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Clinical Considerations

These pages tell the story of a significant human strength, our natural, automatic stress and survival system.  It is a strength that can save lives, but in so doing can lose its balance and become a source of great suffering.  Another essential story is that of recovery—the return to balance and the transformation of human lives—and the role that caring, skilled, and knowledgeable people can play in that transformation.

As our communities welcome the return of veterans from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF, the war in Afghanistan), service systems for substance use disorders (SUD), mental health, homelessness, criminal justice, and other challenges are seeing increasing numbers of returning veterans.  In these kinds of insurgency conflicts, exposure to attack is not limited to combat troops, and the sophistication of our military health care system allows many to survive who would have perished in earlier wars (Hoge et al., 2008).  There is simply a broader field for war-zone stress injuries to take root.


Download Finding Balance After the War Zone: 
Considerations in the Treatment of Post-Deployment Stress Effects


Evidence also indicates that only a little more than half of the OIF/OEF Service Members and veterans who meet the criteria for posttraumatic stress disorder (PTSD) or major depression have sought help from physicians or mental health providers in the past year, and that roughly the same proportion of people with TBI have been evaluated for these injuries.  And of those who have sought medical care for PTSD, TBI, or depression, only a little more than half have received “minimally adequate treatment” (Tanielian and Jaycox, 2008, p. xxii).

The United States Department of Defense (DoD) and Department of Veterans Affairs (VA) have responded to these service gaps by implementing expanded programs, increasing their service capacity—both at home and in the theater of war—and initiating training in evidence-based practices, but it has become clear that community-based services are needed as well (Tanielian and Jaycox, 2008).  In response, the Substance Abuse and Mental Health Services Administration (SAMHSA) has mobilized to help prepare the civilian treatment workforce.

These pages are part of that preparation process.  Although they are written primarily to address the needs of the Substance Use Disorder (SUD) field, they contain information that may be useful to clinicians in a number of helping professions. 

Next: The Role of the SUD Treatment & Recovery Field

Also in this section:


Please Note: Some of the considerations in these pages are taken from written works, but more are based on conversations with or presentations by veterans or therapists who work with trauma survivors.  The reader is encouraged, not to take these ideas as absolute or as the only important considerations, but to respond to them with curiosity and a desire to listen, read, and learn much more.


The material on all of the Clinical Pages is taken directly from the clinicians' manual Finding Balance:  Considerations in the Treatment of Post-deployment Stress Effects, published by the Great Lakes Addiction Technology Transfer Center and Human Priorities.  This manual is copyright © 2008, Pamela Woll.  Reprint permission is universally granted, but attribution is requested. Click here for References and Other Resources.
Click the following links for PDFs of materials in the Finding Balance series:   Clinicians' Guide <> Workbook for Service Members and Veterans <> Quick Guide for Service Members and Veterans <> Workbook for Military Families <> Suggestions for Facilitators (Counselors, Trainers, Mentors) using the workbooks

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