using what works: a review of evidence based ......naadac specialty training series: addiction...

NAADAC Specialty Training Series: Addiction Treatment in Military and Veteran Culture Part 6 of 6

12/7/2019

Presented by Duane K.L. France, MA, MBA, LPC 1

USING WHAT WORKS: A REVIEW OF EVIDENCE BASED

TREATMENTS FOR MILITARY POPULATIONS

PRESENTED BY DUANE K. L. FRANCE, MA, MBA, LPC

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SAMSON TEKLEMARIAM, MA, LPC, CPTM

• Director of Training and Professional Development

• NAADAC, the Association for Addiction Professionals

• www.naadac.org

• [email protected]

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PRODUCED BY

NAADAC, THE ASSOCIATION FOR ADDICTION PROFESSIONALS

WWW.NAADAC.ORG/WEBINARS

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WWW.NAADAC.ORG/MILITARY‐VET‐ONLINE‐TRAINING‐SERIES

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CE CERTIFICATE

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CE HOURS AVAILABLE:1.5 CE

REGISTRATION TO ATTEND:

$25

CE CERTIFICATE:INCLUDED

1. Watch and listen to this entire webinar.

2. Pass the online CE quiz, which is posted at: www.naadac.org/using‐what‐works‐webinar

3. Maintain records of your invoice/receipt of payment and any CE certificate received from this series.

4. Email [email protected] if you experience any difficulty with this process.

To obtain a CE Certificate for the time you spent watching this webinar:

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Control Panel

Asking Questions

Audio (phone preferred)

Polling Questions

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WEBINAR PRESENTER

• Duane K. L. France, MA, MBA, LPC

• www.veteranmentalhealth.com

• [email protected]

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Family Care Center, LLC

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WEBINAR LEARNING OBJECTIVES

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Review the concepts of comprehensive SMVF mental health and the core clinical competencies for

treating the military affiliated population

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Identify core aspects of treatment related

to each of the domains of

comprehensive SMVF mental health

Discuss effective treatments

commonly used to address reduced

functioning in each of the domains

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COMPREHENSIVE VETERAN MENTAL HEALTH (REVIEW)

Purpose and

Meaning

EmotionDysregulation

Addiction TBI

PTSD

Relationships

Needs Fulfillment

Moral Injury

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CORE CLINICAL COMPETENCIES FOR TREATING SERVICE MEMBERS, VETERANS, AND THEIR FAMILIES (REVIEW)

Advocacy represents counselors’ ability to understand and influence individual, system, and public policy efforts to increase access to mental health resources for military-connected clients and promote the role of counseling professionals working with military populations.

Military Culture represents general information about the functioning and worldview of military service members and their families.

Ethics represents counselors’ self-awareness and motivation to serve military-connected clients, as well as ethical considerations working with military populations.

Systems Features represents general information about the nature and structure of the military lifecycle including, but not limited to, deployment, family, spouses and children, health and wellness, employment, and retirement.

Assessment of Presenting Concerns represents common areas of clinical concerns that service members frequently present to mental health services to address.

Identity Development represents the whole person concept of military life including one’s personal identity as a service member and connection to mission and core values of working in a high-risk occupation across the lifespan.

Treatment represents general information about unique issues that may arise in the treatment of military-affiliated clients and approaches supported by research for military populations, including best practices of military care systems, as well as holistic, wellness-oriented services.

www.veteranmentalhealth.com/naadac6Next up: Polling Question 1 10

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POLLING QUESTION #1

The treatment of comorbid PTSD and TBI include treatment for components of each and treatment for condition‐

specific symptoms

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A. Strongly AgreeB. AgreeC. Neither Agree or DisagreeD. DisagreeE. Strongly Disagree

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TREATMENT COMPETENCIES (REVIEWED)

• Is aware of evidence‐based treatments utilized by the U.S. Department of Defense and U.S. Department of Veterans Affairs.

