Every year, thousands of courageous Americans offer to keep the country safe through service in the military. Given the sacrifice that they make, one would expect that the nation would attend to their needs. As the current state of veteran affairs reveal, the nation has failed to take care of those who have served in the army. Upon returning back home from war, soldiers encounter a wide range of challenges. Post-traumatic stress disorder (PTSD) is one of these challenges. This mental health condition is the result of the harsh and brutal realities that they have been exposed to in war. While the US has taken some steps to treat this condition, these steps do not go far enough given the high number of veterans who still struggle with PTSD. The federal and state governments have approved the use of certain interventions to treat PTSD. These approaches have received approval because they have been found to be effective and safe. There are other approaches that though lacking government approval, are still used to treat PTSD. A review of the evidence reveals that there does not appear to be any basis for labelling some treatments legal and others illegal. This is because the legal and illegal treatment approaches are effective with the some of the illegal interventions being far more effective.
Background
Before exploring the difference in effectiveness of the legal and illegal treatments for PTSD, it is important to begin with a look at some of these treatments. Cognitive behavioral therapy (CBT) is one of these treatments. This treatment comes in two types: cognitive processing therapy and prolonged exposure therapy (Reisman, 2016). These treatment approaches involve no drugs and are intended to help veterans cope with their new reality and confront their past. Pharmacotherapy is another legal intervention administered to veterans suffering from PTSD (Reisman, 2016). Essentially, this approach involves the administration of medications which are combined with psychotherapy. Selective serotonin reuptake inhibitors are some of the medications that the veterans with PTSD are provided with (Reisman, 2016). Another legal treatment for PTSD is eye-movement desensitization and processing (EMDR). Initially, this treatment sparked controversy. However, after proving safe and effective, it has found acceptance within the medical community (Reisman, 2016). Essentially, EMDR involves the physician instructing the PTSD sufferer to move their eyes whenever they remember a traumatic event. The patient may also be asked to follow hand taps to coincide with recollection of the traumatic event.
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Despite the numerous approaches that have been shown to be effective and safe, other less safe and less effective approaches have emerged. These approaches are also quite controversial. The administration of ecstasy is among these approaches. Despite being a psychedelic, ecstasy is used to treat PTSD among veterans. This treatment has proven so effective that the Food and Drugs Administration has carried out tests (Wan, 2017). The results of the tests have confirmed the effectiveness of the treatment. The FDA has initiated the process of lifting the restrictions on the use of ecstasy and approving it for treating PTSD. Marijuana is another drug that is used to treat PTSD among veterans. Marijuana is used because it is thought that it has a calming effect on patients (Mulcahey, 2012). The risk of its abuse is the main reason why it remains illegal.
Comparison of effectiveness
As the discussion above makes clear, CBT is among the numerous interventions for PTSD among veterans. This intervention was the focus of a study that Nilamadhab Kar carried out. After reviewing literature, Kar established that CBT is indeed effective. He suggests that the administration of this intervention can be extended beyond veterans with PTSD. In addition to veterans, other adults, children and adolescents also record benefits when they are subjected to the CBT treatment (Kar, 2011). Kar adds that CBT works across a wide range of populations. Provided the practitioner administering this intervention has received proper training on cultural sensitivity, CBT works in nearly all communities (Kar, 2011). Another key benefit of CBT is that it is effective in both individual and group settings. This means that a group of veterans ailing from PTSD can be provided with CBT treatment in an effort to minimize treatment costs and further enhance the effectiveness of this intervention. In his exploration of the effectiveness of CBT, Kar notes that such technologies as the Internet have been integrated into this treatment (Kar, 2011). The implication of this is that more and more veterans are now able to access treatment. Basically, Kar endorses CBT as an intervention with proven effectiveness and safety. Miriam Reisman (2016) adds her voice to the discussion on the impacts of CBT. She agrees that this approach is very effective among veterans. Despite its effectiveness, CBT has been associated with some side effects. These effects include functional neuroimaging, electroencephalographic and physiological changes (Kar, 2011). However, the side effects do not erode the confidence that CBT is an effective treatment for PTSD.
Pharmacological approaches have been identified in an earlier discussion as among the interventions used to treat PTSD among veterans. This approach has been the subject of extensive studies which seek to establish its effectiveness and safety. Some of the drugs that are administered as part of this approach include fluoxetine, venlafaxine and paroxetine (Sochenko & Gabinska, 2017). Each of these drugs produces different results in patients; some are more effective than others. For example, some studies have shown that sertraline and nefazodone yield the best results (Sochenko & Gabinska, 2017). Pharmacological approaches are largely effective (Polak et al., 2012). It is worth noting that pharmacological interventions are usually combined with other approaches to maximize their impact (Sochenko & Gabinska, 2017). For instance, a practitioner may administer medication while offering psychotherapy. It is also important to understand that the medications present a wide range of side effects. Sexual dysfunction is among these effects. Patients may also suffer gastrointestinal dysfunction after receiving medication (Sochenko & Gabinska, 2017). The side effects of the pharmacological interventions are not the only issue that raises questions about their effectiveness and safety. Some drugs require that patients adhere to strict diets (Sochenko & Gabinska, 2017). This requirement complicates the administration of these drugs. There have been cases where patients witness an increase in their weight and develop Diabetes as a result of using medications intended for the treatment of PTSD (Sochenko & Gabinska, 2017). The numerous side effects and complications that result from the pharmacological interventions somewhat erode their effectiveness. However, these interventions have retained their approval and general acceptance within the medical community.
