Skip to main content

Advertisement

SpringerLink
Log in

Web-Based Intervention for Returning Veterans with Symptoms of Posttraumatic Stress Disorder and Risky Alcohol Use

  • Original Paper
  • Published:
Journal of Contemporary Psychotherapy Aims and scope Submit manuscript

Abstract

A substantial number of military personnel who have served in Iraq (Operation Iraqi Freedom; OIF) and Afghanistan (Operating Enduring Freedom; OEF) develop symptoms of posttraumatic stress disorder (PTSD) in response to their military experiences and many of these same individuals will drink in a risky or problematic manner following deployment. If left untreated, PTSD symptoms and alcohol problems can become chronic and have a significant, negative impact on the lives of veterans, their families and communities. Further, OIF and OEF service members are often reluctant to seek treatment for mental health symptoms or alcohol problems secondary to stigma. In order to reach this population it is essential that new strategies and venues for delivering evidence-based care are explored. Web-based interventions are uniquely suited to this cohort of veterans in that they have the potential to reach a significant number of veterans who commonly use the Web and who might not otherwise receive care. This article will review the prevalence of PTSD and alcohol problems among OIF and OEF veterans, common barriers they experience with accessing care in traditional mental health settings, and what is known about the effectiveness of Web-based approaches for PTSD and alcohol problems. It also describes the components of a new Web-based intervention, developed by the authors, that uses motivational enhancement and cognitive-behavioral strategies to intervene with returning veterans who report PTSD symptoms and problem drinking. Recommendations for future directions in working with returning veterans with PTSD and alcohol problems will be offered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Amstadter, A. A., Broman-Fulks, J., Zinzow, H., Ruggiero, K. J., & Cercone, J. (2009). Internet-based interventions for traumatic stress-related mental health problems: A review and suggestion for future research. Clinical Psychology Review, 29, 410–420.

    Article  PubMed  Google Scholar 

  • Back, S. E., Waldrop, A. E., Brady, K. T., & Hien, D. (2006). Evidence-based time-limited treatment of co-occurring substance-use disorders and civilian-related posttraumatic stress disorder. Brief Treatment and Crisis Intervention, 6, 283–294.

    Article  Google Scholar 

  • Calhoun, P. S., Elter, J. R., Jones, E. R., Kudler, H., & Straits-Troster, K. (2008). Hazardous alcohol use and receipt of risk-reduction counseling among U.S. veterans of the wars in Iraq and Afghanistan. Journal of Clinical Psychiatry, 69, 1686–1693.

    Article  PubMed  Google Scholar 

  • Chemtob, C. M., Novaco, R. W., Hamada, R. S., Gross, D. M., & Smith, G. A. (1997). Anger regulation deficits in combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 10, 17–36.

    PubMed  CAS  Google Scholar 

  • Cook, J. M., Walser, R. D., Kane, V., Ruzek, J. I., & Woody, G. W. (2006). Dissemination and feasibility of a cognitive-behavioral treatment for substance use disorders and posttraumatic stress disorder in the veterans administration. Journal of Psychoactive Drugs, 38, 89–92.

    Article  PubMed  Google Scholar 

  • Elliot, J. C., Carey, K. B., & Bolles, J. R. (2008). Computer-based interventions for college drinking: A qualitative review. Addictive Behaviors, 33, 994–1005.

    Article  Google Scholar 

  • Finney, J. W., Wilbourne, P. L., & Moos, R. (2007). Psychosocial treatment for substance use disorders. In P. E. Nathan & J. M. Gorman (Eds.), A guide to treatments that work (pp. 179–202). New York: Oxford University Press.

    Google Scholar 

  • Fleming, M. F., Barry, K. L., Manwell, L. B., et al. (1997). Brief physician advice for problem drinkers: A randomized controlled trial in community-based primary care practices. Journal of the American Medical Association, 277, 1039–1045.

    Article  PubMed  CAS  Google Scholar 

  • Friedman, M. J. (2005). Veterans’ mental health in the wake of war. New England Journal of Medicine, 352, 1287–1290.

    Article  PubMed  CAS  Google Scholar 

  • Glueckauf, R., Pickett, T., Ketterson, T., Loomis, J., & Rozensky, R. (2003). Preparation for the delivery of telehealth services: A self-study framework for expansion of practice. Professional Psychology: Research and Practice, 34, 159–163.