• Recognizes that treatment needs may include a range of presenting concerns prevalent among Service members (e.g., sensory impairment, decreased memory/concentration, headaches, sleep disturbance, physical symptoms, and interpersonal isolation).

• Is aware of the adjunctive interdisciplinary services (e.g., occupational therapy, physical therapy, command consultation, embedded behavioral health, chaplaincy, and peer support) available within the U.S. Department of Defense (DoD) and U.S. Department of Veterans Affairs (VA).

• Supports coping skills development for effective functioning within several areas including career, recreation, housing, justice involvement, financial solvency, and interpersonal relationships.

• Considers inclusion of the military member’s family and social supports in treatment.

General information about unique issues that may arise in the treatment of military-affiliated clients and approaches supported by research for military populations, including best practices of military care systems, as well as holistic, wellness-oriented services (Prosek et al, 2018).


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TREATMENT COMPETENCIES (REVIEWED)

• Understands the effects of pharmacotherapy and supports appropriate client medication management services as needed.

• Continually assesses for the nature, frequency, and severity of trauma exposure, as well as ongoing stressors and protective factors, such as social support, substance use, risk‐seeking behaviors, and financial stability.

• Is aware of holistic, mindfulness‐based treatment approaches that are supported by research for military populations.

• Seeks strategies to improve military members’ access and engagement in mental health services.

• Recognizes that operational tempo impacts scheduling for mental health services.

General information about unique issues that may arise in the treatment of military-affiliated clients and approaches supported by research for military populations, including best practices of military care systems, as well as holistic, wellness-oriented services (Prosek et al, 2018).


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Posttraumatic Stress Disorder Treatment


Addiction TBI

PTSD

Purpose and

MeaningRelationships

Needs Fulfillment

Moral Injury

In a meta analysis conducted in 2016 comparing psychotherapy and medication effectiveness in treating PTSD, trauma-focused psychotherapies outperformed medications in treating PTSD (Lee et al., 2016)

• Outcomes from EBTs persisted longer for psychotherapy, but continued medication use was necessary for long-term benefits

• Medications blunt the symptoms of PTSD, but psychotherapy addresses the underlying neurobiological mechanisms of PTSD

• Trauma-focused psychotherapies also outperformed nontrauma-focused psychotherapy.

• Clinicians should be educated on the priority and method of of trauma-focused therapies in order to provide the clients the most benefit

www.veteranmentalhealth.com/naadac6

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Addiction TBI

PTSD

Purpose and


Needs Fulfillment

Moral Injury

• Manualized trauma-focused psychotherapies that have a primary component of exposure and/or cognitive restructuring

• Prolonged Exposure: CBT that teaches individuals to gradually approach trauma-related memories, feelings, and situations

• Cognitive Processing Therapy: CBT that helps clients learn how to modify and challenge unhelpful beliefs related to trauma

• Eye Movement Desensitization and Reprocessing: a technique that accesses the traumatic memory network so that information processing is enhanced

Posttraumatic Stress Disorder TreatmentAccording to the VA/DOD Clinical Practice Guidelines for treating PTSD, trauma-focused psychotherapy is defined as therapy that uses cognitive, emotional, or behavioral techniques to facilitate processing a traumatic experience and in which the trauma focus is a central component of the therapeutic process.


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Addiction TBI

PTSD

Purpose and


Needs Fulfillment

Moral Injury

Traumatic Brain Injury Treatment

• Neurocognitive rehabilitation can be ineffective because of psychological concerns

• Attention difficulties can undermine the therapeutic process if the client is unable to focus during therapy sessions

• Memory problems can cause the client to fail to retain session details, reducing their ability to apply what has been learned

• PTSD and TBI often overlap; nearly 45% of service members who sustained a mTBI meet full diagnostic criteria for PTSD

The presence of a mild traumatic brain injury (mTBI) can complicate treatment for co-occurring psychological disorders; the efficacy of psychotherapy can be significantly reduced for clients with prior brain injuries (Cole, et al. 2015)


