RESUMEN
Grim national statistics about the U.S. opioid crisis are increasingly well known to the American public. Far less well known is that U.S. servicemembers are at ground zero of the epidemic, with veterans facing an overdose death rate of up to twice that of civilians. Exploiting a quasi-experiment in overseas deployment assignment, this study estimates the causal impact of combat exposure among the deployed in the Global War on Terrorism on opioid abuse. We find that exposure to war theater substantially increased the risk of prescription painkiller abuse and illicit heroin use among active duty servicemen. The magnitudes of our estimates imply lower-bound combat exposure-induced healthcare costs of $1.04 billion per year for prescription painkiller abuse and $470 million per year for heroin use.
Asunto(s)
Trastornos Relacionados con Opioides , Veteranos , Humanos , Masculino , Estados Unidos , Trastornos Relacionados con Opioides/epidemiología , Adulto , Femenino , Personal Militar , Dependencia de Heroína/epidemiología , Analgésicos OpioidesRESUMEN
For many decades, the U.S. military's general operational guideline has been to limit the use of trauma-focused treatments for combat and operational stress reactions in military service members until they have returned from deployment. Recently, published clinical trials have documented that active-duty military personnel with combat-related posttraumatic stress disorder (PTSD) can be treated effectively in garrison. However, there are limited data on the treatment of combat and operational stress reactions or combat-related PTSD during military deployments. This prospective, nonrandomized trial evaluated the treatment of active-duty service members (N = 12) with combat and operational stress reactions or combat-related PTSD while deployed to Afghanistan or Iraq. Service members were treated by deployed military behavioral health providers using modified Prolonged Exposure (PE; n = 6) or modified Cognitive Processing Therapy (CPT; n = 6), with protocol modifications tailored to individual mission requirements. The PTSD Checklist-Military Version (PCL-M) total score was the primary outcome measure. Results indicated that both groups demonstrated clinically significant change in PTSD symptoms as indicated by a reduction of 10 points or greater on the PCL-M. Participants treated with modified PE had significant reductions in PTSD symptoms, t = -3.83, p = .01; g = -1.32, with a mean reduction of 18.17 points on the PCL-M. Participants treated with modified CPT had a mean PCL-M reduction of 10.00 points, but these reductions were not statistically significant, t = -1.49, p = .12; g = -0.51. These findings provide preliminary evidence that modified forms of PE and CPT can be implemented in deployed settings for the treatment of combat and operational stress reactions and combat-related PTSD.
Asunto(s)
Terapia Cognitivo-Conductual , Terapia Implosiva , Personal Militar , Trastornos por Estrés Postraumático , Cognición , Humanos , Guerra de Irak 2003-2011 , Estudios Prospectivos , Trastornos por Estrés Postraumático/terapiaRESUMEN
In the families of the new cohort of war veterans now entering the civilian population in the United States are over two million young children (Cozza, Haskins & Lerner, 2013; Institute of Medicine, 2013). Several noteworthy studies have shown that children exposed to separation from a parent due to combat-related deployment are at elevated risk for a variety of negative consequences (Lester & Flake, 2013). Cozza et al. (2013) argue that existing studies of military children focus too much on the stresses or deficits they experience, failing to give sufficient attention to their strengths, the strengths of their families, or the supports around them. In the current study we focus on risk and promotive factors in the lives of children aged 0-10 in military families. We examine the likelihood of negative outcomes as functions of additive, cumulative, and interactive relationships between risk and promotive factors and children's outcomes. Risk factors, particularly parental depression, community poverty, and cumulative risk, were more strongly associated with children's outcomes than promotive factors. There was, however, a significant risk-protective relationship between accumulations of risk and promotive factors, consistent with promotive conditions operating in a protective fashion under conditions of elevated risk.
Asunto(s)
Trastornos de la Conducta Infantil/psicología , Relaciones Familiares/psicología , Personal Militar/psicología , Factores Protectores , Factores de Riesgo , Veteranos/psicología , Adolescente , Adulto , Niño , Trastornos de la Conducta Infantil/epidemiología , Preescolar , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Entrevistas como Asunto , Estudios Longitudinales , Masculino , Estrés Psicológico/complicaciones , Estados UnidosRESUMEN
Since 9/11, military service in the United States has been characterized by wartime deployments and reintegration challenges that contribute to a context of stress for military families. Research indicates the negative impact of wartime deployment on the well being of service members, military spouses, and children. Yet, few studies have considered how parental deployments may affect adjustment in young children and their families. Using deployment records and parent-reported measures from primary caregiving (N = 680) and military (n = 310) parents, we examined the influence of deployment on adjustment in military families with children ages 0-10 years. Greater deployment exposure was related to impaired family functioning and marital instability. Parental depressive and posttraumatic stress symptoms were associated with impairments in social emotional adjustment in young children, increased anxiety in early childhood, and adjustment problems in school-age children. Conversely, parental sensitivity was associated with improved social and emotional outcomes across childhood. These findings provide guidance to developing preventive approaches for military families with young children.