veterans

K9s For Warriors - Because Together We Stand

Scott Smith
Sep 14, 2018

Soldier, take me from this shelter’s cage.
Give me back my life. In return, I’ll cover your back.
I’ll be your canine warrior, your sixth sense.
I’ll stand guard into the night and chase the demons away,
the uninvited, cloaked in night sweats and darkness. 

I will help you open your cage of solitude
then walk tall by your side into the light of day. 
Together, our faith will rise as tall as your soldier’s pride. 
We are now family in this post-911 world. 
Because together, we stand.

-Bridget Cassidy

MEET JAMES AND DUNKIN

James Rutland is a 12-year Army veteran who served a tour of duty in Iraq in 2004, followed by two more tours in South Korea. He left the military in 2014, suffering from multiple medical conditions related to his service, including mild traumatic brain injury (TBI), sleep apnea, and hearing loss, to name a few.

Most importantly, he suffered from depression and often thought about suicide. Thinking he could do it alone, Rutland tried healing from the trauma on his own. That wasn’t working. “If you do what you’ve always done, you’ll get what you always got,” says Rutland.

What Life Without Dunkin?

  - James Rutland of K9s For Warriors 

In 2016, Rutland finally rounded the bend of recovery when he was paired with his service dog, Dunkin. “I started focusing on "we instead of "me”, says Rutland. 

He has a semi-colon tattoo on his right wrist, a known symbol of taking a pause when thinking about suicide. Unlike a “period” which ends a sentence, the semicolon creates a pause, for the reader, then continues the story. Rutland wears it proudly. "It's a great conversation starter," Rutland says. 

He goes on to explain that breathing, family, friends, and the program that gave him Dunkin are what keeps him going.

THE PROGRAM: K9S FOR WARRIORS

K9s For Warriors is a BBB accredited charity organization located in Ponte Vedra, Florida, that has been pairing rescue dogs with traumatized soldiers since 2011. The dogs are trained to be service dogs, specifically performing tasks to quiet the symptoms of war trauma disabilities in soldiers. 

“The skillsets our dogs learn help these warriors with anxiety, isolation, depression, and nightmares,” says Shari Duval, the founder of K9s For Warriors. “So, the warriors can function again in public.”

Specifically, the dogs are trained to deal with symptoms of Post-traumatic Stress Disorder (PTSD), traumatic brain injury (TBI), or military sexual trauma (MST), as a result of military service on or after 9/11.

K9s For Warriors sees it as two battles: fighting the past of the dog and fighting the past of the warrior. We’re saving two lives here. 

-Brett Simon 

K9s For Warriors veterans walking with their service dogs

Duval started the program after watching her son Brett Simon suffer from PTSD after he returned from Iraq. Simon did two tours, developing PTSD during the first one. Watching her son suffer from the debilitating condition motivated Duval to research alternative treatments to the standard talk therapy and medication, neither of which worked for her son.

“On average, soldiers take 14 meds a day to treat PTSD, TBI, or MST,” says Duval. If treatment is not working, she says veterans are prescribed more and more drugs. “I even knew one soldier who was taking 44 meds per day.”

After two years of researching alternative PTSD treatments, Duval came upon a program that paired service dogs to alleviate their PTSD symptoms in veterans. 

According to Simon, “Mom was the one that suggested I use a service dog to deal with my PTSD when nothing else worked.” Duval saw her son’s symptoms begin to improve. She then wanted to help other veterans do the same.

Thus, the K9s For Warrior program was born. With her son’s background in training dogs, including 13 years as a canine police officer, Duval convinced Simon to start the nonprofit together.

To date, the program has rescued more than 850 dogs and 440 military service members, with an astounding 99% program success rate.

Based on a recent Purdue study, the organization’s mission seems to be making a difference in the lives of warriors.

WHAT IS PTSD?
PTSD is classified as a mental disorder that develops after a person experiences severe trauma as a result of a traumatic event such as warfare, sexual assault, auto accident, or other severely traumatic events. PTSD symptoms are re-experiencing, avoidance, arousal, and negative changes in beliefs and feelings. The disability manifests itself in depression, anxiety, night terrors, and social embarrassment resulting in isolation. Many individuals have initial symptoms while others can worsen, requiring treatment.

According to the Department of Veterans Affairs (VA), it is common to have reactions such as upsetting memories of an event, increased anxiety, or trouble sleeping after experiencing a traumatic event. If these reactions do not go away or worsen, then the individual may have PTSD.