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Addiction TBI

PTSD

Purpose and


Needs Fulfillment

Moral Injury

Traumatic Brain Injury Treatment

• Treatment strategy should remain the same regardless of method of injury (blast vs. blunt force trauma)

• Treat physical symptoms as typical: headache education, vestibular therapeutic exercises for dizziness

• Treatment of sleep disturbances related to mTBI should include sleep hygiene, Cognitive Behavioral Therapy for Insomnia (CBTi)

• Clients with a history of mTBI who present symptoms related to memory, attention, executive function, and other cognitive symptoms, that do not resolve within 30-90 days and not responsive to symptom management be referred to a cognitive rehabilitation therapist for specific treatment

According to the VA/DOD Clinical Practice Guidelines for treating concussion / mild traumatic brain injury, best practices include offering a primary care symptom-driven approach in the treatment of clients with a history of mTBI

www.veteranmentalhealth.com/naadac6Next up: Polling Question 2

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POLLING QUESTION #2

Treatment for emotion dysregulation (anger, anxiety, depression) is similar in the military and non‐military population

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Addiction TBI

PTSD

Purpose and


Needs Fulfillment

Moral Injury

Addiction TreatmentSubstance use disorders remain a significant problem in the military population, despite numerous attempts to reduce problematic substance use. SUD and addiction is associated with negative outcomes, such as medical problems and psychiatric disorders such as depression and anxiety (Teeters et. al, 2017)

• One study indicated that approximately 30% of completed suicides were preceded by alcohol or drug use

• About 20% of high-risk behavior deaths were attributed to alcohol or drug overdose

• Treatment of SUDs can include both behavioral and pharmacological treatments

• Treatment options range from preventive screening to residential treatment programs, and include Intensive Outpatient Programs (IOP), Partial Hospitalized Programs (PHP), and Extensive Outpatient Programs (EOP)


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Addiction TBI

PTSD

Purpose and


Needs Fulfillment

Moral Injury

Addiction TreatmentA best practice for treatment is to engage in shared decision making with clients in order to make the most appropriate decision regarding what care they choose to engage, with guidance and information from clinicians (VA/DOD, 2015)

• Alcohol Use Disorder: Behavioral Couples Therapy, CBT, Community Reinforcement Approach, Motivational Enhancement Therapy, 12-step facilitation

• Opioid Use Disorder: No sufficient evidence to recommend a specific therapeutic intervention, pharmacotherapy is recommended with therapy to support life change

• Cannabis use Disorder: CBT, Motivational Enhancement Therapy, Combined CBT/MET

• Stimulant Use Disorder: CBT, Recovery focused behavioral therapy, Contingency Management


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Addiction TBI

PTSD

Purpose and


Needs Fulfillment

Moral Injury

Emotional Dysregulation TreatmentEmotion dysregulation is associated with many psychological disorders, including PTSD and Substance Use Disorders. Traumatic exposure leads to anger expression, depression and anxiety.

• Veterans experiencing anger control issues sometimes have the outlook of “these are my problems and I have to deal with them” leading to treatment avoidance

• One study indicates that 42% of Guard and Reserve component soldiers screened positive for further evaluation and treatment for depression, but only half sought treatment, and only 30% of treatment seekers completed the full course of treatment (Thomas et al., 2015)


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Addiction TBI

PTSD

Purpose and


Needs Fulfillment

Moral Injury

Emotional Dysregulation TreatmentCognitive Behavioral Therapy interventions have long been known to be effective in reducing emotion dysregulation. For example, Dialectical Behavior Therapy Skills Training has been proven to reduce anxiety and depression severity in adults (Neacsiu et. al, 2014)

Other effective interventions suggested by the VA/DOD Clinical Practice Guidelines (VA/DOD, 2016) include:

• Acceptance and Commitment Therapy: emphasizes acceptance of emotional distress and engagement in goal directed behaviors

