Supporting our Vets: Relationships and PTSD

How does trauma affect relationships?

Trauma survivors with PTSD may have trouble with their close family relationships or friendships. The symptoms of PTSD can cause problems with trust, closeness, communication, and problem solving. These problems may affect the way the survivor acts with others. In turn, the way a loved one responds to him or her affects the trauma survivor. A circular pattern can develop that may sometimes harm relationships.

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How might trauma survivors react?

In the first weeks and months following a trauma, survivors may feel angry, detached, tense or worried in their relationships. In time, most are able to resume their prior level of closeness in relationships. Yet the 5% to 10% of survivors who develop PTSD may have lasting relationship problems.

Survivors with PTSD may feel distant from others and feel numb. They may have less interest in social or sexual activities. Because survivors feel irritable, on guard, jumpy, worried, or nervous, they may not be able to relax or be intimate. They may also feel an increased need to protect their loved ones. They may come across as tense or demanding.

The trauma survivor may often have trauma memories or flashbacks. He or she might go to great lengths to avoid such memories. Survivors may avoid any activity that could trigger a memory. If the survivor has trouble sleeping or has nightmares, both the survivor and partner may not be able to get enough rest. This may make sleeping together harder.

Survivors often struggle with intense anger and impulses. In order to suppress angry feelings and actions, they may avoid closeness. They may push away or find fault with loved ones and friends. Also, drinking and drug problems, which can be an attempt to cope with PTSD, can destroy intimacy and friendships. Verbal or physical violence can occur.

In other cases, survivors may depend too much on their partners, family members, and friends. This could also include support persons such as health care providers or therapists.

Dealing with these symptoms can take up a lot of the survivor's attention. He or she may not be able to focus on the partner. It may be hard to listen carefully and make decisions together with someone else. Partners may come to feel that talking together and working as a team are not possible.

How might loved ones react?

Partners, friends, or family members may feel hurt, cut off, or down because the survivor has not been able to get over the trauma. Loved ones may become angry or distant toward the survivor. They may feel pressured, tense, and controlled. The survivor's symptoms can make a loved one feel like he or she is living in a war zone or in constant threat of danger. Living with someone who has PTSD can sometimes lead the partner to have some of the same feelings of having been through trauma.

In sum, a person who goes through a trauma may have certain common reactions. These reactions affect the people around the survivor. Family, friends, and others then react to how the survivor is behaving. This in turn comes back to affect the person who went through the trauma.

Trauma types and relationships

Certain types of "man-made" traumas can have a more severe effect on relationships. These traumas include:

• Childhood sexual and physical abuse
• Rape
• Domestic violence
• Combat
• Terrorism
• Genocide
• Torture
• Kidnapping
• Prisoner of war

Survivors of man-made traumas often feel a lasting sense of terror, horror, endangerment, and betrayal. These feelings affect how they relate to others. They may feel like they are letting down their guard if they get close to someone else and trust them. This is not to say a survivor never feels a strong bond of love or friendship. However, a close relationship can also feel scary or dangerous to a trauma survivor.

Do all trauma survivors have relationship problems?

Many trauma survivors do not develop PTSD. Also, many people with PTSD do not have relationship problems. People with PTSD can create and maintain good relationships by:

• Building a personal support network to help cope with PTSD while working on family and friend relationships
• Sharing feelings honestly and openly, with respect and compassion
• Building skills at problem solving and connecting with others
• Including ways to play, be creative, relax, and enjoy others

What can be done to help someone who has PTSD?

Relations with others are very important for trauma survivors. Social support is one of the best things to protect against getting PTSD. Relationships can offset feelings of being alone. Relationships may also help the survivor's self-esteem. This may help reduce depression and guilt. A relationship can also give the survivor a way to help someone else. Helping others can reduce feelings of failure or feeling cut off from others. Lastly, relationships are a source of support when coping with stress.

If you need to seek professional help, try to find a therapist who has skills in treating PTSD as well as working with couples or families. 

