Project Justification for Applied Doctoral Project

ADP Project Justification Template (PJT)

Revised 5/8/2018

Student name: Jane Doe

Program: Doctor of Psychology (Psy. D.) Specialization: Criminology and Justice Studies

Working title: Dual Diagnosis of Post-Traumatic Stress Disorder (PTSD) and Substance Abuse in War Veterans: An Analysis of Treatment Options and the Factors Affecting their Success

Draft version: Date:

ADP Planning I/II instructor review:

Approved; may proceed with chair and committee solicitation.

Changes requested; must revise and resubmit. Resubmission must include a change

matrix that includes the instructor comments and how each comment was addressed in the revision.

Beginning on the following page, please complete the following sections in this template, using black, 12-point font. Please address all requested content.

· Justification Statement

· Purpose Statement

· Importance of the Study

· Proposed Project Approach

· Over-arching Study Question(s)/Statement of Project Intent

· References (formatted according to the Publication Manual of the American Psychological Association, sixth edition)

Justification Statement: Provide sufficient background of the topic area and its relationship to the discipline or field of study that supports the need for, or opportunity to, conduct the proposed project. Describe the issue, situation, problem or opportunity that reinforces the need to implement the study, supported by recent citations from the literature. Briefly explain how the intended outcomes of the project could be used to advance knowledge, understanding or practice in the discipline or field of study. (2-3 paragraphs)

Post-traumatic stress disorder (PTSD) is characterized by recurring symptoms of distress felt after an exposure to a traumatic event (Masters, 2018). Veterans with PTSD may have intense and vivid flashbacks to the original traumatic event; in addition, they may feel as if they are reliving the event as well as experience sadness, anger, and detachment or estrangement from others (Cooper et al., 2016). Additional PTSD symptoms include significant changes in attitudes and beliefs, changes in personality, hyperarousal, anxiety, paranoia, depression, and increased suicide ideation (Bowe & Rosenheck, 2014).

Military veterans who are exposed to combat have a higher risk of experiencing PTSD (Steinman, Hunter, & Teachman, 2013). Nemeroff and Marmar (2018) found that every year, approximately 11–20% of veterans who served in the middle eastern Operations Iraqi Freedom and Enduring Freedom, 12% of Gulf War veterans, and 15–30% of the Vietnam War veterans experienced PTSD. Miles, Graham, and Teng (2015) stated that Traumatic Brain Injury (TBI) often accompanies PTSD for many veterans and that it co-occurs with substance abuse. Furthermore, evidence of the comorbidity of PTSD, TBI, and substance abuse is well-documented in health and academic research (Acierno, 2016; Karlin et al., 2010; Miles et al., 2015). However, mental health providers continue to struggle to identify the most effective practice-based treatments for veteran patients with a dual diagnosis of PTSD and substance abuse (Bowe & Rosenheck, 2014; Najavits, Krinsley, Waring, Gallagher, & Skidmore, 2018). Currently, research on the treatment of veterans with a dual diagnosis of PTSD and substance abuse is being conducted at many levels, such as federally funded projects, universities, hospitals, and practitioner organizations (Clees, 2018).

From 2010 to 2019, war has pushed PTSD to the forefront of public health concerns (Karlin et al., 2010). Veterans suffering from PTSD have a higher risk of other health issues than the general population as well as face unique barriers such as inconvenient scheduling, as well as a lack of accessible transportation to and from clinics to access adequate treatment (Bowe & Rosenheck, 2014; Miles et al., 2015). There is a need for a systematic review of the published academic literature covering successful treatment methods and outcomes for veterans with a dual diagnosis of PTSD and substance abuse. Such a review would help practitioners make treatment decisions for their patients as well as aid researchers in their analysis of the treatment modality of veterans with a dual diagnosis of PTSD and substance abuse.

Purpose Statement: Provide a specific, accurate synopsis of the overall purpose of the project. Align the Purpose Statement to the Justification Statement. In one concise paragraph, succinctly describe the focus, project approach, scope, and intended outcomes of the study. (1 paragraph)

The purpose of this project is to conduct a study on why veterans with PTSD do not follow through with treatment. To date, no exploration or unified presentation of effective treatment methods for a dual diagnosis of PTSD and substance abuse in the combat veteran population exists (Berke et al., 2019). The current inequality in access to proper mental health treatment services faced by returning U.S. veterans echoes the variations in access to quality mental health services experienced by the general population (Clees, 2018). Both researchers and practitioners have voiced a need for the identification of effective treatment methods (Bowe & Rosenheck, 2014; Miles et al., 2015). The scope of this research will be limited to journal articles published in academic peer-reviewed publications between 2010 and 2019; such research includes the results of treatment or intervention for veterans with a dual diagnosis of PTSD and substance abuse (Marshall et al., 2019).