• Interpersonal Psychotherapy: focuses on improving interpersonal functioning and exploring relationship-based difficulties

• Problem-solving therapy: Focuses on learning to cope with specific problem areas and client and clinician work collaboratively to identify and solve problems.

www.veteranmentalhealth.com/naadac6Mid-Webinar Q&A

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Q&A

www.veteranmentalhealth.com/naadac6Next up: Polling Question 3 23

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POLLING QUESTION #3

Addressing existential concerns in the military affiliated population has been extensively studied and produced evidence‐based

practices similar to treating PTSD and SUD

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Addiction TBI

PTSD

Purpose and


Needs Fulfillment

Moral Injury

Purpose and Meaning TreatmentMeaning and purpose in post-military life is a significant factor in the wellbeing of service members, veterans, and their families. While not as widely studied as clinically diagnosed disorders such as PTSD, SUD or emotion dysregulation, it is still an important area to explore with military affiliated clients

• Veterans may experience grief-like symptoms related to real or perceived loss of their military identity (Mobbs & Bonanno, 2018)

• Quality of Life for service members includes life satisfaction, functional level, and social-material conditions (Martz et. al, 2018)

• A loss of personal meaning and purpose may manifest itself as an existential or spiritual struggle in veterans (Kopacz, 2015)

• A strong sense of purpose is associated with greater meaning in life along with greater happiness and self-esteem (Goodman et. al, 2018)


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Addiction TBI

PTSD

Purpose and


Needs Fulfillment

Moral Injury

Purpose and Meaning TreatmentExistential interventions could benefit service members, veterans, and their families by addressing meaning-oriented and existential concerns. These interventions are often highly personal, emotion-based, and focus on positive, direct education about meaning in life (Voss, Craig & Cooper, 2015)

• Meaning oriented therapy: Involve discussing, explaining, and supporting clients to act directly and positively towards finding meaning in their life

• Supportive-expressive group therapies: Create a supportive environment in which clients are encouraged to share experiences, explore self-worth, and decrease isolation

• Experiential-existential group therapy: Include sharing of experiences, receiving group support, and focusing on the present

• Cognitive-existential therapy: Existential and cognitive themes are discussed, explained, and exercised


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Addiction TBI

PTSD

Purpose and


Needs Fulfillment

Moral Injury

Moral Injury TreatmentMoral injury describes veterans who are exposed to acts that transgress deeply held moral beliefs. A large portion of service members have reported participation in or exposure to transgressive acts in every conflict since Vietnam (Frankfurt & Frazier, 2016)

• Exposure to combat and length of deployment are significant risk factors for exposure to transgressive events

• Strong leadership and training in battlefield ethics may lower the risk of some transgressive acts

• Transgressive acts are associated with greater PTSD risk

• There is strong support for the relation between transgressive acts and substance abuse, potentially as a form of punishment for engaging or witnessing transgressive acts, or as an escape from the emotional burden of such acts


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Addiction TBI

PTSD

Purpose and


Needs Fulfillment

Moral Injury

Moral Injury TreatmentMoral injury is a relatively new construct, with some aspects of the condition that are shared with PTSD and some that are separate and distinct. A number of interventions are being developed, or existing interventions adapted to, addressing moral injury in service members and veterans

• Adaptive Disclosure: a six-session CBT-Gestalt intervention that promotes self forgiveness and compassion

• Building Spiritual Strength: an eight-session group therapy for use in faith-based settings

• Acceptance and Commitment Therapy for moral injury: a transdiagnostic approach that applies the six core processes of ACT to moral injury (Nieuwsma, et. al, 2015)

• Impact of Killing (IOK) Treatment Program: an adjunctive treatment to be used in conjunction with PTSD treatments to address the moral impact of killing in war (Burkman, Purcell, & Maguen, 2019)

www.veteranmentalhealth.com/naadac6Next up: Polling Question 4

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POLLING QUESTION #4

Addressing a service member’s challenges in meeting their needs in post‐military life requires both psychological and systemic

interventions

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Addiction TBI

PTSD

Purpose and


Needs Fulfillment

Moral Injury

Needs Fulfillment TreatmentSocial and Behavioral Determinants of Health are a combination of behavioral, social, economic, environmental, and occupational factors. They significantly impact morbidity, mortality, and well-being but are not often addressed in the clinical setting (Hatef et. al, 2019).

