Community-Based Wounded Warrior Sustainability Initiative (CBWSI): An integrative medicine strategy for mitigating the effects of PTSD

Abstract

How people behave is dramatically influenced by how we organize institutions. Elliott Jaques INTRODUCTION The U.S. Department of Veterans Affairs (VA) healthcare system is preparing for an increase in the number of veteran patients caused by the drawdown of troops from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), many of whom suffer from posttraumatic stress disorder (PTSD). As such, it is imperative that local communities also prepare for their return. This editorial discusses the unique circumstance of the U.S. veteran with PTSD, examines groundbreaking measures made by the VA to help identify and treat veterans experiencing the invisible wounds of war, and introduces an innovative, community-based, primary care level strategy to mitigate the untoward effects of PTSD on veterans and their families, the VA healthcare system, and local communities. THE VETERAN According to the VA, in June 2010, there were 171,423 OIF/OEF veterans diagnosed with PTSD, out of a total of 593,634 patients treated by the VA [1]. The good and bad news about blast injuries from improvised explosive devices is that while many more individuals survive the initial event because of improved military medicine, many also sustain additional injuries that make rehabilitation and full recovery very challenging (i.e., limb loss, traumatic brain injury [TBI], PTSD). Thus far, 84,005 veteran patients have been granted VA disability compensation; of these, about half were for PTSD [2]. The full effect of OIF/OEF on the mental health of soldiers will not be known for years. One study looked at members of four U.S. combat infantry units (three Army and one Marine Corps) who had served in Iraq and Afghanistan. The majority of soldiers were exposed to a variety of traumatic, combat-related situations, such as being attacked or ambushed (92%), seeking dead bodies (94.5%), being shot at (95%), and/or knowing someone who was seriously injured or killed (86.5%). After deployment, approximately 12.5 percent had PTSD, a rate greater than that found among these soldiers before deployment [3]. There is an alarming rise in PTSD-related suicides, which increased from 11 per day in 2009 to 18 per day in 2011 [4]. Acts of violence by veterans and their associated effects on society are commonly seen in the media [5]. According to VA healthcare services, access to care appears to be a key factor, noting once a veteran is inside the VA care program . . . special efforts are made to track those considered to be at high risk ... [4]. Suicide attempts by Iraq and Afghanistan veterans are of special concern because their rates are so much higher. Combined physical and psychological traumas, such as feelings of hopelessness compounded by a cognitive inability to adjust or cope with stress, may result in a further sense of despair. In fiscal year 2009, there were 1,621 suicide attempts by men and 247 by women, with 94 men and 4 women dying [4]. Early studies were of interest to the military [6-7] because of the large numbers of soldiers returning from Iraq and Afghanistan with TBI and PTSD as a result of having survived blast injuries. PTSD has been identified as one of the signature disorders of OIF/OEF [8]. A 2008 RAND Corporation study estimated that 13.8 percent of U.S. servicemembers experience PTSD [9], while other studies report military prevalence rates ranging from 2 to 22 percent [10-11]. The VA and Department of Defense have recently embarked on additional research in the military population at VA facilities using acupuncture for the treatment of PTSD and related symptoms. The scientific rationale for acupuncture is better understood today, including interactions with muscle fascia and peripheral and central neurologic pathways [12-13]. VA AND NATIONAL CENTER FOR PTSD Recognizing the need for research and education on the prevention, understanding, and treatment of PTSD, the VA designed and implemented a Center of Excellence called the National Center for PTSD. …