    Article  Google Scholar 

  • Hawkins, E. J., Lapham, G. T., Kivlahan, D. R., & Bradley, K. A. (2010). Recognition and management of alcohol misuse in OEF/OIF and other veterans in the VA: A cross-sectional study. Drug and Alcohol Dependence, 109, 147–153.

    Article  PubMed  Google Scholar 

  • Hester, R. K., & Delaney, H. D. (1997). Behavioral self-control program for windows: Results of a controlled clinical trial. Journal of Consulting and Clinical Psychology, 65, 686–693.

    Article  PubMed  CAS  Google Scholar 

  • Hester, R. K., Delaney, H. D., Campbell, W., & Handmaker, N. (2009). A web application for moderation training: Initial results of a randomized clinical trial. Journal of Substance Abuse Treatment, 37, 266–276.

    Article  PubMed  Google Scholar 

  • Hester, R. K., Squires, D. D., & Delaney, H. D. (2005). The Drinker’s Check-Up: 12 month outcomes of a controlled clinical trial of a stand-alone software program for problem drinkers. Journal of Substance Abuse Treatment, 28, 159–169.

    Article  PubMed  Google Scholar 

  • Hirai, M., & Clum, G. A. (2005). An internet-based self-change program for traumatic event related fear, distress and maladaptive coping. Journal of Traumatic Stress, 18, 631–636.

    Article  PubMed  Google Scholar 

  • Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. J., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13–22.

    Article  PubMed  CAS  Google Scholar 

  • Hoge, C. W., McGurk, D., Thomas, J. L., Cox, A. L., Engel, C. C., & Castro, C. A. (2008). Mild traumatic brain injury in U.S. soldiers returning from Iraq, New England. Journal of Medicine, 358, 453–463.

    CAS  Google Scholar 

  • Jacobson, I. G., Ryan, M. A., Ryan, K., Hooper, To. I., et al. (2008). Alcohol use and alcohol-related problems before and after military combat deployment. Journal of the American Medical Association, 300, 663–675.

    Article  PubMed  CAS  Google Scholar 

  • Keane, T. M., & Kaloupek, D. G. (1997). Comorbid psychiatric disorders in PTSD: Implications for research. In R. Yehuda & A. McFarlane (Eds.), Psychobiology of PTSD (pp. 24–34). New York: Annals of NY Academy of Sciences.

    Google Scholar 

  • Keane, T. M., & Wolfe, J. (1990). Comorbidity in posttraumatic stress disorder: An analysis of community and clinical studies. Journal of Applied Social Psychology, 20, 1776–1788.

    Article  Google Scholar 

  • Kessler, R. D., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048–1060.

    PubMed  CAS  Google Scholar 

  • Kypri, K., Langley, J. D., Saunders, J. B., Cashell-Smith, M., & Herbison, P. (2008). Randomized controlled trial of web-based alcohol screening and brief intervention in primary care. Archives of Internal Medicine, 168, 530–536.

    Article  PubMed  Google Scholar 

  • Lange, A., Rietdijk, D., Hudcovicova, M., van de Ven, J., Schrieken, B., & Emmelkamp, P. M. G. (2003). Interapy: A controlled randomized trial of the standardized treatment of posttraumatic stress through the internet. Journal of Consulting and Clinical Psychology, 71, 901–909.

    Article  PubMed  Google Scholar 

  • Lange, A., van de Ven, J., Schrieken, B., & Emmelkamp, P. (2001). Interapy. Treatment of posttraumatic stress through the internet: A controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 32, 73–90.

    Article  PubMed  CAS  Google Scholar 

  • Leibert, T., Archer, J., Jr., Munson, J., & Yoirk, G. (2006). An exploratory study of client perceptions of internet counseling and the therapeutic alliance. Journal of Mental Health Counseling, 28, 69–83.

    Google Scholar 

  • Litz, B. T., Bryant, R., Williams, L., Wang, J., & Engel, C. C. (2004). A therapist-assisted internet self-help program for traumatic stress. Professional Psychology, Research and Practice, 35, 628–634.