• Underlying factors of health and wellness must be addressed at the community level as well as within groups of high-risk individuals (military population)

• Understanding the client’s individual social and behavioral risk factors as well as the socio-environmental impact of their community on their behavior is critical to understanding their level of wellness

• Veterans Health Administration has a statutory commitment to address both medical and non-medical needs of their patients


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Addiction TBI

PTSD

Purpose and


Needs Fulfillment

Moral Injury

Needs Fulfillment TreatmentBased on Maslow’s Hierarchy of Needs, clinicians can help address client’s needs in three areas: Basic Needs (Physiological and safety needs), Psychological Needs (Belongingness and Esteem needs), and Self Fulfillment Needs (Self Actualization and Replication) (Hatef et. al, 2019).

• Solution Focused Brief Therapy: focuses on a client’s present and future circumstances rather than past experiences; goal-oriented rather than symptom oriented (Bannink, 2007)

• Acceptance and Commitment Therapy: Helping clients adapt to life’s demands while focusing on what is personally important (Lang, et. al, 2017)

• Peer Support: congruent with veteran’s common experience of military culture with a high value on camaraderie and cohesion (Gustavsson, 2012)


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Addiction TBI

PTSD

Purpose and


Needs Fulfillment

Moral Injury

Personal Relationship TreatmentPost 9/11 veterans surveyed faced challenges in multiple domains, including community involvement after deployment. Some problems that the military affiliated population faces, such as social functioning, anger control and spiritual functioning, fall outside the traditional scope of clinical practice

• Several factors impact the family unit during deployment: increased domestic responsibilities for those not deployed, loss of physical and emotional intimacy, communication problems (Sayer et. al, 2010)

• Emotional numbing is associated with actual or perceived relationships with the children of combat veterans (Ruscio et. al, 2002)

• Social support is associated with psychological well-being, and social support from a significant other, family, and military peers can act as a resilience trait that reduced the impact of stress in the veteran’s life (Wilcox, 2010)


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Addiction TBI

PTSD

Purpose and


Needs Fulfillment

Moral Injury

Personal Relationship TreatmentMarriage and Family Therapy, and other interpersonal relationship interventions, is language-based, client-directed, and focused on the relational process rather than step-by-step techniques, which leads to difficulty in manualization and replication by independent investigators

• Family therapy is not a single treatment method but a generic term for a number of approaches based on broad principles

• Social constructionism: adopting a point of view that orients the client(s) to view the world in a relational manner

• Narrative family therapy: changing the dominant stories that a family tell themselves and each other, describing the source and scope of relational problems

• Systemic family therapy: helping family members understand each other better, change negative behaviors, and resolve conflicts

www.veteranmentalhealth.com/naadac6Next up: Quote, Reference, Q&A

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WORKING WITH A MENTAL HEALTH CARE PROFESSIONAL WHO UNDERSTOOD MY STRUGGLES WITHIN THE CONTEXT OF MILITARY LIFE INSTEAD OF TRYING TO FORCE MY UNIQUE EXPERIENCES INTO A BOX WITHIN A BROADER WORLDVIEW MADE ALL THE DIFFERENCE FOR ME. WHILE I STILL STRUGGLE WITH ANXIETY (I PROBABLY ALWAYS WILL), I

LEARNED LIFE‐CHANGING, PRACTICAL COPING TECHNIQUES SPECIFIC TO MY ROLE AS A MILITARY SPOUSE.

