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«A Readjustment Handbook A Guide to Understanding and Coping With Readjustment Issues Following a Military Deployment For service members, veterans, ...»

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8. Decrease alcohol - Because alcohol causes mid-night awakenings, have no more than one serving of alcohol with dinner. Of course if you are in recovery from alcohol abuse, it is important to avoid alcohol entirely.

9. Inspect your bedroom environment - Is your bedroom dark and free of noise? Is your bed comfortable? Is the temperature comfortable? Do you feel safe and serene in your bedroom? If not, you can add images that are calming-a picture of your children, pet, an outdoor scene, a poem, or a prayer-to your room.

10. Get help - There are treatments that can help your sleep problems. If you continue to have sleep problems, see a trained sleep specialist to help identify what is the best treatment for you.

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for a long period of time. During nightmares, you may feel like you are "reliving" the event, with the same fear, helplessness, or rage experienced during the original trauma. Nightmares are not a sign that you are "going crazy." They are a way of working through a trauma.

Some people try to avoid nightmares, by using drugs or alcohol, or by avoiding sleep altogether. These "solutions" only lead to new problems, such as substance dependence and sleep deprivation. When you wake up from a nightmare, leave the bedroom and go to another room to get your bearings. It may take a while to re-orient yourself to the present. Do something relaxing. If possible, reach out to someone who supports you. If you live with others, discuss the fact that you are having nightmares. Discuss ways in which you might want to handle the situation and share this handout with them. A small percentage of sufferers act out their nightmare in their sleep. You may want to rearrange your bedroom so that you are safe. If you share your bed with a partner, you may need to make sure he/she is not in harm's way.

How Are Sleep Problems Treated?

There are effective treatments for sleep problems. Choosing one that is right for you will depend on the situation. Medications are available for quick, short-term relief of insomnia and nightmares. Some medications can be addictive, however, so check with your doctor to find out which is best for you.

Some "talk therapies" will help bring about long-term relief of sleep problems. "Cognitive Behavioral Therapy" targets your beliefs and behaviors that can make sleep problems worse. "Sleep Hygiene" Therapy helps people develop habits that can improve sleep. Breathing and relaxation therapies also may be used to help reduce muscle tension and promote sleep.

Therapies to treat nightmares are also available. For example, "Imagery Rehearsal Therapy" focuses upon helping people change the endings of their nightmares, while they are awake, so the dream is no longer upsetting. This therapy has been shown to reduce nightmares in survivors of combat and sexual assault.

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National Center for Post-Traumatic Stress Disorder: www.ncptsd.org National Alliance for the Mentally Ill: http://www.nami.org/ContenVContentGroups/Helpline1/Sleep Disorders.htm

Stanford University Center for Excellence in the Diagnosis and Treatment of Sleep Disorders:

http://www.med.stanford.edu/school/psychiatry/coe/

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Many military personnel experience stress related to their deployment, service, and return home. These quite natural stress reactions can range from mild to severe and may be either short-lived or persist for a very long time. One common approach to managing stress that seems a simple and easy solution is use of alcohol or drugs. Military personnel, like civilians, may use alcohol and drugs as a way to relax or reduce anxiety and other bad feelings. In some cases, alcohol and drugs are not only used to decrease stress but also to manage severe symptoms that can arise from a traumatic experience in the war zone. You might find yourself

drinking or using drugs for a variety of reasons when under stress or after trauma, including to:

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Becoming Dependent on Alcohol/Drugs Initially, alcohol and drugs may seem to make things better. They may help you sleep, forget problems, or feel more relaxed. But any short-term benefit can turn sour fast. In the long run, using alcohol and drugs to cope with stress will cause a whole new set of very serious problems, as well as worsening the original problems that lead you to drink or use. Alcohol and drug abuse can cause problems with your family life, health, mental well-being, relationships, finances, employment, spirituality, and sense of self-worth.

Think about family impact as an example. It's difficult to create good relationships when you are regularly drunk or high. Being intoxicated decreases intimacy and creates an inability to communicate well. Family members can feel rejected by someone who is always under the influence. In addition, witnessing someone's behavior while under the influence can be distressing. Children may not understand the aggressive behavior, the shutting down, or the hiding out that can occur along with substance use. The fallout from an accident or an arrest can have a long-lasting impact on a family. Alcohol and drug problems are dangerous for loved ones, because they are often linked with family violence and driving while intoxicated.





When is Use of Alcohol a Problem?

It is often hard to decide whether alcohol or drug use is becoming a problem. It can happen gradually, and sometimes can be hard to notice by the person who is using. Here are things that people sometimes say to themselves to convince themselves that they do not have a problem. Do you recognize any?

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Have friends or family members commented on how much or how often you drink? Have you have found yourself feeling guilty about your drinking or drug use? Have you found yourself drinking (using) more over time?

Have you tried to cut down your alcohol (drug) use?

Does your drinking (using drugs) ever affect your ability to fulfill personal obligations such as parenting or work?

Do you drink (use) in situations that are physically dangerous such as driving or operating machinery while under the influence?

Have you found that you need more alcohol (drug) to get the same effect?

If you find that you are answering "yes" to one or more of these questions, perhaps it is time to reevaluate your use, cut back, and seek help from friends, family, or a professional.

What to Do if Alcohol or Drugs are Causing Problems

If you think that that alcohol (drug) use has become (or is becoming) a problem for you, there are number of things that you can do. First, recognize that you are not alone and that others are available to lend support. Second, find help. Getting help is the most useful tool in decreasing or stopping problem drinking or drug use, even if you have doubts about being able to quit or if you are feeling guilt about the problem. Call your health provider, contact a physician or therapist, call your local VA hospital, or contact your local Alcoholic's Anonymous for guidance in your recovery. These contacts can help you on the road to the life you want.