    Article  Google Scholar 

  • Litz, B., Engel, C., Bryant, R., & Papa, A. (2007). A randomized, controlled proof-of-concept trial of an internet-based, therapist-assisted self-management treatment for Posttraumatic Stress Disorder. American Journal of Psychiatry, 164, 1676–1683.

    Article  PubMed  Google Scholar 

  • Litz, B., Gray, M. J., Bryant, R., & Adler, A. B. (2002). Early intervention for trauma: Current status and future directions. Clinical Psychology: Science and Practice, 9, 112–134.

    Article  Google Scholar 

  • Litz, B., & Schlenger, W. E. (2009). PTSD in service members and new veterans of the Iraq and Afghanistan wars: A bibliography and critique. PTSD Research Quarterly, 20(1), 1050–1835.

    Google Scholar 

  • Magruder, K. M., Frueh, B. C., Knapp, R. G., Johnson, M. R., Vaughan, J. A., Coleman, T., et al. (2004). PTSD symptoms, demographic characteristics, and functional status among veterans treated in VA Primary Care Clinics. Journal of Traumatic Stress, 17, 293–301.

    Article  PubMed  Google Scholar 

  • Mansell, D., Penk, W., Hankin, C. S., Lee, A. L., Spiro, A., Skinner, K. M., et al. (2005). The illness burden of alcohol-related disorders among VA patients: The veterans health study. Journal of Ambulatory Care Management, 29(1), 61–70.

    Google Scholar 

  • McDevitt-Murphy, M. E., Williams, J. L., et al. (2010). PTSD symptoms, hazardous drinking and health functioning among U.S. OEF and OIF veterans presenting to primary care. Journal of Traumatic Stress, 23, 108–111.

    PubMed  Google Scholar 

  • McLean, C., Schlenger, W. E. & Litz, B. (in press). Using the internet to deliver treatments for PTSD. In A. Brunet, A.R. Ashbaugh, & C.F. Herbert (Eds). Internet use in the aftermath of trauma. Amsterdam: IOS Press.

  • McLean, C. P., Steenkamp, M., Levy, H., & Litz, B. (2009). Technology-assisted interventions for PTSD. In M. A. Cucciare & K. R. Weingardt (Eds.), The use of technology to support evidence-based behavioral health practices: A clinician’s guide (pp. 45–68). New York: Taylor & Francis.

    Google Scholar 

  • Meichenbaum, D. (1985). Stress inocuation training. New York: Pergamon Press.

    Google Scholar 

  • Miller, W. R., & Wilbourne, P. L. (2002). Mesa Grande: A methodological analysis of clinical trials of treatments for alcohol use disorders. Addiction, 97, 265–277.

    Article  PubMed  Google Scholar 

  • Milliken, C. S., Auchterlonie, J. L., & Hoge, C. W. (2007). Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq War. Journal of the American Medical Association, 298, 2141–2148.

    Article  PubMed  CAS  Google Scholar 

  • Najavits, L. (2007). Psychosocial treatments for posttraumatic stress disorder. psychosocial treatment for substance use disorders. In P. E. Nathan & J. M. Gorman (Eds.), A guide to treatments that work (pp. 513–530). New York: Oxford University Press.

    Google Scholar 

  • Najavits, L. M., Ryngala, D., Back, S. E., Bolton, E., Mueser, K. M., & Brady, K. T. (2009). Treatment of PTSD and comorbid disorders. In E. B. Foa, T. M. Keane, M. J. Friedman, & J. A. Cohen (Eds.), Effective treatments for PTSD practice guidelines from the International Society for Traumatic Stress Studies (pp. 508–538). New York: Guilford Press.

    Google Scholar 

  • Nicholls, P. J., Abraham, K., Connor, K. M., Ross, J., & Davidson, J. R. T. (2006). Trauma and posttraumatic stress in users of the Anxiety Disorders Association of America web site. Comprehensive Psychiatry, 47, 30–34.

    Article  PubMed  Google Scholar 

  • Pietrzak, R. H., Goldstein, M. B., Malley, J. C., Johnson, D. C., & Southwick, S. M. (2009a). Subsyndromal posttraumatic stress disorder is associated with health and psychosocial difficulties in veterans of operations enduring freedom and Iraqi freedom. Depression and Anxiety, 26, 739–744.