‐ COURTNEY WOODRUFF

MILITARY TIMES

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Bannink, F. P. (2007). Solution‐focused brief therapy. Journal of contemporary psychotherapy, 37(2), 87‐94.

Burkman, K., Purcell, N., & Maguen, S. (2019). Provider perspectives on a novel moral injury treatment for veterans: Initial assessment of acceptability and feasibility of the Impact of Killing treatment materials. Journal of clinical psychology, 75(1), 79‐94.

Cole, M. A., Muir, J. J., Gans, J. J., Shin, L. M., D'Esposito, M., Harel, B. T., & Schembri, A. (2015). Simultaneous treatment of neurocognitive and psychiatric symptoms in veterans with post‐traumatic stress disorder and history of mild traumatic brain injury: A pilot study of mindfulness‐based stress reduction. Military medicine, 180(9), 956‐963.

Dillon, K. H., Crawford, E. F., Kudler, H., Straits‐Troster, K. A., Elbogen, E. B., & Calhoun, P. S. (2017). An Investigation of Treatment Engagement among Iraq/Afghanistan Era Veterans with Problematic Anger. The Journal of nervous and mental disease, 205(2), 119.

Etchison, M., & Kleist, D. M. (2000). Review of narrative therapy: Research and utility. The Family Journal, 8(1), 61‐66.

Frankfurt, S., & Frazier, P. (2016). A review of research on moral injury in combat veterans. Military psychology, 28(5), 318‐330.

Goodman, F. R., Doorley, J. D., & Kashdan, T. B. (2018). Well‐being and psychopathology: A deep exploration into positive emotions, meaning and purpose in life, and social relationships. Handbook of well‐being. Salt Lake City, UT: DEF Publishers. DOI: nobascholar. com.

Gustavsson, N. (2012). Peer Support, Self‐efficacy, and Combat‐related Trauma Symptoms among Returning OIF/OEF Veterans Ann MacEachron. ADVANCES IN SOCIAL WORK, 13(3).

Hatef, E., Predmore, Z., Lasser, E. C., Kharrazi, H., Nelson, K., Curtis, I., ... & Weiner, J. P. (2019). Integrating social and behavioral determinants of health into patient care and population health at Veterans Health Administration: a conceptual framework and an assessment of available individual and population level data sources and evidence‐based measurements.

Hinojosa, R., Hinojosa, M. S., & Högnäs, R. S. (2012). Problems with veteran–family communication during Operation Enduring Freedom/Operation Iraqi Freedom military deployment.Military medicine, 177(2), 191‐197.

Kopacz, M. S., & Connery, A. L. (2015). The veteran spiritual struggle. Spirituality in Clinical Practice, 2(1), 61.

Lang, A. J., Schnurr, P. P., Jain, S., He, F., Walser, R. D., Bolton, E., ... & Strauss, J. (2017). Randomized controlled trial of acceptance and commitment therapy for distress and impairment in OEF/OIF/OND veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 9(S1), 74.

Larnera, G. (2004). Family therapy and the politics of evidence. Journal of Family Therapy, 26, 17‐39.

Lee, D. J., Schnitzlein, C. W., Wolf, J. P., Vythilingam, M., Rasmusson, A. M., & Hoge, C. W. (2016). Psychotherapy versus pharmacotherapy for posttraumatic stress disorder: Systemic review and meta‐analyses to determine first‐line treatments. Depression and anxiety, 33(9), 792‐806.

Management of Post‐Traumatic Stress Working Group [Inter‐ net]. VA/DOD clinical practice guideline for management of post‐traumatic stress. Washington (DC): Department of Veterans Affairs, Department of Defense; 2017.

REFERENCES

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REFERENCESManagement of Major Depressive Disorder Working Group. (2016). VA/DoD clinical practice guideline for the management of major depressive disorder: Washington (DC): Department of Veterans Affairs. Department of Defense.

Martz, E., Livneh, H., Southwick, S. M., & Pietrzak, R. H. (2018). Posttraumatic growth moderates the effect of posttraumatic stress on quality of life in US military veterans with life‐threatening illness or injury. Journal of psychosomatic research.