Many treatment approaches may be helpful for dealing with relationship issues. Options include:

• One-to-one and group therapy
• Anger and stress management
• Assertiveness training
• Couples counseling
• Family education classes
• Family therapy

Source: Veterans Administration

Spankings can trigger adult mental health problems

Getting spanked as a child can lead to a host of mental health problems in adulthood say researchers

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Spanking is defined as using physical force with the intention of causing a child to experience pain, but not injury, to correct or control the youth's behavior.

Credit: © vkara / Fotolia

Getting spanked as a child can lead to a host of mental health problems in adulthood, say University of Michigan researchers.

A new study by Andrew Grogan-Kaylor and Shawna Lee, both U-M associate professors of social work, and colleagues indicates the violence caused by spanking can lead adults to feel depressed, attempt suicide, drink at moderate-to-heavy levels or use illegal drugs.

"Placing spanking in a similar category to physical/emotional abuse experiences would increase our understanding of these adult mental health problems," Grogan-Kaylor said.

Spanking is defined as using physical force with the intention of causing a child to experience pain, but not injury, to correct or control the youth's behavior.

Researchers note that given that both spanking and physical abuse involves the use of force and infliction of pain, as well as being linked with similar mental health outcomes, it raises the question of whether spanking should be considered an adverse childhood experience. This involves abuse, neglect and household dysfunction, which includes divorce and an incarcerated relative.

The study used data from the CDC-Kaiser ACE study, which sampled more than 8,300 people, ranging in age from 19 to 97 years. Study participants completed self-reports while seeking routine health checks at an outpatient clinic.

They were asked about how often they were spanked in their first 18 years, their household background and if an adult inflicted physical abuse (push, grab, slap or shoved) or emotional abuse (insulted or cursed).

In the study sample, nearly 55 percent of respondents reported being spanked. Men were more likely to experience childhood spanking than women. Compared to white respondents, minority respondents -- other than Asians -- were more likely to report being spanked.

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Those reporting exposure to spanking had increased odds of depression and other mental health problems, the study showed.

Author Tracie Afifi, associate professor at the University of Manitoba, says that it's important to prevent not just child maltreatment, but also harsh parenting before it occurs.

"This can be achieved by promoting evidence-based parenting programs and policies designed to prevent early adversities, and associated risk factors," said Lee, who is also a faculty associate at the U-M Institute for Social Research. "Prevention should be a critical direction for public health initiatives to take."

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Story Source:

University of Michigan. 

More and better drug treatment needed in prisons

Drug abuse and crime continue to be linked; and although addiction is recognized as a chronic, relapsing disease, offenders are still not getting the treatment they need. 

Addiction is a brain disease. A preventable one, but nevertheless a brain disease. LEARN MORE HERE! 

• Chronic drug abuse causes long-lasting brain changes that contribute to an addicted person’s compulsion to seek and use drugs despite catastrophic consequences. These brain changes persist long after drug abuse ends, leading to high rates of relapse (as with other chronic diseases) and the need for continuing treatment to help an individual achieve recovery.
• More and better treatment is needed in the criminal justice system, and continuing through the period of re-entry into the community. It is estimated that about half of state and federal prisoners meet the criteria for drug abuse and dependence and yet fewer than 20 percent who need treatment receive it.
• As in the general population, co-occurring substance use and other mental disorders are common, with about 45% of inmates in local jails and State prisons having both. In addition, about 75% of inmates with a mental illness also meet criteria for substance abuse, and vice-versa. This high rate of co-occurrence underscores the need for offenders, both adults and juveniles, suffering from one disorder to be screened for the other and, where appropriate, treated for both, necessitating an integrated treatment approach.
• Involvement in the criminal justice system provides an opportunity to diagnose and treat these health problems, which also include infectious diseases like HIV. Fourteen percent of HIV-infected individuals pass through correctional facilities each year, and yet criminal justice–based services and community health and social services remain fragmented.

Treatment works, is cost-effective, and can help end the vicious cycle of drug abuse and criminal recidivism. 

• Research demonstrates that treatment can work for drug abusing offenders, even when it is entered involuntarily. Forced abstinence (when it occurs) during incarceration is not equivalent to treatment. Failure to receive needed treatment or access to services often leads to relapse and re-arrest, usually during the first 12 months after release.
  