Importance of the Project: Briefly describe the importance of the proposed project, including how the project represents a unique approach to the topic, how results may contribute to theory, knowledge and/or practice in the discipline, and the implications of the study to scholars and practitioners. Identify any knowledge gaps to be addressed by the proposed project. (1-2 paragraphs)

Since 2010, veterans who serve in active combat experience PTSD (Charney et al., 2018). As much as 11–20% of the veterans who served in Operations Iraqi Freedom and Enduring Freedom are diagnosed with PTSD; this percentage rises to 30% of veterans from other military operations such as Desert Storm and the Vietnam War (Waltman, 2015). Many veterans have received a dual diagnosis of PTSD and substance abuse (Bowe & Rosenheck, 2014; Miles et al., 2015). Despite the large number of veterans with PTSD, there is a dearth of academic literature that reviews and discusses the various approaches taken to treat this population (Berke et al., 2019). Researchers, academicians, and practitioners have all noted that there is a need to compile and review evidence-based, experimental, and quasi-experimentally researched treatment approaches. This should be done to help mental health providers make more informed choices when treating veterans with a dual diagnosis of PTSD and substance abuse (Bowe & Rosenheck, 2015).

This project aims to determine why veterans do not seek treatment. Several factors come into play regarding veterans who do not reach out for treatment. The distance between the veteran and the nearest clinic can be an obstacle to the required mental health treatment (Cooper et al., 2016). Many veterans suspect that something is not right but are not sure what it is; knowing the signs of PTSD can help to promote the timely acquisition of the necessary treatment. Furthermore, veterans who believe they can get better with treatment and who believe that treatment can work are more likely to seek treatment (Cooper et al., 2016). Support from family, friends, and nearby clinics will increase the chances of the veterans getting treatment (Waltman, 2015). Organizations such as the National Center for PTSD are working to educate both veterans and the general population about PTSD to help them make informed decisions (Marshall et al., 2019).

Proposed Project Approach: Briefly describe the approach for the proposed project, including how the project will be conceptualized, organized and implemented, and discuss how the proposed project will reflect accumulated learning from the student’s academic program. Discuss any proposed data collection methodologies and instrumentation, as well as the study population, as appropriate. Describe how project outcomes will be achieved. (2-3 paragraphs)

The approach for this project is a systematic literature review. A systematic literature review is a research methodology where the researcher reviews academic literature on a specific topic; said research consists primarily of articles published in peer-reviewed or open-access journals (Panaite et al., 2018). Systematic literature reviews are usually a standalone research project where the researcher does not gather any primary data and, instead, uses existing academically published literature on a chosen topic as the data in the study.

The project will be conducted in several steps, as recommended by Turgoose, Ashwick, and Murphy (2017). First, the researcher will establish the criteria for article selection. These criteria will include a consideration of the articles that will be included and those that will be excluded from the final analysis and synthesis. Second, the researcher will search for the articles using academic search engines via the university library and other academic search engines, such as Google Scholar. Third, the researcher will evaluate the quality of each article; a decision will then be made as to whether each article should be included in the final synthesis of the results, based on the exclusion and inclusion criteria. Finally, each article will be analyzed, and the results will be synthesized, with the conclusions being provided about best therapy practices for veterans with a dual diagnosis of PTSD and substance abuse.

Writing a literature review is perhaps the best piece of literature that a student can work with because it means the student is already near the end of their final stages in their studies (Lewis, Easterday, Harburg, Gerber, & Riesbeck, 2017). In a literature review, the student refers to sections of articles. This aspect of a research paper is designed to assess the student’s level of skill and understanding of the subject. Keeping aside the purpose of writing down how much one knows, writing the literature review is mostly aimed at researching previous works and studies that are related to the student’s field of research (Lewis et al., 2017). A systematic literature review is one of the best literature reviews to write because it focuses on critically analyzing the work done by previous authors (Lewis et al., 2017).

Over-arching Study Question(s)/Statement of Project Intent: Present the over-arching study question(s) or statement of project intent to be addressed, consistent with the proposed Purpose Statement and project approach. If hypotheses will be tested, identify the specific quantitative research questions and hypotheses, as well. (1 paragraph)

Study Question 1: Which therapeutic techniques reported by mental health practitioners in the academic literature have been the most effective at treating veterans who have a dual diagnosis of PTSD and substance abuse?

Study Question 2: Why do veterans who have a dual diagnosis of PTSD and substance abuse decline treatment?

The research questions will help to identify the reason veterans who have served in the military decline treatment. As stated in the purpose statement, these will help manage and conduct a study on why veterans with a dual diagnosis of PTSD and substance abuse do not follow through with treatment. Male veterans are less likely to receive proper care compared to female veterans (Turgoose et al., 2017). Furthermore, this also includes veterans less than 25 years old who received their PTSD treatment from care clinics that refers them to a mental health program and those living in areas away from cities (Hundt et al., 2018). One of the benefits of performing the systematic literature review is that it will quickly indicate which authors have researched extensively to procure information and have written the most on the topic and are, therefore, probably experts on the topic (Turgoose et al., 2017).

