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War and Drugs: Veteran Battles Ep 3 – A Hopeful Future

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War and Drugs: Veteran Battles Ep 3 – A Hopeful Future

Hosted by Lauren Brande & Written by Dan Wagener | Published 5/31/18

Listen On: SoundCloud | Youtube | iTunes | Google Play

Welcome back to Let’s Talk Drugs. I’m Lollie, and in our last episode we looked at the challenges that veterans face once they return home from active duty. Not only is the adjustment to normal everyday life difficult, they may also be faced with fallout from injuries, chronic pain, and PTSD from the countless traumas that war can inflict. Coping with these difficulties is made even more difficult by the confusing systems that are there to help veterans, but are often under supported by the U.S. government and unable to provide the extensive care that many veterans need upon returning home.

If you’re a veteran struggling with PTSD and addiction, you might not have any idea where to turn for help. Although the Veterans Administration, or VA, is an option, wait times can be long for appointments, and many veterans live long distances from medical centers. If that’s the case, where do you even start to look for treatment?

You might also wonder how treatment works. What kinds of medications or therapies will be used? Will I get to be around other vets, or treated by people who understand what I’m going through? What actually helps people like me get better?

In this episode, we’re going to continue to look at veterans and addiction. Whereas the last two episodes focused on drug use and addiction, this episode is going to explore the hopeful future for veterans: treatment.

We spoke with 2 different people with different perspectives on this topic. One is Jay Russell, who you might remember from our previous podcast. Jay is a veteran who is recovering from PTSD. The other is Mark Calarco, the national medical director for American Addiction Centers. He’s worked extensively with veterans in recovery from PTSD and addiction.

They both had some interesting insights into where to get help and what kinds of treatments can be effective for veterans with PTSD and substance abuse, also known as a dual diagnosis or co-occurring disorder.

A Wealth of Resources

We’ll begin with Jay. He struggled with PTSD for a long time and has experienced that sense of hopelessness that is so familiar to so many veterans. But, he found a way out. He is currently a treatment consultant with American Addiction Centers and helps other veterans find recovery programs. We asked him what worked for him and what kind of resources he thought could be helpful for veterans in need.

Jay Russell: In my case, my faith helped me out, my family helped me out, my church helped me out, and that’s when I started realizing that there were options.

Even like the United Way helpline. I have lost track of how many people do not know the simple number 2-1-1 to get help and find a bed that will help them out or to talk to someone. The crisis hotlines to call when you feel like you’re going to hurt yourself.

There are so many options out there, even calling facilities like American Addiction Centers. I mean nobody is going to get turned away, and if I can’t get them into one of my programs I’m going to get them somewhere where they can get help.

The SAMHSA [Substance Abuse and Mental Health Services Administration] website, you can type in your zip code at findtreatment.samhsa.gov, and it will pull up all the facilities in your 100-mile radius and you can break it down to find what you’re looking for—be it Medicaid or diagnosis, scholarship.

But most veterans aren’t even in the Veterans Choice Program. If they are not dishonorably discharged they can usually get in the VA choice program simply by calling the VA and going, hey, am I in this? No, I need to register. And then that opens up a whole new doorway. I’ve seen the VA program pay for people to go for 6 months to treatment and turn their life around.

The Veterans Choice Program is a program offered through the U.S. Department of Veterans Affairs. The VA will pay for a veteran to receive care from a community provider if the VA can’t provide the care the veteran needs or the nearest VA facility is too far or difficult for the veteran to get to.1

Those who are interested in this program should be aware that the VA published a notice in the Federal Register that it expected funding for this program to run out in mid-January 2018. It’s unclear how this program will be funded in the future.1

Jay also talked about specific treatments that helped him with his PTSD.

Jay Russell: One of the treatments that worked for me that works with PTSD is called EMDR. The eye movement disassociation tactic or even bio sound chairs—we use those in a lot of our facilities.

The best way to describe PTSD for someone who doesn’t understand it is we all get nervous when someone tailgates us. I want you to imagine you’re on the highway and the person tailgating is so close you can’t even see their headlights. But guess what? It’s not a car, it’s a semi-tractor trailer with a full load. No matter how fast you turn, no matter which way you go, you cannot get this thing off your tail.

When you do EDMR and this disassociation tactic, it doesn’t get rid of these memories. But what it does is after a couple sessions now that semi is a quarter mile back, and then it’s a half mile back, and at some point, it may never get more than a mile back—it’s always there, you’re aware of it—but you’re able to function again.

During eye movement desensitization and reprocessing (EMDR), a therapist moves their hand back and forth in front of a client’s field of vision. The therapist asks the client to think about a disturbing event and track the therapist’s hand.2

It’s unclear exactly how EMDR works. But it is believed to activate the same mechanisms involved in rapid eye movement (REM) sleep and help the client process the memory. The theory is that the symptoms are from the person being unable to process what happened to them.