  Juvenile Offenders: Virtually every juvenile offender should be screened for drug abuse and mental disorders, and receive an intervention:
  
  
  • Treatment for those who are dependent on alcohol or drugs, or mentally ill.
  • Drug abuse prevention for those who are not.
  • HIV prevention or treatment as needed.
• Longitudinal studies show that treatment begun in the criminal justice system and continued in the community garners lasting reductions in criminal activity and drug abuse. This includes medication-assisted treatment (i.e., methadone) for prisoners with heroin addiction (see figure below).
• Providing treatment is cost-effective, saving between $2 and $6 for every $1 spent on it, which in part reflects reductions in criminal behavior and re-incarceration.

TOMORROW

Getting proven treatments into the criminal justice system will promote abstinence, help identify and mitigate related diseases like HIV, and foster productive reintegration back into the community. 

Source: NIH

In autism, too many brain connections may be at root of condition

Learning, social issues may reflect neuronal miscommunication

Source:

Washington University School of Medicine

Summary:

Mutations in a gene linked to autism in people causes neurons to form too many connections in rodents, according to a new study. The findings suggest that malfunctions in communication between brain cells could be at the root of autism.

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A defective gene linked to autism influences how neurons connect and communicate with each other in the brain, according to a study from Washington University School of Medicine in St. Louis. Rodents that lack the gene form too many connections between brain neurons and have difficulty learning.

The findings, published Nov. 2 in Nature Communications, suggest that some of the diverse symptoms of autism may stem from a malfunction in communication among cells in the brain.

"This study raises the possibility that there may be too many synapses in the brains of patients with autism," said senior author Azad Bonni, MD, PhD, the Edison Professor of Neuroscience and head of the Department of Neuroscience at Washington University School of Medicine in St. Louis. "You might think that having more synapses would make the brain work better, but that doesn't seem to be the case. An increased number of synapses creates miscommunication among neurons in the developing brain that correlates with impairments in learning, although we don't know how."

Autism is a neurodevelopmental disorder affecting about one out of every 68 children. It is characterized by social and communication challenges.

Among the many genes linked to autism in people are six genes that attach a molecular tag, called ubiquitin, to proteins. These genes, called ubiquitin ligases, function like a work order, telling the rest of the cell how to deal with the tagged proteins: This one should be discarded, that one should be rerouted to another part of the cell, a third needs to have its activity dialed up or down.

Patients with autism may carry a mutation that prevents one of their ubiquitin genes from working properly. But how problems with tagging proteins affect how the brain is hardwired and operates, and why such problems may lead to autism, has remained poorly understood.

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To understand the role of ubiquitin genes in brain development, Bonni, first author Pamela Valnegri, PhD, and colleagues removed the ubiquitin gene RNF8 in neurons in the cerebellum of young mice. The cerebellum is one of the key brain regions affected by autism.

The researchers found that neurons that lacked the RNF8 protein formed about 50 percent more synapses -- the connections that allow neurons to send signals from one to another -- than those with the gene. And the extra synapses worked. By measuring the electrical signal in the receiving cells, the researchers found that the strength of the signal was doubled in the mice that lacked the protein.

The cerebellum is indispensable for movement and learning motor skills such as how to ride a bicycle. Some of the recognizable symptoms of autism -- such as motor incoordination and a tendency to walk tippy-toed -- involve control of movement.

The animals missing the RNF8 gene in the neurons of their cerebellum did not have any obvious problems with movement: They walked normally and appeared coordinated. When the researchers tested their ability to learn motor skills, however, the mice without RNF8 failed miserably.

The researchers trained the mice to associate a quick puff of air to the eye with the blinking of a light. Most mice learn to shut their eyes when they see the light blink, to avoid the irritation of the coming air puff. After a week of training, mice with a functioning copy of the gene closed their eyes in anticipation more than three quarters of the time, while mice without the gene shut their eyes just a third of the time.

