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For the most part veterans are young men, she points out, and young men in the general population tend to have higher rates of substance abuse in general.
"That being said, it's a big problem," she adds. "Let's face it, this is a high-exposure population. The military are more likely to get injured than average folk. They are getting more exposure to these things and may be at higher risk."
"This is a problem that is likely to grow rather than shrink," she adds.
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That risk of addiction skyrockets when you add in a PTSD dual-diagnosis.
Dr. Andrew Saxon, director of the VA's Addiction Treatment Center in Seattle, say the two conditions feed off each other. "It just becomes this vicious circle that they can't get out of," he says. "A lot of them get emotional relief or sedation from using opioid drugs, so certainly that's kind of a setup for them, because they get the opioids for pain and then they find that the drugs also work for their mental disorder," he says. Then, he adds, they frequently begin telling themselves that they are in physical pain when they are not, all so they can keep the prescriptions coming.
It's a dilemma for medical professionals. Which do you treat first? Saxon says that in some cases, taking away patients' chemical crutches has allowed their PTSD to become unmanageable. Others can't begin to address their nightmares and flashbacks until they are clean and sober.
In some cases, the drugs make them think that other forms of therapy are not necessary, he adds. Why submit to the pain of remembering your worst experiences and talking through your fears again and again — in his view, one of the most effective treatments for PTSD — when a little white pill can carry you away from all of that in mere minutes?
Trafton says a good portion of her work lies in retraining doctors on how to talk and listen to their patients, especially those in the middle ground of the pain continuum. "[Those patients] say things like 'Oh, I take it when I feel like I can't cope with my pain.' And that's kind of along that line where you're thinking maybe it's not such a good idea, but it's also where a typical MD would prescribe medication and say to take them when you need 'em. That's not that specific enough.' A lot of what we are trying to do is fix what the doctors are saying and help the patients understand that this isn't a way to manage your mood, this is a way to help you do something."