Research on EMDR is mixed. One study with 17 Vietnam veterans with PTSD found that EMDR produced modest to moderate improvements in symptoms.3 According to Francine Shapiro, the creator of EMDR, 24 randomized controlled trials demonstrated positive effects of EMDR in the treatment of trauma.4 However, a review in Scientific American found that while EMDR was more effective than no treatment or supportive listening, it was not superior to exposure treatment.5

In exposure therapy, a therapist helps a person face a situation that triggers a trauma or fear. The gradual exposure helps lessen the fear and helps the person learn to cope with the trauma.6

Support groups are another helpful resource for recovering veterans, and many of them are completely free to join and attend.

Jay Russell: Going to a PTSD support group is something that is phenomenal as well. That’s why our company came up with our veterans programs. Being able to talk to someone else who is going through what you’re going through and dealing with what you’re going through takes away that fear of a stigma or a scarlet letter being thrown on you, and all those are offered in our programs and also by the VA at some point, much less counselors.

Support groups for PTSD are available across the country, in many communities. One place you can start is the National Alliance on Mental Illness, which has a helpline and area-specific resources for people and family members who have PTSD.

The New Frontier of PTSD Treatment

When we asked Mark from AAC what treatments he thought were most effective for treating veterans with addiction and PTSD, he shared several cutting-edge therapies that involved drugs traditionally used for other purposes.

Mark Calarco: So, they’ve done some really interesting research and focus on the biological model, the medical model, about how you know PTSD affects neurotransmitter functions and things in the brain. And so a couple different medications are being used. One of them is called ketamine, are you familiar with that?

Dan Wagener: You mean like ketamine? Like Special K?

Mark Calarco: No, ketamine is a prescription medication well I don’t know (laughing) it’s a prescription medication it’s called ketamine. You know it seems to really help a lot of veterans who suffer from PTSD. Now the medicine, the medication is used as a sedative and has other functions outside of… so it’s been experimented with. It has a short half-life, but it does have some significant benefits. I mean when they do studies with it, it really shows significant improvements in their PTSD. So, there’s something going on obviously from a biological standpoint in the brain.

Ketamine, a dissociative anesthetic, is an emerging treatment for PTSD. A study published in 2014 found that intravenous infusion of ketamine led to rapid reduction in PTSD symptoms, as well as reduction in depression symptoms.7

A study jointly funded by the Department of Defense and the Department of Veterans Affairs will further study how ketamine can help veterans who suffer from PTSD.9

One of the concerns with this treatment is that ketamine can be abused, and researchers aren’t sure what happens to the brain with repeated injections of ketamine.8

Mark also mentioned another medication, modafinil, which is normally used to treat narcolepsy, shift work sleep disorder, and hypersomnia.

Mark Calarco: Modafinil is Provigil. They’re both made by the same company. Armodafinil is just a newer version of it, and it’s called Nuvigil. But they basically work very much the same way and they have very much the same indications. They’re used for sleep shift disorder, narcolepsy, and fighter pilots actually.

The thing about these two, we don’t exactly understand how they work to some degree but for narcolepsy and sleep shift disorder. But they really help in my—now this is my own personal experience that I’m talking about—they’ve really been beneficial in helping with cognitive function, energy, attention, focus, and other aspects, symptoms of PTSD when we’re treated with these.

There’s not much research out there on the use of Modafinil for PTSD. A study published in 2016 found that it helped reduce PTSD symptoms in rats after they were exposed to a stressful experience.10 Though there is evidence supporting the use of these medications, Mark emphasized the importance of a combined approach to veteran recovery: therapy and medication, rather than either on its own.

Mark Calarco: Obviously, you still want to engage them in all the in the group and all therapy sessions, CBT or cognitive behavioral therapy or you know motivational interviewing, could be EDMR, all those things have a place and certain people respond really well so those should always be there and group therapy individual therapy sessions and things are extremely important for veterans coming in who are in recovery or are in a recovery program. But I think it’s important to emphasize that you do need to address the underlying neurochemical and neurophysiological issues that are going on that are fundamental to veterans especially if we know that addiction is a brain disease but we understand more and more that PTSD is also a brain disease, it’s not just a psychological issue. It causes very distinct biochemical neurophysiological changes in the brain of certain individuals. Some people are more susceptible than others and it’s probably related to genetics and other factors.

Mark then turned to the NSS-2 Bridge device, a new therapy that’s mainly been used for opioid withdrawal.

Mark Calarco: The Bridge device is a transcutaneous electronic device that you put on your ear, OK? And it has a 5-day battery and it has FDA approved for chronic pain but it was being used off label for withdrawal. And now just recently it was approved for that by the FDA, in fact.