References: List and cite a minimum of 10 sources that support and reinforce justification of the project.

References

Berke, D. S., Yeterian, J., Presseau, C., Rusowicz-Orazem, L., Kline, N. K., Nash, W. P., & Litz, B.T. (2019). Dynamic changes in marines’ reports of PTSD symptoms and problem alcohol use across the deployment cycle. Psychology of Addictive Behaviors, 33(2), 162–170. doi:10.1037/adb0000430

Bowe, A., & Rosenheck, R. (2015). PTSD and substance use disorder among veterans: Characteristics, service utilization and pharmacotherapy. Journal of Dual Diagnosis, 11(1), 22–32, doi: 10.1080/15504263.2014.989653

Charney, M. E., Bui, E., Sager, J. C., Ohye, B. Y., Goetter, E. M., & Simon, N. M. (2018). Complicated grief among military service members and veterans who served after September 11, 2001. Journal of Traumatic Stress, 31(1), 157-162. doi:10.1002/jts.22254

Clees, J. (2018). Differential diagnosis and treatment of comorbid PTSD and TBI in combat veterans. UF Journal of Undergraduate Research, 20(1), 11–22. doi:10.32473/ufjur.v20i1.106242

Cooper, D. C., Helfrich, C. D., Thielke, S. M., Trivedi, R. B., Nelson, K. M., Reiber, G. E., . . . Fan, V. S. (2016). Association between mental health staffing level and primary care-mental health integration level on provision of depression care in veteran’s affairs medical facilities. Administration and Policy in Mental Health and Mental Health Services Research, 45(1), 131-141. doi:10.1007/s10488-016-0775-9

Hundt, N. E., Helm, A., Smith, T. L., Lamkin, J., Cully, J. A., & Stanley, M. A. (2018). Failure to engage: A qualitative study of veterans who decline evidence-based psychotherapies for PTSD. Psychological Services, 15(4), 536-542. doi:10.1037/ser0000212

Karlin, B. E., Ruzek, J. I., Chard, K. M., Eftekhari, A., Monson, C. M., Hembree, E. A., . . . Foa, E. B. (2010). Dissemination of evidence-based psychological treatments for post-traumatic stress disorder in the Veterans Health Administration. Journal of Traumatic Stress, 23(6), 663–673. doi:10.1002/jts.20588

Lewis, D. G., Easterday, M. W., Harburg, E., Gerber, E. M., & Riesbeck, C. K. (2017). Overcoming barriers between volunteer professionals advising project-based learning teams with regulation tools. British Journal of Educational Technology, 49(3), 354-369. doi:10.1111/bjet.12550

Marshall, G. N., Jaycox, L. H., Engel, C. C., Richardson, A. S., Dutra, S. J., Keane, T. M., . . . Marx, B. P. (2019). PTSD symptoms are differentially associated with general distress and physiological arousal: Implications for the conceptualization and measurement of PTSD. Journal of Anxiety Disorders, 62, 26–34. doi:10.1016/j.janxdis.2018.10.003

Masters, K. J. (2018). Post-traumatic stress disorder in combat veterans. Journal of the American Academy of Physician Assistants, 31(11), 11-22. doi:10.1097/01.jaa.0000546487.96721.81

Miles, S. R., Graham, D. P., & Teng, E. J. (2015). Examining the influence of mild traumatic brain injury and posttraumatic stress disorder on alcohol use disorder in OEF/OIF veterans. Military Medicine, 180(1), 45–52. doi:10.7205/milmed-d-14-00187.

Najavits, L. M., Krinsley, K., Waring, M. E., Gallagher, M. W., & Skidmore, C. (2018). A randomized controlled trial for veterans with PTSD and substance use disorder: Creating change versus seeking safety. Substance Use & Misuse, 53(11), 1788–1800.

Panaite, V., Brown, R., Henry, M., Garcia, A., Powell-Cope, G., Vanderploeg, R. D., & Belanger, H. G. (2018). Post-deployment mental health screening: A systematic review of current evidence and future directions. Administration and Policy in Mental Health and Mental Health Services Research, 45(6), 850–875. doi:10.1007/s10488-018-0869-7

Steinman, S. A., Hunter, M. D., & Teachman, B. A. (2013). Do patterns of change during treatment for panic disorder predict future panic symptoms? Journal of Behavior Therapy and Experimental Psychiatry, 44(2), 150–157. doi:10.1016/j.jbtep.2012.09.003

Turgoose, D., Ashwick, R., & Murphy, D. (2017). Systematic review of lessons learned from delivering tele-therapy to veterans with post-traumatic stress disorder. Journal of Telemedicine and Telecare, 24(9), 575-585. doi:10.1177/1357633x17730443

Waltman, S. H. (2015). Functional analysis in differential diagnosis. Clinical Case Studies, 14(6), 422–433. doi:10.1177/1534650115571003