Along with TBI and MST, PTSD is recognized under the American Veterans Aid (AVA), the Department of Justice through the American Disabilities Act (ADA), and the Veteran’s Association of America (VA). The Department of Defense (DoD) is also strongly committed to providing service members and families with access to quality mental health care and resources for all mental health conditions including PTSD. 

I appreciated the willingness of K9s for Warriors to open their doors to research and science.

-Dr. Maggie O'Haire

PILOT STUDY AFFIRMS ANTICIPATED OUTCOME

K9s For Warriors recently partnered with Purdue University College of Veterinary Medicine on a pilot study testing the effectiveness of service dogs as a complementary treatment for military members and veterans who suffer from PTSD. Dr. Maggie O'Haire, assistant professor of human-animal interaction, along with Kerri E. Rodriguez, research assistant, conducted the study and published the findings earlier this year.

The study had a total of 141 participants from the K9s For Warriors’ program or individuals on the program’s waiting list. Half of the program's participants had service dogs; the other half did not.

The study found that PTSD symptoms were significantly lower in veterans with service dogs, demonstrating that service dogs are associated with lower PTSD symptoms among war veterans. “The initial findings showed lower depression, lower PTSD symptoms, lower levels of anxiety, and lower absenteeism from work due to health issues,” says Dr. O'Haire.

Each morning, she measured levels of cortisol - a stress hormone, in each participant; an increase of the hormone in the morning is indicative of a healthy level or curve. We tend to see a rise in cortisol immediately after waking up. “We call it the morning rise”, says Dr. O'Haire. 

Dr. Anantha Shekhar, Director of Indiana Clinical and Translational Sciences Institute, and professor at Indiana University School of Medicine was the lead researcher on the grant at the university. "Service dogs are a great resource for veterans to modulate their own reactions and to cope better with symptoms of PTSD,” says Dr. Shekhar.

Dr. Timothy Hsiao, a Yale graduate, as well as the Program Director of the National Center for Advancing Translational Sciences (NCATS) at the National Institute of Health (NIH) awarded the NCATS award to Dr. O’Haire as a KL2 Scholar under the CTSA Career Development Award.

“This is an innovative approach to a serious medical issue,” said Dr. Hsiao. “This study highlights the unique skills that the CTSA Program Hubs and their KL2 Scholars bring to address difficult conditions like PTSD.”

Other key findings (in a related study) included a significant reduction in suicidal thoughts, required medication (not suggested by K9s For Warriors),  night terrors, and an increase of three to four more hours of sleep per night. That is, in part, due to the fact that the service dogs are trained to wake up the warriors when experiencing night terrors. Purdue University is currently studying this behavior and although it hasn't been substantiated scientifically, it has been reported by K9s For Warriors anecdotally. 

Dr. O’Haire has been granted additional funding from NIH to perform a large-scale study on the efficacy of service dogs as a complementary treatment of PTSD symptoms in military members and veterans. The study is scheduled to be completed in 2019.

THEY RESCUED EACH OTHER

Her senses were always up, in a constant state of fight or flight, ever since that day in May of 2012. Tiffany Baker, an Army National Guard soldier, was traveling in a Mine-Resistant Ambush Protected (MRAP) vehicle while stationed in Afghanistan when it hit a 250-pound IED. The bomb was so powerful, it rolled the heavily-enforced vehicle.

Baker sustained major physical injuries, requiring four hip surgeries the next year. She also suffered a traumatic brain injury because of the attack. “I was taking 17 medications between being overseas and then coming back,” says Baker. She was frequently going to the VA, seeing a counselor, psychiatrists, and psychologists. “They were constantly giving me medications.” She was feeling more and more isolated.

In February 2015, Baker medically retired, saying goodbye to her unit, the 1157 Transportation Company. That same year, she met Buddy through K9s For Warriors.

Buddy had been badly abused and neglected by his owner. Before being rescued, he was found tied to a tree without any food or water. “K9s For Warriors is great at pairing the dog with veterans,” says Baker. She explains that Buddy always covers her back. He’s "got her 6", and he creates a safe barrier between her and other people, allowing her to function in public.

Just as Buddy is my service dog, I am Buddy's service human.

-Tiffany Baker, K9s For Warrior graduate and advocate 

Baker was so taken with Buddy and the K9s For Warriors program that she got involved in supporting the PAWS (Puppies Assisting Wounded Service Members) Act of 2017 that got the VA on board with service dogs helping veterans. The bill directs the VA to carry out a five-year pilot program, providing grant funding to qualifying nonprofits that provide service dogs to military members or veterans who suffer from PTSD after they finalize other traditional treatments. 

