Health Promotion Program Veterans Who Suffer from Addictions and Dual Disorders - Dissertation Example

? Health Promotion Program for Veterans Who Suffer with addictions and Dual Disorders Submission Abstract The primary aim of this program is to provide a clear structure and support steps that can potentially be used to promote the health of Veterans who suffer from additions and dual disorders. The health program will particularly be based on evidenced based therapeutic procedures such as Dialectical Behavior Therapy which are not only effective in the provision of both individualized and group treatment. Consequently this proposal will enable the veteran to handle life stressors, learn coping mechanism along with a nine-step health plan. Health Promotion Program Veterans Who Suffer with addictions and Dual Disorders Introduction Drug addictions and dual disorders are serious mental health problems that often occur together. Health promotion program generally refers to a set of guidelines that can be used to enable individuals to improve their control over their health. War veterans remain one of the social groups with the highest number of individuals suffering from addictions, substance abuse and dual disorders. The statistics for these health problems have particularly worsened in the recent years and it is widely estimated that nearly one their of all the veterans returning from combat zones such as Afghanistan and Iraq have mental health related problems in one way or the other. Many of the affected individuals often end up resorting to drug and alcohol abuse in an attempt to silence their pains (Soyka, 2000). On the other hand, numerous studies have also revealed that returning military service members often find it extremely hard to effectively integrate back into the society life with their families and even those with the best support system occasionally find themselves overcome by substance abuse and suicidal thoughts. Some of the major reasons for the dual disorders and the associated mental health issues that affect war veterans include the traumatic combat experiences (post traumatic stress disorders), grief, survivor guilt and traumatic brain injury. According to Buckley (2006), most of these factors not only drive the affected individuals to despair but have also been known to alter the brain of some people resulting into serious mental health problems. Depression forces them into drug and substance abuse, which makes them develop violent and rude behaviors. Cases of dual disorders are common for most veterans especially in the United States because of the numerous combat experiences such as during the Iraq and Afghanistan wars (Amara and Hendricks, 2009). The cases affect the veterans and their families severely to an extent that forced the US to budget for the medical requirements of the veterans. In most cases, some the main health promotion strategies that are currently used in the United States include developing personal skills, creating supportive environments, strengthening community support as well as promoting early prevention and intervention. Consequently the proposed program will be based on a number of evidence based strategies that not only foster individual resilience and supporting environments for the affected war veterans but also show respect for social justice, culture and personal dignity. This paper seeks to present a comprehensive program that will help end the long term effects of traumatic war experiences on the minds of our men and women in the armed services as well as promote their everyday lives. Goals of the program This health promotion program will focus on rural areas in the southeast region of Ohio. The southern Ohio region has an alarming rate of homeless veterans due to chronic substance abuse issues along with ongoing battle of untreated “PTSD”. The purpose of this program is to promote the implementation of a successful health promotion practices for post war Veterans Who Suffer with addictions and Dual Disorders. The program will therefore serve as an important resource for all mental and physical health promotion service providers working with the veteran population in the United States. Normally the primary focus of some of the health promotion best practices proposed in this program is on the war veterans because it is currently one of the leading social groups that are most affected by dual disorders and drug addictions due to post traumatic experiences (Tiet and Mausbach, 2007). Consequently the program offers an opportunity to review some of the current health promotion guidelines in order to improve their effectiveness in addressing some of the mental health challenges affecting war veterans due to their combat experiences. The other important goal of this program will be to educate the affected persons as well as their families and friends about the nature of addictions related to post-traumatic stress disorders and dual disorder reactions. This objective will be particularly achieved through the administration of various cognitive behavioral treatments that primarily focuses on the feelings, thoughts and of the Veterans that are related to their past traumatic experiences. The therapy will be carried out using a number of evidence based practices such as repeated discussions over the past traumatic experiences as well as exposing the affected individuals to situations that are normally safe but they have been avoiding due to their previous traumatic