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While it is best known for its role in movement, the cerebellum is also important in higher cognitive functions such as language and attention, both of which are affected in autism. People with autism often have language delays and pay unusually intense attention to objects or topics that interest them. The cerebellum may be involved not only in motor learning but in other features of autism as well, the researchers said.

Of course, there is a world of difference between a mouse that can't learn to shut its eyes and a person with autism who struggles to communicate. But the researchers said the findings suggest that changing how many connections neurons make with each other can have important implications for behavior.
Since this paper was written, Bonni and colleagues have tested the other autism-associated ubiquitin genes. Inhibition of all genes tested cause an increase in the number of synapses in the cerebellum.

"It's possible that excessive connections between neurons contribute to autism," Bonni said. "More work needs to be done to verify this hypothesis in people, but if that turns out to be true, then you can start looking at ways of controlling the number of synapses. It could potentially benefit not just people who have these rare mutations in ubiquitin genes but other patients with autism."

Story Source:

Materials provided by Washington University School of Medicine. 

Regular marijuana use linked to more sex, study finds

Sex...it happens in the brain first.

Despite concerns among physicians and scientists that frequent marijuana use may impair sexual desire or performance, the opposite appears more likely to be the case, new research indicates.

FULL STORY

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The jury's still out on rock 'n' roll. But the link between sex and at least one drug, marijuana, has been confirmed.

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A study by investigators at the Stanford University School of Medicine indicates that, despite concerns among physicians and scientists that frequent marijuana use may impair sexual desire or performance, the opposite appears more likely to be the case.

The findings, to be published online Oct. 27 in the Journal of Sexual Medicine, are based on an analysis of more than 50,000 Americans ages 25-45. And they're unambiguous.

"Frequent marijuana use doesn't seem to impair sexual motivation or performance. If anything, it's associated with increased coital frequency," said the study's senior author, Michael Eisenberg, MD, assistant professor of urology. The lead author is Andrew Sun, MD, a resident in urology.

Hint of a causal connection
The study does not establish a causal connection between marijuana use and sexual activity, Eisenberg noted. But the results hint at it, he added. "The overall trend we saw applied to people of both sexes and all races, ages, education levels, income groups and religions, every health status, whether they were married or single and whether or not they had kids."

The study is the first to examine the relationship between marijuana use and frequency of sexual intercourse at the population level in the United States.

"Marijuana use is very common, but its large-scale use and association with sexual frequency hasn't been studied much in a scientific way," Eisenberg said.

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According to the National Institute on Drug Abuse, more than 20 million adult Americans are current marijuana users. With the drug's legalization for medical or recreational use in 29 states, that number is climbing. But despite marijuana's growing status as a recreational drug, its status as a procreational drug remains ambiguous: On one hand, there are reports of erectile dysfunction in heavy users, and rigorous studies have found reduced sperm counts in men who smoke it; on the other hand, experiments conducted in animal models and humans indicate that marijuana stimulates activity in brain regions involved in sexual arousal and activity.

Looking at survey responses
To arrive at an accurate determination of marijuana's effect on intercourse frequency, Eisenberg and Sun turned to the National Survey of Family Growth, sponsored by the federal Centers for Disease Control and Prevention. The survey, which provides data pertaining to family structures, sexual practices and childbearing, reflects the overall demographic features of the U.S. population.

Originally conducted at regular intervals, the survey is now carried out on an annual basis. It explicitly queries respondents on how many times they've had intercourse with a member of the opposite sex in the past four weeks, and how frequently they've smoked marijuana over the past 12 months.

The investigators compiled answers to those questions for all years since 2002, when the survey first began collecting data on men as well as women. They included data from respondents ages 25-45 and excluded a small percentage (fewer than 3 percent) of respondents who had failed to answer one or more relevant questions.

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In all, Eisenberg and Sun obtained data on 28,176 women averaging 29.9 years of age and 22,943 men whose average age was 29.5. They assessed these individuals' self-reported patterns of marijuana use over the previous year and their self-reported frequency of heterosexual intercourse over the previous four weeks.