Baker actually spoke at a press conference in support of the act. “Going into the public was very difficult,” says Baker. “I’m always watching over my back.”

But Buddy has helped Baker to get back out into the public. Tiffany graduated this past May from Waukesha County Technical College with a degree in business management, and an emphasis in social media marketing.  As Baker puts it, she is like every other broken person whose service dog keeps them going. She says, “I need to get out of bed to take care of him.”

The two rescued each other.

Service dog gazing up at veteran

WAR TRAUMA: THE MONSTER IN THE ROOM

Seventeen years at war with a volunteer military has resulted in U.S. soldiers being deployed multiple times more than any other time in modern history. According to a recent Rand Corporation report, 2.77 million service members have been deployed on 5.4 million deployments since 9/11, with around 225,000 Army soldiers having been deployed at least three times or more.

The DoD reported that between 2000 and September 2017, about 173,000 active-duty service members were diagnosed with PTSD in the military health system, with about 139,000 of those being diagnosed following a deployment of 30 days or more.

According to the DoD, PTSD is treatable, and many service members will recover with appropriate treatment. However, many do not.

It is invisible and causes panic attacks, survivor guilt, anger, etc.

-Brett Simon 

Dr. Andrea Roberts, Research Scientist with the T.H. Chan School of Public Health at Harvard University says PTSD is common in civilian life. “Most PTSD goes untreated,” says Roberts. “Individuals suffering from PTSD have higher tendencies for cardiovascular disease, high-blood pressure, and autoimmune disease (Lupus).”

Roberts went on to explain there are effective treatments for PTSD, including talk therapy or exposure therapy (where a patient is led through the trauma to understand that the event is part of the past and not in the present). Another treatment is prescription medication on its own or in combination with talk or psychotherapy.

HOW K9S FOR WARRIORS IS SAVING LIVES

Take Me from the Shelter’s Cage

According to the American Society for the Prevention of Cruelty to Animals (ASPCA), 670,000 dogs are euthanized each year in the United States. “We take shelter or rescue dogs and turn them into warriors,” says Duval. K9s For Warriors rescues dogs from animal shelters across the United States, particularly local ones including the Alachua County Humane Society, Putnam County Shelter, and Lake City County Shelter.

It takes K9s For Warrior six months to train a dog. They train a total of 120 dogs per year. They rescue most breeds except full-bred Pitbulls, Dobermans, Chow Chows, Rottweilers, or Dalmatians due to insurance restrictions or state sanctions. The service dogs have full public access (with papers) but are not emotional support dogs or pets.

Once the dogs are fully trained, they are ready to be paired with their warrior. As Duval says, “When the dog's healthy, the warrior is healthy.”

As of May 2018, K9s has rescued 870 dogs with 434 dogs becoming service dogs, and the remaining rescues placed for adoption with loving families.

I Got Your 6

The K9s For Warriors program trains rescue or shelter dogs to perform four specific tasks: averting panic attacks, waking warriors from nightmares, creating personal space comfort zones in public situations by standing in front of the veteran (barrier) and reminding warriors to take their medications.

Dogs also learn two other commands: brace and cover. Many warriors suffer physical disabilities as well, so the brace command prepares the dog to assist the warrior with standing, sitting or kneeling. The cover command is used to cover the warrior’s back.

Many soldiers with PTSD do not like people coming up from behind them. In the field, soldiers say to one another, “I got your back” or “I got your 6.” The cover command does just that. The service dog literally becomes the warrior’s sixth sense, by sitting and facing the opposite way the warrior is facing. When someone approaches from behind, the dog wags its tail.

According to Moira Smith of the ASPCA, service animals can also boost the handler’s social and emotional life, in addition to providing safety and autonomy in public. “The dog acts as a bridge for social interaction,” says Smith. She explains that most Americans can’t relate to war experiences, but they are familiar with taking care of a dog as a pet. “It also adds another dimension to their identity.”

Dogs and Warriors Together: Let the Healing Begin

The three-week program is open to veterans or military members who became disabled while serving in the U.S. Armed Forces on or after 9/11. The program costs $27,000 per participant but at no cost to the warrior. If one cannot cover travel costs, K9s pays for travel to and from the facility. To Duval, every military member or veteran who walks through her door is family and is treated with honor and respect. “We bring the warrior home to heal, to a place to regroup, to hit the reset button,” says Duval.