experiences in similar situations. On the other hand, the program will also attempt to help the Veterans who suffer from addictions and dual disorders to identify some of the associated problems such as anger and feelings of guilt that are attributed to their traumatic combat experiences. In this regard, the therapy program will not only seek to help the individuals learn from their past traumatic combat experiences but will also work towards desensitizing the triggers of the past memories. For example, various learning relaxation and psycho-education techniques will be used to assess some of the negative beliefs that the affected individual associate with the traumatic event and consequently replace such negative beliefs with positive self beliefs. It is however worth noting that this goal will require a lot of efforts to be achieved since it is always difficult to treat cases of post-traumatic stress disorder and substance abuse among veterans. This is due to different cultural and religious beliefs. Some have serious injuries and wounds, but their religions and culture denies medical staff the opportunity of attending to their needs (Wallace, Myers and Osai, 2004). Demographics of the target population The target population for this health promotion program is the Veterans who suffer from addictions and dual disorders due to their previous combat experiences. Recent researches suggest that addictions and Dual Disorders among combat veterans are significantly high with nearly between 10-30% of combat veterans affected. In the past few years alone, the number of some of these cases diagnosed in the military rode by over 50% and this does not include the other cases that often go unreported (APA,2002).Veterans with no combat experience have a high risk of substance abuse and post-traumatic stress disorder based on the surroundings of the military installation. Our men and women of armed forces usually deal with additional challenges when it comes to addictions and Dual Disorders. This is particularly attributed to the pressures of combat and deployment that sometimes exacerbate their underlying mental disorders. Additionally Veterans and service men encounter a myriad of problems in the course of the war. Many of them develop injuries to the extent that they require evacuation from the battlefront. The most common of these injuries are brain injuries that lead to hearing problems and mental disorders. On the other hand, substance abuse is one of the ways through which Veterans often use to cope up with their unpleasant memories and feelings and this may sometimes result in addictions. These mental conditions make it difficult for veterans join their families and friends after war. In most cases, the veterans may indulge in drug and substance abuse in an attempt to cope up with their past unpleasant experiences and this increases their health risks of most veterans Isolation from other members of society develops feelings of withdrawal and depression in veterans. The recent increase in the number of affected individuals is primarily attributed to the rising number of American military personnel and soldiers returning from Afghanistan and Iraq. During these wars, soldiers often witness death and injuries of their colleagues. The trauma of the experiences of the battlefront haunts the veterans even after they return to their homes. Depression forces them to turn into drugs as a measure of fighting their frustrations. Many veterans turn into drug abuse and substance abuse where they develop mental disorders. Additionally although the number of women serving as combat troops is only 17%, addictions and Dual Disorders among women veterans is high and this is as a result of the post traumatic stress disorder due to the numerous sexual assaults within the military ranks. Many of these veterans however do not know that services exist for substance abuse and mental disorders along with housing and food assistance. Examples of some of the individuals who are likely to be the beneficiaries of this program include combat soldiers, service men and veterans who witness death and other severe conditions in the course of their duty. Dual disorders are cases in patients those that result from mental problems and substance abuse. Research shows that majority of people develop mental problems due to substance and drug abuse. Veterans and service men encounter a myriad of problems in the course of the war. Many of them develop injuries to the extent that they require evacuation from the battlefront. The most common of these injuries are brain injuries that lead to hearing problems and mental disorders. Strengths and Competencies of the program Substance abuse veterans with dual disorders and addiction need integrated care and treatment for their condition to be contained to enhance their health. Several recommendations have been made to help promote this. The national institute of mental health recommends that those suffering from increased risks to use and abuse drugs are associated with anti-social personality disorders. Those who suffer from these personality disorders are nearly 15% more likely to abuse drugs such as alcohol or even the prohibited drugs like cocaine. It is therefore effective for people to be socially active because this will reduce the increased risk factors for drug abuse due to psychological disorders which may arise due to anti-social personality disorders. Dual diagnosis patients need a much more