Some 24.5 percent of men and 14.5 percent of women in the analysis reported having used marijuana, and there was a positive association between the frequency of marijuana use and the frequency of sexual intercourse. This relationship applied to both sexes: Women denying marijuana use in the past year, for example, had sex on average 6.0 times during the previous four weeks, whereas that number was 7.1 for daily pot users. Among men, the corresponding figure was 5.6 for nonusers and 6.9 for daily users.

In other words, pot users are having about 20 percent more sex than pot abstainers, Eisenberg noted.

Positive association is universal
Moreover, Eisenberg said, the positive association between marijuana use and coital frequency was independent of demographic, health, marital or parental status.

In addition, the trend remained even after accounting for subjects' use of other drugs, such as cocaine or alcohol. This, Eisenberg said, suggests that marijuana's positive correlation with sexual activity doesn't merely reflect some general tendency of less-inhibited types, who may be more inclined to use drugs, to also be more likely to have sex. In addition, coital frequency rose steadily with increasing marijuana use, a dose-dependent relationship supporting a possible active role for marijuana in fostering sexual activity.

Nevertheless, Eisenberg cautioned, the study shouldn't be misinterpreted as having proven a causal link. "It doesn't say if you smoke more marijuana, you'll have more sex," he said.

Source:

Stanford University Medical Center

Large declines seen in teen substance abuse, delinquency

Surveys over a decade indicate positive behavioral shifts

Summary:

In recent years, teens have become far less likely to abuse alcohol, nicotine and illicit drugs, according to researchers. Teens also are less likely to engage in behaviors like fighting and stealing, and the researchers believe the declines in substance use and delinquency are connected.

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FULL STORY

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More than a decade of data indicates teens have become far less likely to abuse alcohol, nicotine and illicit drugs, and they also are less likely to engage in delinquent behaviors, such as fighting and stealing, according to results of a national survey analyzed by researchers at Washington University School of Medicine in St. Louis.

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The data come from the National Survey on Drug Use and Health, an annual survey of 12- to 17-year-olds from all 50 states that is sponsored by the Substance Abuse and Mental Health Administration, an agency of the U.S. Department of Health and Human Services. The data include information from 2003 through 2014, the last year for which survey numbers are available. A total of 210,599 teens -- 13,000 to 18,500 each year -- were part of the study.
The findings are reported Oct. 25 in the journal Psychological Medicine.

The researchers found that the number of substance-use disorders among 12- to 17-year olds had declined by 49 percent over the 12-year span, along with a simultaneous 34 percent decline in delinquent behaviors, such as fighting, assault, stealing, selling drugs or carrying a handgun.

The drop in substance abuse among teens parallels findings in other recent surveys, but until now no one has looked at how the drop-off may be linked to other behavioral issues.

"We've known that teens overall are becoming less likely to engage in risky behaviors, and that's good news," said first author Richard A. Grucza, PhD, a professor of psychiatry. "But what we learned in this study is that the declines in substance abuse are connected to declines in delinquency. This suggests the changes have been driven more by changes in adolescents themselves more than by policies to reduce substance abuse or delinquent behavior."

Other researchers have found that teens are delaying sex and using seat belts more often than their parents and grandparents. Grucza's team focused on substance-use disorders -- involving alcohol, nicotine, marijuana, opioids and the abuse of other prescription drugs or nonprescription drugs -- and delinquent behaviors.

"It's not clear what is driving the parallel declines," Grucza said. "New policies -- including things like higher cigarette taxes and stricter anti-bullying policies -- certainly have a positive effect. But seeing these trends across multiple behaviors suggests that larger environmental factors are at work. These might include reductions in childhood lead exposure, lower rates of child abuse and neglect, and better mental health care for children."

Although heroin and opioid abuse have become epidemic in many areas of the United States, the use among teens has fallen, according to the survey data.
"Opioid problems continue to increase among adults," he said. "But among the 12- to 17-year-old population, we saw a drop of nearly 50 percent."