Listed below are some useful websites if you are looking for more information about alcohol and drug use or about how to get help.

Alcohol and Drug Abuse Information and Resources: http://www.alcoholanddrugabuse.com/

National Institute on Alcohol Abuse and Alcoholism: Frequently Asked Questions:

http://www.niaaa.nij.gov/faq/faq.htm Substance Abuse Treatment Facility Locator: http://findtreatment.samhsa.gov/ Alcoholics Anonymous Homepage: http://www.alcoholics-anonymous.org/

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Depression is a common problem in which severe and long lasting feelings of sadness or other problems get in the way of a person's ability to function. In any given year, as many as 18.8 million American adults-9.5% of the adult population-experience some type of depression. Unlike a blue mood that comes and goes, depression is a persistent problem that affects the way a person eats and sleeps, thinks about things, and feels about him- or herself.

What are the Symptoms of Depression?

The symptoms of depression can vary quite a bit, but most people who experience depression feel down or sad more days than not, or find that things in their life no longer seem enjoyable or interesting.

Additionally, people with depression may notice changes in their sleeping, eating, concentration, or feelings about themselves, and may find themselves feeling hopeless. These symptoms typically last for at least 2 weeks without letting up.

What Causes Depression?

Depression has many causes. Difficulty coping with painful experiences or losses contributes to depression. People returning from a war zone often experience painful memories, feelings of guilt, or regret about their war experiences, or have a tough time readjusting back to normal life. Trouble coping with these feelings and experiences can lead to depression. Some types of depression run in families, and depression is often associated with chemical imbalances and other changes in the brain.

How is Depression Treated?

There are many treatment options for depression. An evaluation should be done by a healthcare professional to help determine which type of treatment is best for an individual. Typically, milder forms of depression are treated by psychotherapy, and more severe depression is treated with medications or a combination of psychotherapy and medication. Your doctor can help you determine which treatment is best for you.

Psychotherapy. There are a number of types of psychotherapy (or talk therapy) that are used to treat depression. These treatments may involve just a few sessions, or may last 10-20 weeks or longer.

Psychotherapy treatments tend to focus on helping patients learn about their problems and resolve them, through working with a therapist and learning new patterns of behavior to help decrease depression.

Two of the main types of psychotherapy for depression are interpersonal therapy and cognitivebehavioral therapy. Interpersonal therapy focuses on the patient's relationships with other people, and how these relationships may cause and maintain depression. Cognitive-behavioral treatments help patients change negative styles of thinking and acting that can lead to depression.

Medication. In addition to psychotherapy, there are several types of antidepressant medications used to treat depression. These include selective serotonin reuptake inhibitors (SSRIs), tricyclics, and monoamine oxidase inhibitors (MAOls). The newer medications for treating depression, such as the SSRIs, generally have fewer side effects than older types of medications. A healthcare provider may try more than one type of medication, or may increase the dosage, to find a treatment that works. Improvements in symptoms of depression typically occur after the medication is taken regularly for 3 to 4 weeks, although in some medications it may take as long as 8 weeks for the full effect to occur.

Antidepressant medications are typically safe and effective. They help patients feel less depressed and generally do not make people feel "drugged" or different during their daily lives. The side effects of depression medications vary depending on the medication, and can include dry mouth, constipation, bladder problems, sexual problems, blurred vision, dizziness, drowsiness, headache, nausea, nervousness, or insomnia. Because of side effects or because they begin feeling better, patients are often tempted to stop taking their medication too soon. Some medications must be stopped slowly to give your body time to readjust to not having the medication. Never stop taking an antidepressant without consulting your doctor.

What Can I Do about Feelings of Depression?

Depression can make a person feel exhausted, worthless, helpless, hopeless, and sad. These feelings can make you feel as though you are never going to feel better, or that you should just give up. It is important to realize that these negative thoughts and feelings are part of depression, and often fade as treatment

begins working. In the meantime, here is a list of things to try to improve your mood:

• Talk with your doctor or healthcare provider

• Talk with family and friends, and let them help you

• Participate in activities that make you feel better, or that you used to enjoy before you began feeling depressed

• Set realistic goals for yourself

• Engage in mild exercise

• Try to be with others and get support from them

• Break up goals and tasks into smaller, more reachable ones Where Can I Find More Information About Depression?

National Institute of Mental Health Depression Fact Sheet: www.nimh.nih.gov/publicaUdepression.cfm National Alliance for the Mentally Ill: www.nami.org National Center for Post-Traumatic Stress Disorder: www.ncptsd.org

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Military personnel in war zones frequently have serious reactions to their traumatic war experiences. Sometimes the reactions continue after they return home. Ongoing reactions to war

zone fear, horror, or helplessness connected with posttraumatic stress and can include:

Nightmares or difficulty sleeping Unwanted distressing memories or thoughts Anxiety and panic Irritability and anger Emotional numbing or loss of interest in activities or people Problem alcohol or drug use to cope with stress reactions How Traumatic Stress Reactions Can Affect Families Stress reactions in a returning war veteran may interfere with the ability to trust and be emotionally close to others. As a result, families may feel emotionally cut off from the service member. The veteran may feel irritable and, have difficulty with communication, making him/her hard to get along with. He or she may experience a loss of interest in family social activities. The veteran may lose interest in sex and feel distant from his or her spouse. Traumatized war veterans often feel that something terrible may happen "out of the blue" and can become preoccupied with trying to keep themselves and family members safe.



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