comprehensive facility to improve their state compared to sole drug addicts though the two are quite connected as serious addiction anticipates dual diagnosis. A simultaneous treatment plan which includes dual diagnosis education, medication management, job training, varied therapeutic modalities, individualized treatment plans, exercise and nutrition, hypnotherapy and relapse restraining to fully combat their condition as the victims are always affected mentally, emotionally and even physically. Psychotherapy, cognitive behavioral therapy, psychotropic medications and electro convulsive therapy are also fundamental to dual diagnosis patients since the improper treatment that does not cater for the underlying mental illness will turn them back to substance abuse. Lastly, mental illness is also one of the major contributing factors to suffering with addiction and dual disorders among the veterans .Most of those diagnosed with severe mental illness also suffer from addiction and roughly half of all the individuals are always addicted to drugs. It is therefore easy to see that there is a correlation between drug abuse and psychiatric disorders and at least those who seek treatment will discover a psychological issue that is always recommended to be treated first by the experts. Christian worldview Christian worldview provides an effective conceptual framework within which the health promoting program for Veterans Who Suffer with addictions and Dual Disorders will be based. Generally the Christian worldview is based on the belief that Jesus Christ is the lord of all situations and circumstances and therefore individuals are encouraged to explore some of the implications of this worldview when protecting and promoting the health of other persons, friends, families and communities. In this regard, the practice of health promotion is regarded as an opportunity to work towards unity within God’s kingdom. The act of counseling, nursing and other health promoting activities are usually conceptualized as the efforts to maintain and improve our healthy state. Generally in the biblical context, health promotion is normally understood as an activity motivated by our inbuilt desire to maximize our human potential and increase wellness. This includes measures that prevent or protect individuals from diseases as well as their consequences. For example, the bible encourages individuals suffering from guilt due to their past traumatic experiences that the only solution for guilt is the forgiveness that is given freely by Jesus Christ when a person is born again. Lastly, with regard to the problems such as addictions, drug and substance abuse, Christians believe that it is the responsibility of the church to provide healing services to the affected individuals through volunteers. Literature review Many scholars have expressed the view that most health conditions that affect veterans develop after they leave the battle. Veteran healthcare guidance published (2010) provides specific facts about the Iraq war veterans. The article indicates that at least one veteran in a group of ten veterans suffers from mental problems. Most of these vets are victims of alcohol abuse and often involve themselves in violent behaviors. According to this article, majority of the vets turn to drugs due to depression and frustrations. Many experts concur that condition usually worsens after they leave the battlefield because they do not have access to peer counselors or other medical facilities. Veterans Healthcare (2009) shares the same sentiments in an article, featured in Paraplegia News. It argues that veterans in the Iraq and Afghanistan war suffer from depression and stress disorders. The article raises concerns that the veterans do not receive adequate medical care from the government despite their sacrifices and contributions. The two articles are relevant to the research because they prove that there are cases of dual disorders among vets. Dreher (2009) used the results of a research on the plight of veterans and soldiers to develop arguments in his article. The article indicates that close to 40% of soldiers and vets suffer from mental illnesses and the related behaviors. The seal team conducted a research on the Iraq and Afghanistan veterans in the Veteran Affairs medical centers. The research results showed that most of the veterans diagnosed in the facility suffered from depression and psychological problems and behaviors. The American Legion guide on women veterans shows that most women veterans engage in substance and drug abuse due to depression. Chang, Stein, Stewart, Hendricks and Skarf (2012) outline the importance of spiritual help to veterans. The spiritual assist the vets to overcome the difficult experiences that affect their mental capabilities. The VA (Veteran Administration) offers spiritual help to veterans. This is enough evidence to prove that most veterans suffer from dual disorders (Zivin, Ganoczy, & Paul, 2009). The department of Veteran Affairs has attended to many cases of mental problems and substance abuse among many veterans. Trauma and depression affect the veterans and soldiers after events of a war. It is difficult for the veterans to re-unite with their families and friends due to their health conditions. Isolation from other members of society develops feelings of withdrawal and depression in veterans. Depression forces them into drug and substance abuse, which makes them develop violent and rude behaviors. Cases of