Post-Traumatic Stress Disorder and substance abuse in Vietnam combat veterans: treatment problems, strategies and recommendations.

Post-Traumatic Stress Disorder (PTSD) rarely presents as a discrete diagnostic entity. Frequently, PTSD is accompanied by substance abuse, somatoform, and/or affective disorders. This article focuses on the interplay of PTSD and substance abuse in Vietnam combat veterans. PTSD symptoms, assessment and diagnostic difficulties, treatment strategies and recommendations are discussed. The role of substance abuse should be determined before initiating treatment. Substance abuse may suppress, exacerbate or perpetuate PTSD symptoms. Substance-free combat veterans, veterans who use substances to self-medicate PTSD symptoms, and chronic substance abusers can be differentiated. Treatment goals and strategies differ for each group. Case histories, intake procedures and treatment recommendations conclude this article. To conform with APA guidelines (1983) for non-sexist language and to avoid ambiguity of reference, it should be stated that all of the information in this paper came from or relates to male Vietnam combat veterans. It is truly unfortunate that so little is known about the role of females in the Vietnam conflict. The authors, who are themselves Vietnam veterans, have interviewed or treated more than 2,000 combat veterans and their families and have found that 80% of the veterans seen have had alcohol related problems. The information in this paper is largely drawn from the authors' personal experiences, that of co-professionals with whom they have worked, and from the direct experiences of patients who have been treated by the authors.