To qualify, a warrior must submit an application and have a verified clinical diagnosis of PTSD, TBI, or MST. All applications go through a full vetting process that takes 2-4 weeks to complete. During that time, a trained service dog is identified that matches the applicant’s specific situation and needs. The organization stays in constant contact with applicants throughout the entire application process, including after approval or while a warrior is put on the waiting list. The waiting period is currently one year.

The dog doesn’t know or care about their diagnoses - they love the handler unconditionally. 

-Moira Smith of the ASPCA

If accepted into the program, the warrior must reside at Camp K9, the organization’s Florida facility, for three weeks. There is one program per month with 12 warriors in attendance. Warriors arrive on a Sunday and are introduced to their canine warriors within 24 hours. “After that, you go nowhere without your dog,” says Simon.

K9s For Warriors believes their program is unique. In addition to matching warriors with service dogs and providing training, certifications, seminars, legal instruction, and housing, they also offer what Duval calls “wrap-around services.” These include lifelong health care and food for the service dogs and ongoing unconditional love and support of the warrior pair.

The program includes grooming, health care, and command classes, among others. Public access classes take warriors out in public with their dogs, to Costco, to the Jacksonville Zoo, to downtown St. Augustine or a restaurant. “They go to places in a high-stress environment to force them to use their dogs,” says Simon. At the end of the program, warriors and their dogs go to a local park and practice all the commands. Before graduating, the pairs take a Public Access test regulated by the Assistance Dogs International (ADI).

ADI sets the standards for training guide, hearing, and service dogs. Sheila O’Brien, the President of the North America Chapter, says, “This is a rigorous process, holding organizations to the highest standards.” According to O’Brien, the committee was formed (with ADI) nine years ago to look at programs that are placing dogs with vets and persons with PTSD to develop best practices.

She went on to explain that the initial purpose of ADI was to meet the physical needs of veterans. “After speaking with vets, we understood they could handle the physical disabilities, but it was the PTSD that was with them 24/7, and that’s where the service dogs provided the most value.”

There are now 72 ADI-accredited programs throughout North America with a total of 17,502 service dog teams formed from accredited programs. Each team must be recertified every five years.

We Are Family

Duval is all about family and serving those she vehemently sees as our nation’s greatest asset: our country’s military members.

Each month, a new family is formed when a warrior takes his or her first step onto the grounds at Camp K9 in Florida. In addition to meeting their dog and dog trainer, warriors meet the “Housemoms,” volunteers who stay in the facility day and night and talk with the warriors about everyday things instead of their military service.

The Housemoms run errands, grocery shop, and take warriors on outings. After graduation, Housemoms continue to stay in touch with the warriors by phone and on social media.

Apart from the Housemoms, K9s For Warriors relies heavily on its volunteers, local businesses, and support from Florida's veteran community. Many of the meals donated to the program come from local restaurants, neighbors, and organizations. Whether it be offering emotional aid to our veterans or helping with kennel enrichment, K9s is readily available to accept new Volunteer Ambassadors.

Service dogs are prescriptions on four legs

-Shari Duval 

At the start, K9s For Warriors operated out of two houses with the dogs in the garages and vets sleeping on couches. "Then our humble beginnings were transformed by Summit Contracting. They believed in our program and built us a beautiful 17,000 square foot facility on nine acres. It was the most incredible gift in the world" said Simon. 

In 2017, Steve Gold and family, gifted The Gold Family Campus to K9s For Warriors. The campus is a 67-acre property featuring a 9-bedroom and 7-bath house. It will be powered by solar panels (worth $1 million), making the campus energy-independent. The facility is currently under construction and will be operational in 2019.

It will allow four more veterans to attend each monthly program, bringing the total number of warriors graduating per month to 16. The campus will also function as the primary facility for female military members and veterans.

An additional facility means more space for Duval and Simon to save lives.

STANDING TOGETHER FOR A BETTER TOMORROW

There are good things in K9s For Warriors’ future.

As previously stated, Dr. O’Haire is partnering again with K9s For Warriors on a more extensive study funded by NIH. The findings will be published in 2019.

The VA is also running a Congressionally-mandated PTSD service dog study that will be completed in 2019. A total of 180 veterans have received either a service dog or an emotional support dog as part of the study. According to a VA spokesperson, after peer reviews, the VA will submit the study and results to the National Academy of Sciences for review, as required by the authorizing legislation (Section 1077 of the 2010 National Defense Authorization Act).

