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Effective Treatment Responses

No one knows exactly when the bulk of the troops will come home from Iraq or Afghanistan, or how rapidly the level of need will increase, but one thing is certain: Given the many sacrifices they have made, all veterans deserve the best, safest, most appropriate, most seamless care and support that our communities and service systems can provide. It is not enough to offer SUD or mental health “treatment as usual,” and great care will be needed to avoid iatrogenic effects (harm caused by the treatment or the treatment provider). For example, former Army Psychiatric Nurse Alison Lighthall warns that:

  • Group therapy with general client populations can set the scene for well intended but devastating questions or comments by civilian group members.
  • Psychotherapeutic techniques that fail to lay a firm groundwork in stability—or that probe traumatic wounds for signs of underlying pathology—can destabilize veterans and bring on new wounds and crises.

Instead, appropriate responses to the needs of returning veterans will include:

  • A strength- and recovery-based focus
  • An empowering, skill-training approach
  • Careful, individualized, respectful, veteran-specific assessment and treatment planning
  • A primary emphasis on stabilization and development of internal and external resources
  • Education for veterans and families on the physical aspects of trauma and substance use disorders, as a method of empowerment and a way of destigmatizing these effects
  • Assertive linkage to ongoing support within the community—and in the larger military and veteran community nationwide

Click here for a full-page summary of
Characteristics of Effective Treatment Responses

As services for returning veterans and their families evolve, significant input from veterans and family members will be needed to ensure that these services are accessible, respectful, culturally competent, consumer-driven, and effective for this population. These conversations are taking place on a national level and in many regions and states. But it is also the responsibility of individual service systems and treatment organizations to ensure that veterans and families play an active role in shaping local responses to their needs.

Clinicians need to:

  • Understand on deeper levels our human survival systems, the effects of war-zone stress on these systems, and the reality of recovery and return to balance
  • Communicate with veterans and their families about these matters in strength-based and normalizing terms that remove the stigma and shame from their experiences, their reactions, and their willingness to accept help
  • Organize SUD and mental health treatment and recovery responses around the state of the science, knowledge of the military culture, the wisdom and experience of those who have made progress in regaining balance, and the goals and choices of individual veterans and family members
  • Offer veterans treatment approaches that are tailored to their symptoms and disorders and have the smallest possible chance of triggering iatrogenic effects.
  • Maintain an openness and curiosity about the individual veteran and his or her experiences and realities
  • Understand their own experience of trauma, and maintain stability in the conscious process of addressing and resolving any issues attached to that realm of experience
  • Keep any agendas they might have about the war or the veteran’s participation in it (e.g., feelings or opinions about the war in Iraq, political issues) completely separate from the therapeutic process

Treatment organizations need to:

  • Educate staff at all levels on the military culture, the circumstances of returning veterans, the nature of post-deployment stress effects, and the nature of substance use disorders
  • Have a plan in place to ensure that all staff treat returning veterans as welcome and valued customers
  • Listen to recovering veterans and their families, and understand that they are the experts on their own feelings, symptoms, and treatment goals
  • Help them understand their post-deployment effects, including substance-related symptoms, in terms of their automatic physical stress and survival systems, and the natural reactions of those systems to circumstances in the theatre of war
  • Help veterans understand their post-deployment effects as signs of the power of the natural stress systems that kept them alive and functioning in the heat of combat
  • Show veterans and their families the strengths that exist within them in spite of their symptoms, and the transformative power of the recovery process
  • Give veterans and their families meaningful opportunities to influence the development and improvement of services for this population


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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