    Article  PubMed  Google Scholar 

  • Pietrzak, R. H., Johnson, D. C., Goldstein, M. B., Malley, J. C., & Southwick, S. M. (2009b). Perceived stigma and barriers to mental health care utilization among OEF-OIF veterans. Psychiatric Services, 60, 1118–1122.

    Article  PubMed  Google Scholar 

  • Riper, H., Kramer, J., Smit, F., Conijn, B., Schippers, G., & Cuijpers, P. (2008). Web-based self- help for problem drinkers: A pragmatic randomized trial. Addiction, 103, 218–227.

    Article  PubMed  Google Scholar 

  • Saitz, R., Helmuth, E. D., Aromaa, R. E., Guard, A., Belanger, M., & Rosenbloom, D. L. (2004). Web-based screening and brief intervention for the spectrum of alcohol problems. Preventive Medicine, 39, 969–975.

    Article  PubMed  Google Scholar 

  • Schnurr, P. P., Ford, J. D., Friedman, M. J., Green, B. L., Dain, B. J., & Sengupta, A. (2000). Predictors and outcomes of posttraumatic stress disorder in world war II veterans exposed to mustard gas. Journal of Consulting and Clinical Psychology, 68, 258–268.

    Article  PubMed  CAS  Google Scholar 

  • Seal, K. H., Bertenthal, D., Miner, C. R., Sen, S., & Marmar, C. (2007). Bringing the war back home. Mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs Facilities. Archives of Internal Medicine, 167, 476–482.

    Article  PubMed  Google Scholar 

  • Seal, K. H., Metzler, T. J., Gima, K. S., Bertenthal, D., Maguen, S., & Marmar, C. R. (2009). Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs Health Care, 2002–2008. American Journal of Public Health, 99, 1651–1658.

    Article  PubMed  Google Scholar 

  • Shea, M. T., Vujanovic, A. A., Mansfield, A. K., Sevin, E., & Liu, F. (2010). Posttraumatic stress disorder symptoms and functional impairment among OEF and OIF National Guard and Reserve Veterans. Journal of Traumatic Stress, 23, 100–107.

    PubMed  Google Scholar 

  • Sobell, M. B., & Sobell, L. C. (1996). Problem drinkers: Guided self-change treatment. New York: Guilford Press.

    Google Scholar 

  • Vernon, M. L. (2010). A review of computer-based alcohol problem services designed for the general public. Journal of Substance Abuse Treatment, 38, 203–211.

    Article  PubMed  Google Scholar 

  • Walters, S., Hester, R. K., Chiauzzi, E. M., & Miller, E. (2005). Demon Rum: High-tech solutions to an age-old problem. Alcoholism, Clinical and Experimental Research, 29, 270–277.

    Article  PubMed  Google Scholar 

  • Weller, L. A. (2005). Group therapy to treat substance use and traumatic symptoms in female veterans. Federal Practitioner, 22, 27–38.

    Google Scholar 

  • Wilk, J. E., Bliese, P. D., Kim, P. Y., Thomas, J. L., McGurk, D., & Hoge, C. W. (2010). Relationship of combat experiences to alcohol misuse among U.S. soldiers returning from the Iraq War. Drug and Alcohol Dependence, 108, 115–121.

    Article  PubMed  Google Scholar 

Download references

Acknowlegments

This article was supported in part by funds from the National Institute on Alcohol Abuse and Alcoholism.

Author information

Authors and Affiliations

  1. VA Boston Healthcare System, Boston University School of Medicine, 150 S. Huntington Ave (116B), Boston, MA, 02130, USA

    Deborah J. Brief, Justin L. Enggasser & Monica Roy

  2. VA Boston Healthcare System, Boston University School of Medicine, 150 S. Huntington Ave (151B), Boston, MA, 02130, USA

    Amy Rubin & Terence M. Keane

Authors
  1. Deborah J. Brief
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amy Rubin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Justin L. Enggasser
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Monica Roy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Terence M. Keane
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deborah J. Brief.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Brief, D.J., Rubin, A., Enggasser, J.L. et al. Web-Based Intervention for Returning Veterans with Symptoms of Posttraumatic Stress Disorder and Risky Alcohol Use. J Contemp Psychother 41, 237–246 (2011). https://doi.org/10.1007/s10879-011-9173-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10879-011-9173-5

Keywords

Search

Navigation