On the legislative side, Simon is working to secure public access identification from Service Dog Credentials, so K9s For Warriors’ service dogs will be recognized by airlines, hotels, and restaurants, bypassing the need for the warriors to provide paperwork or visit the disability office.

The future for K9s For Warriors looks promising as Duval and Simon continue to fight to save lives, both of soldiers and their canine warriors.

Because together, they stand.

https://www.consumersadvocate.org/features/k9s-for-warriors

--------------------------------------------

For more information on PTSD treatment options, visit the U.S. Department of Veterans Affairs, PTSD: National Center for PTSD or the DoD, which encourages service members to ask for help by affirming that seeking help is actually a sign of strength.

Co-Author Bridget Cassidy, Associated Editor

Self-harm, suicide ideation tightly linked in Iraq, Afghanistan veterans

May 8, 2015

Science Daily/Veterans Affairs Research Communications

Non-suicidal self-injury -- that is, purposefully hurting oneself without conscious suicidal intent -- is relatively common among Iraq and Afghanistan veterans, and it is a strong risk factor for suicidal behavior, according to research.

http://images.sciencedaily.com/2015/05/150508091602_1_540x360.jpg

 

Moreover, the study found that those who deliberately hurt themselves were more likely to engage in suicidal behavior. The researchers hope that NSSI could serve as a marker for identifying which veterans are most likely to attempt suicide.

 

For the study, Kimbrel and his colleagues recruited Iraq and Afghanistan veterans at the Central Texas VA Health Care System. The researchers excluded those with schizophrenia or bipolar disorder, but they included a higher-than-average proportion of veterans with PTSD. In the final study group, 35 percent had PTSD, 21 percent had depression, and 8 percent had alcohol use disorder. More than 90 percent of group was male and 67 percent were white.

 

After identifying suicidal ideation via a standardized screening questionnaire, the researchers further classified the participants as having either passive or active suicidal ideation.

 

Passive suicidal ideation could be described, says Kimbrel, as wishing you would go to sleep and not wake up. Active suicidal ideation is characterized by actually thinking about specific ways to end one's life.

 

Kimbrel found that NSSI was most strongly associated with active suicidal ideation. Specifically, Iraq and Afghanistan veterans who reported a history of NSSI were five times more likely to engage in active suicidal ideation, compared with veterans without a history of NSSI.

 

"These are people who are purposefully engaging in bodily harm, but the intent is not to commit suicide," says Kimbrel. "There are many reasons why they do this, but this behavior is associated with increased odds of eventually attempting suicide."

 

Kimbrel points to cutting oneself as the most commonly thought-of form of NSSI. "But there are a wide range of non-suicidal self-injurious behaviors that Veterans might be engaging in that clinicians should be aware of, such as burning or hitting oneself," notes Kimbrel.

 

Another recent study by Kimbrel's team that was published in the Journal of Traumatic Stress in 2014 found that more than half of 214 male Iraq and Afghanistan veterans seeking treatment for PTSD reported engaging in NSSI during their lifetime. Forty-five percent reported NSSI during the previous two weeks.

 

Those same veterans were nearly four times more likely to engage in suicidal ideation, compared with veterans seeking treatment for PTSD but without a history of NSSI.

 

"Among veterans, burning and hitting appear to be the specific forms of NSSI most strongly associated with suicidal ideation," says Kimbrel. Veterans who reported burning themselves were 17 times more likely to engage in suicidal ideation, compared with similar veterans who did not report NSSI. Veterans who reported hitting themselves were nearly eight times more likely to have suicidal ideation.

 

"Obviously, the rates of suicidal ideation that we identified among veterans engaging in these forms of NSSI were much higher than what we typically see among patients seeking treatment for PTSD," says Kimbrel.

 

According to Kimbrel, NSSI may increase a person's capacity to commit suicide. This ties in with a theory originally described by Florida State University's Dr. Thomas Joiner in his 2005 book Why People Die By Suicide. The theory is that suicide essentially requires two components to align, a desire and a capacity.

 

According to Kimbrel, NSSI, along with the kind of violence often encountered in combat, can increase people's capability for suicide by mitigating some of their natural, innate responses to injury.

 

Kimbrel's hope is that by expanding suicidal assessments of veterans to include NSSI information, providers can better identify those at high risk for suicide long before they ever make an attempt.

