf

http://www.dualdiagnosis.org/post-traumatic-stress-disorder-and-addiction/

http://www.bhevolution.org/public/perspectices_201203.page

http://www.bellwood.ca/programs/post-traumatic-stress/

http://www.recoveryconnection.org/addiction-post-traumatic-stress-disorder-treatment/

http://healthland.time.com/2012/08/15/how-ptsd-and-addiction-can-be-safely-treated-together/

http://alcoholrehab.com/drug-addiction/ptsd-substance-abuse/

http://www.ptsd.va.gov/public/problems/ptsd_substance_abuse_veterans.asp

http://www.recoveryranch.com/articles/addiction-research/post-traumatic-stress-disorder-addiction-ptsd/

http://gsappweb.rutgers.edu/cstudents/readings/Summer/Heffernan_WorkingTrauma/brown_substance.pdf

http://www.combatstress.org.uk/medical-professionals/academic-publications/journal-publications/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4124907/

http://www.helpguide.org/articles/ptsd-trauma/post-traumatic-stress-disorder.htm

http://search.proquest.com/openview/ebb0d5f3fc85e2e1fbff439384205a5d/1?pq-origsite=gscholar

http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.153.3.369?journalCode=ajp

http://onlinelibrary.wiley.com/doi/10.1111/j.1521-0391.1997.tb00408.x/abstract

http://www.sciencedirect.com/science/article/pii/027273589290125R

http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.158.8.1184

http://onlinelibrary.wiley.com/doi/10.1002/jts.2490060409/abstract

http://www.nejm.org/doi/pdf/10.1056/NEJM198712243172604

http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.149.5.664

http://www.sciencedirect.com/science/article/pii/S0924977X03001779

http://psycnet.apa.org/books/10460/

http://archpsyc.jamanetwork.com/article.aspx?articleid=207281

http://journals.lww.com/jonmd/Abstract/1995/03000/Childhood_Trauma_and_Posttraumatic_Stress_Disorder.8.aspx

https://books.google.co.uk/books?hl=en&lr=&id=MFyEg007YEIC&oi=fnd&pg=PR1&dq=Combat+Stress+%2B+PTSD+%2B+Substance+Addiction&ots=ctPJqC2rSF&sig=iJPUmuMzIVOdZqBDMFX13PmKrvs#v=onepage&q=Combat%20Stress%20%2B%20PTSD%20%2B%20Substance%20Addiction&f=false

http://archpsyc.jamanetwork.com/article.aspx?articleid=495250