dual disorders are common for most veterans especially in the United States. The cases affect the veterans and their families severely to an extent that forced the US to budget for the medical requirements of the veterans. Different researchers and scholars have explored the field of veteran health and the effects of war on veterans. Most of them base their research on Iraq and Afghanistan war to make conclusions about veterans in other countries. Different research and articles show that the number of veteran cases has increased, not to mention women veterans (Campbell & Alexander, 2005). Most of the research studies on the Iraq and Afghanistan war indicate that the majority of soldiers and veterans who survived were diagnosed with cases of mental problems and substance abuse. The department of Veteran Affairs (VA) caters for all the needs of veterans including offering them comprehensive health care. Close to 40% of all the Iraq and Afghanistan vets are victims of substance abuse and suffer from mental disorders. Therefore, the literature review above proves that dual disorders among veterans are conditions that have enough weight of qualify as a research topic. The cost of taking care of veterans The US has spent huge amounts of money in taking care of Iraq and Afghanistan veterans. The US discovered that there was a rise in the number of cases of mental disorders and hence the need to develop a panel to cater for their needs. Kenny (2010) shows the cost estimates that the US government speculated to care for issues related to veteran health. The health issues of the veterans range from disabilities to other medical reasons. However, most of the costs cater for restoring the mental conditions of veterans. The US government has spent a lot of money on improving the welfare of veterans. The government incurs such medical costs on veterans because of its understanding of the risks associated with the medical conditions of veterans (Amara & Hendricks, 2009). Therefore, the two articles show that cases of dual disorders in veterans are so severe that they force the US government to allocate resources towards veterans’ medical care. Post-Traumatic Stress Disorder and substance abuse among veterans The battlefield results in death and injuries of colleagues. The trauma of the experiences of the battlefront haunts the veterans even after they return to their homes. Depression forces them to turn into drugs as a measure of fighting their frustrations. Many veterans turn into drug abuse and substance abuse where they develop mental disorders. Cacciola et al. (2009) argue that most of the Iraq and Afghanistan veterans suffered from post-traumatic stress disorder, which is a mental condition that develops from depression and withdrawal. These mental conditions make it difficult for veterans join their families and friends after war. In most cases, veterans are subject to alcohol and nicotine abuse, which adds to the health risks of most veterans (Stecker et al. 2010). It is difficult to treat cases of post-traumatic stress disorder and substance abuse among veterans. This is due to different cultural and religious beliefs. Some have serious injuries and wounds, but their religions and culture denies medical staff the opportunity of attending to their needs (Wallace, Myers, & Osai, 2004). The care for veterans has changed in the recent past. Many health institutions isolated the veterans from the rest of the patients, but this has changed in an attempt to improve the welfare of veterans. Doctors have come up with new diagnosis tactics of addressing health issues that affect veterans as well as new medications. Most countries must take care of their veterans after a war to help them in restarting their lives (Davidson, 2010). It is evident that veterans have been suffering from depression, withdrawal and mental problems due to the effects of the war environment. These developments promote addressing the research question and it is the reason that the literature review has found them useful. Measurable Objectives 1. To have a total enrollment of at least 10% of the veterans that has completed Substance Abuse Treatment Program at Veterans Medical Center. And by the end of the first year to increase that rate to 25% by the end of second year. 2. To have at least an 80% overall success rate by the veterans involved in the program. 3. To have at least an 80% support rate by the veterans family members being involved in the treatment plan of the veterans. 4. To reduce the high rate of homelessness and drug abuse in the southeastern Ohio region. 5. To reduce the level of harmful activity that is presented with veterans and dual disorders (drugs, violence, illegal activities, gang violence, std’s, etc.) Evaluation Process 1. Daily program attendance and monitoring 2. Veteran and family support surveys taking place at the beginning (survey will be attached initial assessment application packet), middle, and end of the program survey. The surveys will track veteran progress and satisfaction levels of the program, Track any rates of harmful activities, identify strengths and weakness of the program, and other applicable areas. Surveys can be anonymous if the veteran and or family member choose not to. 3. Follow-up phone calls for those who have perhaps withdrew or did not complete program due to relapse or other reasons. The reasons will be noted and tracked. Health Promotion Nine-Step Plan 1. Assessment of mental capacity and behavior, health assessment past health issues, social support network and spiritual network and family support. Generally this is an important diagnostic step that will help identify the therapeutic needs of the affected individuals as well as what is needed to promote their wellbeing. 