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Col. Elspeth Ritchie, a psychiatry consultant to the Army surgeon general, says it is anticipated that the rate of post-traumatic stress disorder will be higher among troops who have been to Iraq more than once.

Col. Elspeth Ritchie, a psychiatry consultant to the Army surgeon general, says it is anticipated that the rate of post-traumatic stress disorder will be higher among troops who have been to Iraq more than once. (Courtesy of the Army’s Office of the Surgeon General)

As an Army computer specialist, Brian didn’t expect to find himself in combat in Iraq.

But two months after arriving in Baghdad, while on patrol with a cavalry unit, he faced his first of many brushes with death when a makeshift bomb exploded near his vehicle.

“That scared the [expletive] out of me,” said Brian — which is not his real name. As a member of Alcoholics Anonymous who recently completed mandatory treatment for alcohol and drug abuse problems, he spoke on condition he wouldn’t have to give his name.

Brian didn’t realize his clashes on the battlefield had mentally scarred him, but memories of what he went through put him in a state of perpetual anxiety. After returning from Iraq, he dealt with his anxiety the same way many Vietnam veterans did and still do: He turned to alcohol and drugs.

Substance abuse often goes hand in hand with post-traumatic stress disorder, a psychiatric condition that affects roughly 15 percent of Vietnam veterans and perhaps as much as 17 percent of Iraq veterans — including, doctors say, Brian. The condition often occurs after experiencing or witnessing life-threatening events.

Soon after the war in Iraq started, the Department of Defense began screening returning combat vets for evidence of mental health issues so troubled troops could get help as soon as possible. The Army also sent mental health professionals downrange to check on the quality of care troops were getting. The hope is that these efforts will keep new vets from suffering the mental health and substance abuse problems that plague Vietnam vets.

If they fail, the result could look a lot like Brian did before treatment.

Having slipped through the PTSD screening process, Brian dulled his anxiety with a self-prescribed regimen of alcohol and drugs. His heavy drinking and risky behavior got him two charges of drunken driving in less than seven months.

“It wasn’t until I got my second DWI that I was ready to admit I had a problem,” he said.

He was about to get promoted to sergeant, but instead was busted down to private, sentenced to 45 days of extra duty and restriction, and had to forfeit pay. He was also ordered into the Army Substance Abuse Program.

It was only after his mental health had thrown his career on the rocks that doctors said he likely suffered from PTSD.

After the diagnosis, he was enrolled in a six-week in-patient treatment program at Landstuhl Regional Medical Center in Landstuhl, Germany, that helped him deal with his dependence on alcohol and drugs and identify the events that had driven him to substance abuse.

“They did a great job with getting me the help I needed,” Brian said.

If substance abuse among Iraq vets with PTSD follows the course of Vietnam vets, more than 13 percent of troops returning from Iraq with mental health issues could be expected to find themselves in Brian’s shoes, as they face alcohol or other substance abuse problems.

“I think a lot of that information is still coming in,” Kate Azar, the clinical director of Darmstadt, Germany’s Army Substance Abuse Program, said. “That is something we are definitely keeping an eye on.”

DOD’s efforts to rein in mental health problems among combat vets, though robust compared with those from any previous U.S. armed conflict, aren’t going far enough for some.

In May, the Government Accountability Office filed a report that said only one out of every five troops who screened positive for PTSD upon leaving a war zone were referred for follow-up evaluations.

But those in the military have been more optimistic about the mitigating effects of the mental health care now afforded troops.

A January 2005 report chartered by the U.S. Army surgeon general said mental health and well-being improved from the first to the second year of the Iraq war. The report included troops stationed throughout the Middle East, including those in noncombat roles in places such as Kuwait and Qatar.

According to the report, 18 percent of troops screened positive for mental health issues during the first year of the war in Iraq. The number dropped to 13 percent among those who served during the second year of the war.

The Army has continued to monitor troops’ health, and in November a Mental Health Advisory Team finished looking at troops in the third Iraq rotation. What the team concludes might provide some insight into what happens when troops are sent back into the fray.

“The world is speculating that PTSD will be higher” among troops who have been to Iraq more than once, said Col. Elspeth Ritchie, a psychiatry consultant to the Army surgeon general.

Reports from two previous teams were filed within two to three months of their return from the field. It has been eight months since the last team returned, and it has yet to file a report.

Ritchie said the information wasn’t in yet.

“There’s a lag time,” she said.

If mental health issues among vets of Iraq and Afghanistan are on the rise, programs such as the Army Substance Abuse Program could soon find themselves overwhelmed.

Among Vietnam veterans seeking treatment for PTSD, 60 percent to 80 percent have alcohol use disorders, according to a fact sheet from the U.S. Department of Veterans Affairs’ National Center for PTSD.

Robert McCollum, who runs the Army Substance Abuse Program for the Installation Management Agency-Europe, said the program’s offices across the continent are already feeling the pressure.

“My people are busy. Their plates are full,” he said.

Researchers adjust to get more honest input on health effects

Col. Charles W. Hoge, chief of psychiatry and behavior sciences at the Walter Reed Army Institute of Research, Division of Neurosciences, is leading one team of researchers in the quest to see how war affects troops’ mental health.

So far, Hoge and his team have published two studies — one in 2004 and one in March — that analyze information collected from more than 300,000 soldiers and Marines who deployed to Iraq and Afghanistan. For his most recent study, Hoge tracked all of the troops for a year, unless they left the military, to try to determine how often they accessed mental health care during the first year of redeployment.

Among his findings are these conclusions:

More than 19 percent of servicemembers returning from Iraq reported having mental health problems.12 percent of returning troops have been diagnosed with mental health problems.Among troops who served in Iraq between May 1, 2003, and April 30, 2004, 35 percent accessed mental health services in the year after returning home. That figure is about 16 percent more than the number who thought they had a problem immediately after leaving a combat zone.In his latest paper, Hoge cites another recent study that concluded that “17 percent of soldiers and Marines who returned from Iraq screened positive for Post-Traumatic Stress Disorder, generalized anxiety or depression, a prevalence nearly twice that observed among soldiers surveyed before deployment.”

But Army researchers realize all these numbers could be off, and to some extent the troops themselves are to blame.

Redeploying troops may not be honest about the effects of their war experiences, Ritchie said. Researchers think the reason for the dishonesty is that troops returning from war want to get home as quickly as possible and fear their homecoming could be delayed if they admit to mental health concerns.

To get a more accurate view of the health of troops after redeployment, earlier this year the military began screening troops three to six months after their return from deployment, giving them time to adjust to home and reflect on their mental states. Results from those assessments have not been compiled yet.

— Matt Millham

Stripes in 7

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