Based on the survey data, Grucza and his team estimated that in 2014 there were nearly 700,000 fewer adolescents with substance-use disorders than in 2003. And because it's possible for a person to be addicted to nicotine while abusing alcohol or marijuana, the researchers estimate the total number of substance-use disorders among adolescents declined by about 2 million.

Source:

Washington University School of Medicine

Breaking the Chain: Dramatic Advances Loom in Drug Treatment

More than 200,000 people worldwide die every year from drug overdoses and drug-related illnesses, such as HIV, according to the United Nations Office on Drugs and Crime, and far more die from smoking and drinking.

Brain researchers often refer to "the toolkit" that exists for drug addiction. New additions to "agonist" drugs and psychologic "talk" therapy are emerging rapidly. We look at a promising one here: brain stimulation.

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BREAKING THE CHAIN 

A serious cocaine addict who’d relapsed several times after treatment, Patrick Perotti finally resorted to an experimental treatment—the application of electromagnetic pulses to his prefrontal cortex— at a clinic in Padua, Italy. It worked. Psychiatrist Luigi Gallimberti has used transcranial magnetic stimulation on other patients with similar success. He and his colleagues are planning a large-scale trial. The technique is now being tested for other types of addiction by researchers around the world.

Patrick Perotti scoffed when his mother told him about a doctor who uses electromagnetic waves to treat drug addiction. “I thought he was a swindler,” Perotti says.

Perotti, who is 38 and lives in Genoa, Italy, began snorting cocaine at 17, a rich kid who loved to party. His indulgence gradually turned into a daily habit and then an all-consuming compulsion. He fell in love, had a son, and opened a restaurant. Under the weight of his addiction, his family and business eventually collapsed.

He did a three-month stint in rehab and relapsed 36 hours after he left. He spent eight months in another program, but the day he returned home, he saw his dealer and got high. “I began to use cocaine with rage,” he says. “I became paranoid, obsessed, crazy. I could not see any way to stop.”

When his mother pressed him to call the doctor, Perotti gave in. He learned he would just have to sit in a chair like a dentist’s and let the doctor, Luigi Gallimberti, hold a device near the left side of his head, on the theory it would suppress his hunger for cocaine. “It was either the cliff or Dr. Gallimberti,” he recalls.

Gallimberti, a gray-haired, bespectacled psychiatrist and toxicologist who has treated addiction for 30 years, runs a clinic in Padua. His decision to try the technique, called transcranial magnetic stimulation (TMS), stemmed from dramatic advances in the science of addiction—and from his frustration with traditional treatments. Medications can help people quit drinking, smoking, or using heroin, but relapse is common, and there’s no effective medical remedy for addiction to stimulants like cocaine. “It’s very, very difficult to treat these patients,” he says....

Source: National Geographic 

 VIEW IMAGESBREAKING THE CHAIN A serious cocaine addict who’d relapsed several times after treatment, Patrick Perotti finally resorted to an experimental treatment—the application of electromagnetic pulses to his prefrontal cortex— at a clinic in Padua, Italy. It worked. Psychiatrist Luigi Gallimberti has used transcranial magnetic stimulation on other patients with similar success. He and his colleagues are planning a large-scale trial. The technique is now being tested for other types of addiction by researchers around the worlGallimberti, a gray-haired, bespectacled psychiatrist and toxicologist who has treated addiction for 30 years, runs a clinic in Padua. His decision to try the technique, called transcranial magnetic stimulation (TMS), stemmed from dramatic advances in the science of addiction—and from his frustration with traditional treatments. Medications can help people quit drinking, smoking, or using heroin, but relapse is common, and there’s no effective medical remedy for addiction to stimulants like cocaine. “It’s very, very difficult to treat these patients,” he says.

 VIEW IMAGBREAKING THE CHAIN A serious cocaine addict who’d relapsed several times after treatment, Patrick Perotti finally resorted to an experimental treatment—the application of electromagnetic pulses to his prefrontal cortex— at a clinic in Padua, Italy. It worked. Psychiatrist Luigi Gallimberti has used transcranial magnetic stimulation on other patients with similar success. He and his colleagues are planning a large-scale trial. The technique is now being tested for other types of addiction by researchers around the world.