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PTSD/SUBSTANCE ABUSE COMMITTEE REPORT
BY TOM BERGER, CHAIR
According to a GAO report issued in
November 2006, the Department of Veterans Affairs did not
spend all of the extra $300 million it had budgeted to increase
mental health services and failed to keep track of how some
of the money was used. The VA launched a plan in 2004 to
improve its mental health services for veterans with Post-traumatic
Stress Disorder and substance-abuse problems. To fill gaps
in services, the department added $100 million for mental
health initiatives in 2005 and an additional $200 million
in 2006. That money was to be distributed to its regional
networks of hospitals, medical centers, and clinics for new
services.
But the VA fell short of the spending by $12 million
in 2005 and about $42 million in fiscal 2006, the GAO report
said. It distributed $35 million in 2005 to its 21 health
care networks but didn’t inform the networks that the
money was supposed to be used for mental health initiatives.
VA medical centers returned $46 million to headquarters because
they couldn’t spend the money in fiscal 2006.
In addition,
the VA cannot determine to what extent about $112 million
was spent on mental health services improvements or new services
in 2006. In September 2006 the VA said that it had increased
funding for mental health services, hired 100 additional
counselors, and was not overwhelmed by the rising demand.
The
money is only a portion of what VA spends on mental health.
The VA planned to spend about $2 billion on mental health
services in FY 2006. But the additional spending from existing
funds on what VA dubbed its Mental Health Care Strategic
Plan was trumpeted by VA as a way to eliminate gaps in mental
health services now and in the future.
ON THE DRUG FRONT
If you were still recovering from your
turkey-induced coma on the Sunday immediately following Thanksgiving
and your TV was locked onto CBS, you probably saw the 60
Minutes report on Army research that’s looking at whether
the blood-pressure drug propranolol can be used to treat
PTSD. Propanolol belongs to that class of drugs known as
beta blockers that are already being used to treat anxiety
disorders such as performance jitters in public speakers.
Studies
funded by the Army will look at whether propranolol can reduce
veterans’ emotional responses to certain
memories by cutting down on the accompanying adrenaline rush,
according to Dr. Scott Orr, a researcher at the VA Medical
Center in Manchester, New Hampshire. As some of us know,
stress hormones such as adrenaline play a big role in PTSD.
A
post-traumatic stress event amounts to a spectacular breakdown
of what is normally a very helpful mechanism in which emotional
components are bundled with a memory. Threats of any kind—especially
life-threatening ones—trigger the release of the fight-or-flight
chemical neurotransmitter acetylcholine. Add more stress,
and the brain’s neurons fire faster (i.e., they produce
more chemicals) and more efficiently. In the fight-or-flight
example, adrenaline not only helps you escape, but strengthens
that emotional component to make sure you won’t forget.
But extremely traumatic events can unleash a torrent of these
stress hormones that sear the memory into the brain because
the brain cannot release enough of certain other chemicals
to help buffer or reduce the fight-or-flight response, even
after the threat has passed. Too much of these stress hormones
can permanently alter the structure of our brain, disrupt
the neurochemical balance, and lead to PTSD problems.
Enter
propanolol. The drug blunts the impact of stress hormones
on the small, emotional control center in the middle of the
brain, the amygdala. As a result, the brain is able to encode
the traumatic memory as a factual event—just a horrible
memory—rather than as the panic-inducing “freak-out” in
consciousness that chronic sufferers of PTSD endure. According
to a report in Stars and Stripes, people given the drug during
preliminary tests were observed to have reduced physiological
responses (such as heart rates) to certain memories. Dr.
Orr is looking for Afghan and Iraq War veterans to participate
in the research. But as of yet, we have had no word on any
possible side effects with the use of the drug in this treatment
modality.
Meanwhile, Israeli neurobiologist Dr. Hermona Soreq
has developed a drug to block PTSD at the DNA level. Called
Monarsen (after her nickname “Mona”), it stops
the brain’s
neurochemical imbalances by blocking production of one of
the buffering compounds, a persistent, fast-moving version
that appears only during stressful situations. Monarsen,
in effect, handcuffs the DNA blueprint, or gene, from being
actively turned into a biologically active protein. According
to Dr. Soreq, “We try to block the bottom of the gene
expression pyramid—the proteins, the stress hormones
such as cortisol or adrenaline. Since you have one gene at
the top of the pyramid controlling everything, why not aim
there?” That precision, according to the researcher,
enables the drug to be administered in smaller doses with
fewer possible side effects.
In our opinion, both drug therapies raise serious bioethical
and moral questions.
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©2006-
2008, Vietnam Veterans of America. All Rights Reserved. 8605 Cameron
Street, Silver Spring, MD 20910