EMDR is another legal intervention used to treat PTSD among veterans. This intervention aims to “reprocess traumatic memories” and to eliminate the negative impacts of traumatic events on the wellbeing of an individual (Sochenko & Gabinska, 2017). Francine Shapiro is among the scholars who have carried out studies to establish how effective EMDR is in the treatment of PTSD. In her article, she concludes that “EMDR therapy provides physicians and other clinicians with an efficient approach to address psychological and physiological symptoms stemming from adverse life experiences” (Shapiro, 2014). Here, Shapiro is basically endorsing EMDR as an effective and efficient treatment for PTSD. While she does not explicitly state that this intervention yields positive results in veterans, it is fair to extrapolate the results of her studies to apply to veterans as well. The evidence regarding the effectiveness of EMDR appears to be inconclusive. While such scholars as Shapiro maintain that this intervention is effective, there are other scholars who are somewhat skeptical. David Albright and Bruce Thyer are among these scholars. They detail the findings of a study that they conducted in an article they penned. In the article, they caution that “it is premature to incorporate EMDR into routine care for veterans to alleviate combat-related PTSD” (Albright & Thyer, 2009). Albright and Thyer note that the evidence available concerning the effectiveness of PTSD is not sufficient to conclude that this intervention works for all patients. Sietse Verstrael and his colleagues raise further questions about the effectiveness of EMDR. Having conducted a meta-analysis, they find that this treatment’s effectiveness cannot be guaranteed. They go further to advice that practitioners should only use this intervention when other approaches fail to deliver results (Verstrael, Van der Wurff & Vermetten, 2013). Whereas it is true that conclusive evidence regarding the effectiveness of EMDR is lacking, this approach is still used to alleviate the anguish that veterans with PTSD endure.
The discussion above has focused on the approaches that are legal and have been approved for the treatment of PTSD among veterans. According to this discussion, these approaches are effective for the most part. However, some of the approaches are responsible for side effects which erode their effectiveness. Moreover, the administration of these approaches can be complicated. This raises further questions about whether the legal approaches are truly effective. Of the various approaches that have been examined, EMDR appears to be the least effective. While some scholars endorse this approach, others issue warnings and advise that the approach should only be used as the last resort. The key take-away from the discussion above is that the mere fact that the approaches examined are legal does not necessarily mean that they are effective. In the discussion that follows, the effectiveness of the illegal and unapproved approaches is investigated.
The use of medical marijuana remains a sensitive and controversial issue in the United States. Despite the controversy surrounding it, medical marijuana has delivered relief to thousands of veterans ailing from PTSD. There is some convincing evidence that marijuana helps to alleviate the symptoms of PTSD. It is worth noting that much of this evidence is anecdotal. Veterans who have used marijuana insist that it works (Ugwu, 2017). The effectiveness of marijuana has emboldened veterans and inspired them to call for a lifting of the restrictions that make it extremely difficult to access medical marijuana. Such bodies as the American Legion have joined veterans in declaring that medical marijuana is effective and calling for an easing of restrictions (Ugwu, 2017). While the sentiments of the veterans who have enjoyed relief from PTSD symptoms thanks to medical marijuana are encouraging, they do not constitute solid and scientific evidence that medical marijuana works. There are very few studies that seek to determine the effectiveness of medical marijuana. The Multidisciplinary Association for Psychedelic Drugs is scheduled to carry out a study through which it wishes to prove that medical marijuana works. The FDA has expressed a desire to become involved in the study (Zhang, 2017). The FDA’s actions can be taken to be indication that it feels that marijuana could actually be effective. This demonstration of confidence in the effectiveness of marijuana adds weight to the argument that medical marijuana works.
Apart from medical marijuana, ecstasy is another illegal intervention for PTSD. As is the case with medical marijuana, there is little scientific evidence to suggest that this intervention is effective. However, results from a number of studies show that ecstasy is a promising intervention. For example, the FDA recently labelled ecstasy a “breakthrough” after a study found that this intervention yields positive outcomes (Linehan, 2017). In fact, it is believed that ecstasy could be far more effective than the pharmacological approaches that many practitioners seem to prefer. These approaches relieve the symptoms of PTSD in one out of three patients. This success rate is very disappointing and helps to explain why such non-conventional and controversial approaches as ecstasy are being considered. Even without solid evidence, ecstasy is being hailed as a promising approach to treating patients with PTSD. The effectiveness of this and other illegal approaches raises questions about the processes that are used when vetting interventions. It appears that the concerned regulators are more concerned with the politics surrounding interventions instead of their effectiveness. If such agencies as the FDA adopt a sober approach and objectively examine the benefits of such illegal interventions as ecstasy and medical marijuana, they will be convinced that it is time to approve these approaches. There is need for the FDA and other relevant authorities to lift the restrictions on these approaches.
Conclusion
There is no question that the US needs to do more to attend to the needs of its veterans. Such hardships as PTSD are a slap in their face and an insult to the tremendous sacrifice that they make. The medical community appears committed to finding solutions to PTSD. Thanks to the efforts of this community, such approaches as CBT and EMDR have been developed. While they possess some drawbacks, these approaches are largely effective. There are also some interventions that are illegal yet effective. The fact that these interventions are considered illegal despite the positive impacts that they have on the health of PTSD patients underscores the need for their legalization and approval.
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