So basically what it does it is—it’s very Star Trekkian it’s really cool—so what you do is you hook up this little device and you wear it like a hearing aid sort of bit and then you have a little bit of wires that go right underneath the skin by the ear.

We don’t know exactly how it works but it says an electromagnetic field goes into the brain, the deep brain, and it really does something, it helps people go through withdrawal without medication or in some instances they need minimum medication.

So, now how would that affect other psychological conditions like PTSD? I don’t think there’s any studies on that—we couldn’t say. But we do know that we can use … these are all part of energy medicine you know where people can have – you know about electroconvulsive therapy and things that people use for depression? Yeah, this is not like that because it doesn’t shock anybody it’s just…it’s very benign it doesn’t hurt but it really it’s using a sort of noninvasive, low as far as we can tell, low-risk way of helping people go into recovery.

The NSS-2 Bridge device is a small nerve stimulator placed behind the ear. A battery-powered chip in the device emits electrical impulses that stimulate cranial nerves in the brain. These stimulations have been found to provide relief from withdrawal symptoms from drugs such as oxycodone and heroin.11

Like modafinil, there isn’t much research out there on the Bridge device for PTSD. But researchers are continuing to investigate new treatments for PTSD, which is notoriously difficult to treat.

Another potential treatment is the use of MDMA, or Ecstasy. Clinical trials have shown that Ecstasy offers significant relief for PTSD patients, and last August the FDA designated MDMA as “breakthrough status” for treatment of PTSD, opening the door for more trials.12

Mark cautions that MDMA (also known as Ecstasy) and similar drugs that are typically used recreationally could potentially be problematic for people in PTSD treatment due to their effects on the brain—especially if the person has a history of addiction.

Mark Calarco: So, the one concern about that though is that even if it does help them with PTSD let’s say …could you know, anything that stimulants the reward center in the brain could potentially increase the risk for relapse, right?

Dan Wagener: Yeah.

Mark Calarco: So that’s a concern with things like MDMA, MDE, MDEA, any of those. And that’s also an issue with amphetamine salts that are used for ADD. People come into recovery and they have a diagnosis of that you have to really confirm it because that can actually promote relapse. And even marijuana you know is a gateway drug for people who have the brain disease—not for other people but for that 10-15% of the population, and certainly for veterans who have the brain disease of addiction. It may help some of their symptoms, but it certainly can increase their risk for relapse.

* * *

MDMA, and other drugs such as methylphenidate—an ADHD drug that’s also been used to treat PTSD—can be abused, and there’s irony in using these drugs to treat a population that has a high rate of drug and alcohol problems. It’ll be interesting to see how research develops in this area, and we look forward to a more hopeful future for our veterans.

We’d like to thank Jay Russell and Mark Calarco of American Addiction Centers for talking to us about this critical issue. And to all the veterans out there who may be listening: thank you. From the bottom of our hearts, thank you for everything you have sacrificed to keep us safe. Now we must help you. You don’t have to suffer under the weight of addiction and PTSD forever. Reach out to us at and we will find you the best recovery program to get you the help that you deserve. Don’t wait until it’s too late.


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Sources

  1. U.S. Department of Veterans Affairs. (2018). Veterans Choice Program (VCP).
  2. EMDR Institute, Inc. What is EMDR?
  3. Pitman et al. (1996). Emotional processing during eye movement desensitization and reprocessing therapy of Vietnam veterans with chronic posttraumatic stress disorder. Comprehensive Psychiatry, 37(6), 419-429.
  4. Shapiro, F. (2014). The Role of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experiences. The Permanente Journal, 18(1), 71-77.
  5. Arkowitz, H. and Lilienfeld, S. (2012). EMDR: Taking a Closer Look. Scientific American.
  6. National Alliance on Mental Illness. (2017). Posttraumatic Stress Disorder.
  7. Feder, A. et al. (2014). Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiatry, 71(6), 681-688.
  8. Levine, S. (2017). Ketamine is being used as a cutting-edge treatment for depression, PTSD. New York Daily News.
  9. Yale School of Medicine. (2017). VA study to examine ketamine’s potential to treat posttraumatic stress disorder.
  10. Cohen, S. et al. (2016). The wake-promoting drug modafinil stimulates specific hypothalamic circuits to promote adaptive stress responses in an animal model of PTSD. Translational Psychiatry, 6(10), e917.
  11. U.S. Food and Drug Administration. (2017). FDA grants marketing authorization of the first device for use in helping to reduce the symptoms of opioid withdrawal.
  12. Welch, A. (2017). FDA designates MDMA as ‘breakthrough therapy’ for PTSD. CBS News.