 

"If we can identify veterans engaging in NSSI early on, then hopefully we can begin to change their trajectory and put them onto a more positive course," says Kimbrel. "There are treatments that can help. The most important thing is to get veterans at increased risk for suicide into treatment as soon as possible."

http://www.sciencedaily.com/releases/2015/05/150508091602.htm

Study adds evidence on link between PTSD, heart disease

March 26, 2015

Veterans Affairs Research Communications

In a study of more than 8,000 veterans in Hawaii and the Pacific Islands, those with posttraumatic stress disorder had a nearly 50 percent greater risk of developing heart failure. The study adds to a growing body of evidence linking PTSD and heart disease. The research to date--including these latest findings--doesn't show a clear cause-and-effect relationship. But most experts believe PTSD, like other forms of chronic stress or anxiety, can damage the heart over time.

 

The study adds to a growing body of evidence linking PTSD and heart disease. The research to date--including these latest findings--doesn't show a clear cause-and-effect relationship. But most experts believe PTSD, like other forms of chronic stress or anxiety, can damage the heart over time.

 

"There are many theories as to how exactly PTSD contributes to heart disease," says Dr. Alyssa Mansfield, one of the study authors. "Overall, the evidence to date seems to point in the direction of a causal relationship."

 

Mansfield was senior author on the study while with the Pacific Islands Division of the National Center for PTSD of the Department of Veterans Affairs (VA). She is now with the VA Pacific Islands Health Care System and also an assistant adjunct professor of epidemiology at the University of Hawaii.

 

The study tracked 8,248 veterans who had been outpatients in the VA Pacific Islands system. The researchers followed them an average of just over seven years. Those with a PTSD diagnosis were 47 percent more likely to develop heart failure during the follow-up period. The researchers controlled for differences between the groups in health and demographic factors.

 

Out of the total study group, about 21 percent were diagnosed with PTSD. Of the total 371 cases of heart failure during the study, 287 occurred among those with PTSD, whereas only 84 cases occurred among the group without PTSD.

 

Combat service, whether or not it led to a full-blown PTSD diagnosis, was itself a strong predictor of heart failure. Those Veterans with combat experience were about five times more likely to develop heart failure during the study period, compared with those who had not seen combat. Other predictors of heart failure were advanced age, diabetes, high blood pressure, and overweight or obesity.

 

The authors of the study say they didn't have access to a full range of data that would have provided further clues as to the PTSD-heart disease link. For example, they were not able to distinguish in the data between those who had served in the Gulf during 1990 and 1991, and those who served more recently in Iraq or Afghanistan. Nor were they able to analyze whether racial or ethnic identity plays a role one way or the other, as that information was not complete for most veterans in study.

 

Nonetheless, the authors point out that the work is the "first large-scale longitudinal study to report an association between PTSD and incident heart failure in an outpatient sample of U.S. veterans."

 

Heart failure, in which the heart grows weaker and can't pump enough blood to adequately supply the body's needs, affects about 5 million Americans in all, with some 500,000 new cases each year. People with the condition feel tired with physical activity, as the muscles aren't getting enough blood.

 

The new results, says Mansfield, provide further potent evidence of the nexus between mental and physical health. The practical upshot of the findings, she says, is that veterans with PTSD should realize that by treating their PTSD, they may also be helping to prevent heart disease down the road.

 

By the same token, the authors point out that VA and other health care systems may need to step up efforts to prevent and treat heart failure among those with PTSD.

http://www.sciencedaily.com/releases/2015/03/150326130958.htm

Mental health providers not well prepared to care for military veterans

November 12, 2014

Science Daily/RAND Corporation

Policymakers have expanded military veterans' access to community-based health providers as a way to meet demands, given capacity constraints in the VA health system. But a new study finds that most community-based mental health providers are not well prepared to take care of the special needs of military veterans and their families.

 

"Our findings suggest that community-based mental health providers are not as well prepared as they need to be to address the needs of veterans and their families," said Terri Tanielian, the study's lead author and a senior social research analyst at RAND, a nonprofit research organization. "There is a need for increased training among community-based providers in high quality treatment techniques for PTSD and other disorders that are more common among veterans."

 

"Veterans and their family members face unique challenges, and addressing their needs requires understanding military culture as well as their mental health challenges," said retired Navy Vice Adm. Norb Ryan, president of the Military Officers Association of America. "It's crucial that our civilian mental health providers acquire the training and perspective they need to guide their practice in the care of our military and veteran population."

