Institute of Medicine Reports on Veterans’ Behavioral Health

Due to the decade-long wars in Iraq and Afghanistan, behavioral health providers in the Department of Veterans Affairs and in the communities where veterans return have been confronted with what has been referred to as the “invisible wounds of war”.  These wounds have included post-traumatic stress disorder, traumatic brain injury, and substance use disorders.  The Institute of Medicine has formed a number of committees to examine the side effects of war; these reports are available for free online.  A brief synopsis of each of the three reports follows.

Institute of Medicine.  Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations.  Washington, DC:  National Academy Press, 2012

The Committee on the Assessment of Ongoing Efforts in the Treatment of Posttraumatic Stress Disorder conducted an extensive literature review of PTSD-related programs on prevention, screening, diagnosis, and treatment as well as co-occurring conditions and psychosocial complexities.  In terms of psychosocial therapies, they recommended evidence-based interventions—exposure therapies (e.g. prolonged exposure, stress inoculation training, or anxiety management programs); cognitive therapies such as cognitive processing therapy; and eye movement desensitization and reprocessing.

Institute of Medicine.   Substance Use Disorders in the U.S. Armed Forces.  Washington, DC:  National Academy Press, 2012

The Committee on Prevention, Diagnosis, Treatment, and Management of Substance Use Disorders in the U.S. Armed Forces was charged with assessing SUD policies and programs in the Department of Defense (DoD) and military branches.  They found wide variability across the branches resulting from lack of standardization mechanisms in place at the DoD level.  The Committee highly recommended evidence-based practices for screening (i.e., SBIRT), assessment, and management of SUDs as delineated in the 2009 VA/DoD Clinical Practice Guideline for Management of Substance Use Disorders.

Institute of Medicine.  Returning Home from Iraq and Afghanistan:  Readjustment Needs of Veterans, Service Members, and Their Families. Washington, DC:  National Academy Press, 2013

The Committee on the Assessment of Readjustment Needs of Military Personnel, Veterans, and Their Families conducted a comprehensive assessment of the physical, psychological, social, and economic effects of deployment on servicemembers, veterans, and their families and identified gaps in services.  In terms of screening, assessment, and treatment interventions for brain injuries and psychosocial challenges, the Committee recommended that the DoD and VA use the same thresholds for identified screening and assessment tools and that DoD and VA policies be aligned with the evidence base.  Delivery of evidence-based therapies was deemed low; clinical follow-up was seen as inadequate and untimely.