McNamee, S. (2017). Social Constructionism in Couple and Family Therapy.

Mobbs, M. C., & Bonanno, G. A. (2018). Beyond war and PTSD: The crucial role of transition stress in the lives of military veterans. Clinical psychology review, 59, 137‐144.

Nieuwsma, J. A., Walser, R. D., Farnsworth, J. K., Drescher, K. D., Meador, K. G., & Nash, W. P. (2015). Possibilities within Acceptance and Commitment Therapy for Approaching Moral Injury. Current Psychiatry Reviews, 11, 193‐206.

Neacsiu, A. D., Eberle, J. W., Kramer, R., Wiesmann, T., & Linehan, M. M. (2014). Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: A pilot randomized controlled trial. Behaviour research and therapy, 59, 40‐51.

Prosek, E., Burgin, E., Atkins, K., Wehrman, J., Fenell, D., Carter, C., & Green, L. (2018). Competencies for Counseling Military Populations. Journal of Military and Government Counseling, 87‐99.

Ruscio, A. M., Weathers, F. W., King, L. A., & King, D. W. (2002). Male war‐zone veterans' perceived relationships with their children: The importance of emotional numbing. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 15(5), 351‐357.

Sayer, N. A., Noorbaloochi, S., Frazier, P., Carlson, K., Gravely, A., & Murdoch, M. (2010). Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving VA medical care. Psychiatric services, 61(6), 589‐597.

STATEMENTS, Q. (2009). VA/DoD clinical practice guideline for management of concussion/mild traumatic brain injury. Journal of Rehabilitation Research & Development, 46(6).

Teeters, J. B., Lancaster, C. L., Brown, D. G., & Back, S. E. (2017). Substance use disorders in military veterans: prevalence and treatment challenges. Substance abuse and rehabilitation, 8, 69.

Thomas, K. H., Turner, L. W., Kaufman, E. M., Paschal, A., Knowlden, A. P., Birch, D. A., & Leeper, J. D. (2015). Predictors of depression diagnoses and symptoms in veterans: Results from a national survey.Military behavioral health, 3(4), 255‐265.

US Department of Veteran Affairs, Department of Defense (VA/DOD). VA/DoD clinical practice guideline for the management of substance use disorders. Version 3.0. 2015.

Vos, J., Craig, M., & Cooper, M. (2015). Existential therapies: A meta‐analysis of their effects on psychological outcomes. Journal of consulting and clinical psychology, 83(1), 115.

Wilcox, S. (2010). Social relationships and PTSD symptomatology in combat veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 2(3), 175.

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Q&A

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[email protected]

WWW.VETERANMENTALHEALTH.COM

THANK YOU!

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WWW.VETERANMENTALHEALTH.COM

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CE CERTIFICATE

41

CE HOURS AVAILABLE:1.5 CE

REGISTRATION TO ATTEND:

$25

CE CERTIFICATE:INCLUDED

To obtain a CE Certificate for the time you spent in this training:

1. Watch and listen to this entire webinar.

2. Pass the online CE quiz, which is posted at: www.naadac.org/identifying‐presenting‐concerns‐webinar

3. Maintain records of your invoice/receipt of payment and any CE certificate received from this series.

4. Email [email protected] if you experience any difficulty with this process.

4242

Over 145 CEs of free educational webinars are available. Education credits are FREE for NAADAC members.

WEBINAR SERIES

In each issue of Advances in Addiction & Recovery, NAADAC's magazine, one article is eligible for CEs.

MAGAZINE ARTICLES

NAADAC offers face-to-face seminars of varying lengths in the U.S. and abroad.

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Earn CEs at home and at your own pace (includes study guide and online examination).

INDEPENDENT STUDY COURSES

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CERTIFICATE PROGRAMS

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using what works: a review of evidence based ......naadac specialty training series: addiction...

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