 

The study recommends that organizations that maintain registries or provider networks include information about mental health practitioners' ability to properly treat the special needs of military and veteran populations.

http://www.sciencedaily.com/releases/2014/11/141112102638.htm

 

Coenzyme Q10 helps veterans battle Gulf War illness symptoms

November 3, 2014

Science Daily/University of California, San Diego Health Sciences

A high quality brand of coenzyme Q10 (CoQ10) -- a compound commonly sold as a dietary supplement -- provides health benefits to persons suffering from Gulf War illness symptoms, researchers report.

 

In a study published in the Nov. 1 issue of Neural Computation, researchers at the University of California, San Diego School of Medicine report that a high quality brand of coenzyme Q10 (CoQ10) -- a compound commonly sold as a dietary supplement -- provides health benefits to persons suffering from Gulf War illness symptoms.

 

Forty-six United States Gulf War veterans participated in the randomized, double-blind, placebo-controlled study. Each veteran had been diagnosed with Gulf War illness.

 

"Gulf War illness is not the same as post-traumatic stress disorder or traumatic brain injury, signature illnesses of later deployments, which are caused by psychological and mechanical injury, respectively," said Beatrice Golomb, MD, PhD, professor of medicine at UC San Diego School of Medicine and principal investigator on the study. "Evidence instead links Gulf War illness to chemical exposures, such as pesticides or pills given to soldiers to protect them from possible nerve agents. These chemicals can damage mitochondria, which generate the energy our cells need to do their jobs. When these powerhouses of the cells are disrupted, it can produce symptoms compatible with those seen in Gulf War illness."

 

The connection to chemical and toxin exposures is fortified by evidence of mitochondrial problems in affected veterans, said Golomb, as well as evidence showing those veterans who became ill are significantly more likely than others to harbor genetic variants that render their enzymes less effective at detoxifying these chemicals.

 

CoQ10 is a fat-soluble antioxidant made by the body to support basic cell functions, including directly assisting mitochondrial energy production. Over a course of three and a half months, the veterans in the study received a pill form of either CoQ10 or a placebo. Researchers found 80 percent of those who received 100mg of CoQ10 had improvement in physical function. The degree of improvement correlated to the degree in which CoQ10 levels in the blood increased.

 

The researchers reported that Gulf War illness symptoms like headaches, fatigue with exertion, irritability, recall problems and muscle pain also improved.

 

"The statistical significance of these benefits, despite the small sample size, underscores the large magnitude of the effects," Golomb said. "Mounting evidence suggests findings in Gulf War illness are relevant to toxin-induced health problems in the civilian sector, so what we learn by studying health challenges of these veterans, will likely benefit others."

Golomb and colleagues are seeking additional funding to test a more complete "mitochondrial cocktail," which combines CoQ10 with additional nutrients that support cell energy and reduce oxidative damage to cells.

http://www.sciencedaily.com/releases/2014/11/141103121020.htm

Vets' alcohol problems linked to stress on home front

July 31, 2014

Science Daily/Columbia University's Mailman School of Public Health

Regardless of traumatic events experienced during deployment, returning National Guard soldiers were more likely to develop a drinking problem if faced with civilian life setbacks, including job loss, legal problems, divorce, and serious financial and legal problems -- all commonplace in military families. Researchers found having at least one civilian stressor or a reported incident of sexual harassment during deployment raised the odds of alcohol use disorders.

 

Alcohol abuse is a major concern for reservists returning home. Nearly 7% of Americans abuse or are dependent on alcohol, but among reserve soldiers returning from deployment, the rate of alcohol abuse is 14%, almost double that of the civilian population.

 

The study looked at a group of 1,095 Ohio National Guard soldiers who had primarily served in either Iraq or Afghanistan in 2008 and 2009. Over three years, the soldiers were interviewed three times via telephone and were asked about their alcohol use, exposure to deployment-related traumatic events and stressors like land mines, vehicle crashes, taking enemy fire, and witnessing casualties, and any stress related to everyday life since returning from duty.

 

More than half (60%) of the responding soldiers experienced combat-related trauma, 36% of soldiers experience civilian stressors, and 17% reported being sexually harassed during their most recent deployment. Among the group, 13% reported problems consistent with an alcohol use disorder in the first interview, 7% during the second, and 5% during the third. Alcohol use disorder is defined as alcohol abuse or dependence.