2. Plan will emphasize strengths and competencies of each veteran. Does the veteran show issues of denial of having substance abuse issues or behavior problems. Does the family approve of veterans erratic behavior. This step is critically important particularly in view of that worrying attitude on the armed forces that seeking help is a sign of weakness. 3. Get the veteran to identify goals he or she would like achieve. Identify behavioral change options asses if the veteran would seek treatment through either our program or through Veterans Medical Center. 4. Identify behavioral or health outcomes by identification of such issues this will reinforce that the veteran needs help. 5. Develop a behavior-change plan this plan is geared so the veteran takes ownership in his or her actions of things in the past and in future. 6. Continue to reinforce benefits of change through the trans-theoretical model. Create a pocket planner for the veteran to carry around as a survival guide to success. 7. This plan will address the surrounding environment for the veteran. During the assessment seek out interpersonal facilitators and barriers to change that could slow the process down with the veteran for success in life. Use outside agency’s that can assist with jobs and housing while in transition. Get family support if available and take care of any legal issues that the veteran may have encountered prior to coming to the program. 8. Plan of action for the veteran at his or her own pace self-care maintenance plan. 9. Formalize a commitment to behavior-change plan, develop a commitment to change agreement and have the veteran discuss this plan with his or her support network like family members and sponsors and mentors. (Health Promotion Program). The above plan was formulated in an effort to start a non-profit program here in Chillicothe, Ohio that is needed for this area. Conclusion In conclusion, war veterans are increasingly facing serious mental health problems that are attributed to their traumatic experiences during combat operations. It is very difficult for such issues to be treated when you deal with addiction and post-traumatic stress disorder. You cannot treat one without the other because it leads to over behavioral changes with the veteran. These issues make it hard for the men and women veterans to reunite with loved ones and friends after returning home from combat. Majority of veterans come home with alcohol and nicotine abuse, which adds to additional health problems for veterans. The above health promotion program will look to employ people from local churches, community members who share our vision, as well as Ohio University students. It is important that all who are involved share the values and love for God in sponsoring the program. References Amara, J., Hendricks, A. (2009). Issues of the Iraq and Afghan Wars: Short - and Long-term impacts on US Veterans' Healthcare. Defense & Security Analysis, 25(3), 285- 298. American Psychiatric Association.(2002). Diagnostic and Statistical Manual of Mental Disorders. Washington: American Psychiatric Press Inc. Buckley P. (2006). Prevalence and consequences of the dual diagnosis of substance abuse and severe mental illness. J Clin Psychiatry, 67,5-10. Cacciola, J. S., Koppenhaver, J. M., Alterman, A. I., & McKay, J. R. (2009, January 4). Posttraumatic stress disorder and other psychopathology in substance abusing patients. Drug & Alcohol Dependence, 101(1), 33. Campbell, C., & Alexander, J. A. (2005). Health Services for Women in Outpatient Substance Abuse Treatment. Health Services Research, 40(3), 781-810. Chang, B., Stein, N., Stewart, M., Hendricks, A., & Skarf, L. (2012). Spiritual needs of veterans: healthcare implications for returning troops. BMC Complementary and Alternative Medicine, 12(1), 406. Davidson, L. (2010, January). Healthcare for U.S. Veterans: Is the system sufficient? The Internet Journal of Healthcare Administration, 7(1). Dreher, H. M. (2009, March). Veteran’s healthcare: is there any innovation here? Holistic nursing practice, 23(2), 83. Justice, A., Erdos, J., Brandt, C., Conigliaro, J., Tierney, W., & Bryant, K. (2006, August). The Veterans Affairs Healthcare System. Medical Care, 44(2), 7-12. Kenny, P. (2010). Message from the president. The healthcare needs of our veterans. Pennsylvania Nurse, 65(3), 3-23. Soyka M. (2000). Substance misuse, psychiatric disorder, and violent disturbed behaviour. Br J Psychiatry176, 345-50. Stecker, T., Fortney, J., Owen, R., McGovern, M. P., & Williams, S. (2010, January 11). Co-Occurring Medical, Psychiatric, and Alcohol-Related Disorders Among Veterans Returning From Iraq and Afghanistan. Psychosomatics; Washington, 51, 6, 507. Tiet Q, Mausbach B. (2007) Treatments for patients with dual diagnosis: A review. Alcohol Clin Exp Res31,4, 513-36.  Wallace, J. M., Myers, V. L., & Osai, E. R. (2004). Faith Matters: Race/Ethnicity, Religion and Substance Use. Faith Matters, 1-56. Zivin, K., Ganoczy, D., & Paul, N. (2009, January 11). Antidepressant Adherence After Psychiatric Hospitalization Among VA Patients with Depression. Administration and Policy in Mental Health and Mental Health Services Research New York, 36, 6, 15. Read More