 

The researchers found having at least one civilian stressor or a reported incident of sexual harassment during deployment raised the odds of alcohol use disorders. The effect of the stressors was restricted to cases of new-onset alcohol use disorders, and wasn't seen among those with a history of problem drinking. In contrast, combat-related traumatic events were only marginally associated with alcohol problems.

 

The study highlights the important role civilian life and the accompanying stress plays in cases of alcohol use disorder in the National Guard.

 

"Exposure to the traumatic event itself has an important effect on mental health in the short-term, but what defines long-term mental health problems is having to deal with a lot of daily life difficulties that arise in the aftermath -- when soldiers come home," explains lead investigator Magdalena Cerdá, DrPH, MPH, assistant professor of Epidemiology at the Mailman School of Public Health. "The more traumatic events soldiers are exposed to during and after combat, the more problems they are likely to have in their daily life -- in their relationships, in their jobs -- when they come home. These problems can in turn aggravate mental health issues, such as problems with alcohol, that arise during and after deployment."

 

With high rates of alcohol abuse among soldiers, there is a critical need for targeted interventions to help soldiers handle stressful life events without alcohol, the investigators observe. More than 1.6 million service members have been deployed in support of war efforts Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn.

 

"Guardsmen who return home need help finding jobs, rebuilding their marriages and families, and reintegrating into their communities," says Karestan Koenen, PhD, professor of Epidemiology at the Mailman School and senior author of the study. "Too many of our warriors fall through the cracks in our system when they return home. This is particularly true of Guardsmen who do not have the same access to services as regular military personnel. We need to support our soldiers on the home front just as we do in the war zone."

http://www.sciencedaily.com/releases/2014/07/140731095005.htm

Combat Veterans Suffering from PTSD, 'Fear Circuitry' in the Brain Never Rests

May 18, 2013 —

Science Daily/NYU Langone Medical Center

Chronic trauma can inflict lasting damage to brain regions associated with fear and anxiety. Previous imaging studies of people with post-traumatic stress disorder, or PTSD, have shown that these brain regions can over-or under-react in response to stressful tasks, such as recalling a traumatic event or reacting to a photo of a threatening face. Now, researchers at NYU School of Medicine have explored for the first time what happens in the brains of combat veterans with PTSD in the absence of external triggers.

 

Their results, published in Neuroscience Letters, and presented today at the annual meeting of the American Psychiatry Association in San Francisco, show that the effects of trauma persist in certain brain regions even when combat veterans are not engaged in cognitive or emotional tasks, and face no immediate external threats. The findings shed light on which areas of the brain provoke traumatic symptoms and represent a critical step toward better diagnostics and treatments for PTSD.

 

A chronic condition that develops after trauma, PTSD can plague victims with disturbing memories, flashbacks, nightmares and emotional instability. Among the 1.7 million men and women who have served in the wars in Iraq and Afghanistan, an estimated 20% have PTSD. Research shows that suicide risk is higher in veterans with PTSD. Tragically, more soldiers committed suicide in 2012 than the number of soldiers who were killed in combat in Afghanistan that year.

 

"It is critical to have an objective test to confirm PTSD diagnosis as self reports can be unreliable," says co-author Charles Marmar, MD, the Lucius N. Littauer Professor of Psychiatry and chair of NYU Langone's Department of Psychiatry. Dr. Marmar, a nationally recognized expert on trauma and stress among veterans, heads The Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury at NYU Langone Medical Center.

 

The study, led by Xiaodan Yan, a research fellow at NYU School of Medicine, examined "spontaneous" or "resting" brain activity in 104 veterans of combat from the Iraq and Afghanistan wars using functional MRI, which measures blood-oxygen levels in the brain. The researchers found that spontaneous brain activity in the amygdala, a key structure in the brain's "fear circuitry" that processes fearful and anxious emotions, was significantly higher in the 52 combat veterans with PTSD than in the 52 combat veterans without PTSD. The PTSD group also showed elevated brain activity in the anterior insula, a brain region that regulates sensitivity to pain and negative emotions.

 

Moreover, the PTSD group had lower activity in the precuneus, a structure tucked between the brain's two hemispheres that helps integrate information from the past and future, especially when the mind is wandering or disengaged from active thought. Decreased activity in the precuneus correlates with more severe "re-experiencing" symptoms -- that is, when victims re-experience trauma over and over again through flashbacks, nightmares and frightening thoughts.

http://www.sciencedaily.com/releases/2013/05/130518153257.htm

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