Drug overdose not only affects those who have died—it also affects family members and loved ones left behind.

Around 42% of U.S. adults know someone who has died from a drug overdose. Overdose-related deaths are often sudden and cause extreme grief for the deceased’s family and friends.

Individuals struggling with drug misuse are more likely to keep their habit and whereabouts a secret from family and friends. Those left behind are often unaware their loved one was using drugs or had challenges with addiction. This can lead to feelings of distress and guilt for not noticing signs or intervening to prevent the person’s death.

How to cope with loss after someone overdoses

Death caused by an overdose, whether the person meant to or not, is a distressing situation that requires care, compassion and support for those left behind. Here are some helpful ways to cope with the trauma of losing someone to a drug overdose.

• Think about getting therapy. Loss of a loved one to a drug overdose can have a lasting impact on you and your family. The effects may vary from person to person. Therapy can help everyone address and process emotions.
• Check for and join in self-help activities. Practices, such as mindfulness meditation, journaling and exercise, can help with managing the stress and grief you may feel. These wellness practices are helpful tools for building emotional strength and personal development.
• Practice self-compassion. Drug overdose is often perceived as being preventable, even though addiction and substance use disorders are recognized as mental illnesses. Remember to be patient and compassionate with yourself. The process of grieving and healing takes time.
• Join support groups. Connecting with individuals who have experienced a similar situation may help you feel understood. You can support each other and share real-life stories that promote hopefulness and strength to get through this challenging time.
• Find meaningful ways to honor your loved one’s memory. You can cherish and remember good times shared with your loved one by supporting a cause they were passionate about, going through photographs, remembering happier times, or keeping something of theirs close to you.

Allowing yourself time and space to process your emotions is essential for coping with grief. There may be times when you feel guilty for not recognizing your loved one’s struggles with drug misuse or being unable to help them. However, this tragedy is not your fault. While you can’t bring your loved one back, you can make a difference by being alert and noticing the signs of drug misuse and overdose in others, potentially saving another life.

Drug misuse warning signs

People who misuse drugs frequently try to hide their symptoms. Here are some warning signs:

Physical

• Red/ bloodshot eyes or pupils larger or smaller than normal
• Slurred speech and/or impaired coordination
• Unusual odors from their body or clothes
• Change in weight

Behavioral

• Demonstrating conduct changes and mood swings (e.g., arguing, fighting or conflicts with authority)
• Avoiding once-pleasurable activities
• Appearing anxious or fearful for no reason
• Struggling financially (e.g., unexplained need for and willingness to steal money)
• Making changes in friends
• Fluctuating sleep patterns or appetite
• Behaving secretively
• Neglecting home, work or school duties

What to do if you think someone has overdosed

• Call 911 right away!
• Check for overdose symptoms:
  • Unresponsive or appears lifeless
  • Absence of breathing or shallow/slow breaths
  • Gasping for air or snoring
  • Blue lips and fingertips
  • Clammy skin
• Turn the person over to their side to help avoid choking.
• Check for any visible drugs or bottles that may have caused the overdose.
• Stay with the person until emergency responders arrive.
• Perform chest compressions if there’s no sign of breathing or pulse.

If you have a loved one using opioids, learn more about Naloxone, a medication that reverses opioid overdose. The National Institute on Drug Abuse has a drug facts page and the Substance Abuse and Mental Health Administration (SAMHSA) offers an Opioid Overdose Prevention Toolkit that can be downloaded.

Resources for bereaved families and loved ones

Mental health and substance misuse support:

• Crisis Call Center: 800-273-8255 or 988
• Substance Abuse and Mental Health Services Administration (SAMHSA) provides resources and free, confidential, 24/7 treatment referral and information services, including a National Helpline:

– Phone: 1-800-662-HELP (4357)

– Website: samhsa.gov/find-help/national-helpline

Support for grieving individuals and families:

• Griefshare is a worldwide directory of support groups for people grieving the death of a family member or friend.
• National Alliance for Children’s Grief provides a directory of programs and support groups for children dealing with grief and loss.
• National Funeral Directors Association provides resources from community experts.
• The Compassionate Friends provides support for people who have experienced the death of a child.
• What’s Your Grief is a website devoted to families who are going through grief and loss.

For more mental health resources, visit magellanhealthcare.com/about/bh-resources.

This article is for your information only. It is not meant to give medical advice. It should not be used to replace a visit with a provider. Magellan Health does not endorse other resources that may be mentioned here.

SOURCES:

• https://www.cnn.com/2024/02/21/health/us-adults-overdose-survey/index.html
• https://www.ihs.gov/asap/familyfriends/warningsignsdrug/
• https://mountainside.com/blog/secrecy-in-addiction/
• https://sadod.org/sites/default/files/2021-02/How-to-Help-Newly-Bereaved.pdf

The opioid epidemic is a significant public health problem in the United States. In 2021, over 75% of drug overdose deaths involved an opioid.[1] Between 2010 to 2019, drug overdose mortality rates have increased by 53% among U.S. military veterans.4 Opioids include prescription opioids, heroin, and synthetic opioids. About 150 individuals die each day from synthetic opioids. 2

Fentanyl is a synthetic opioid that has been associated with a significant number of overdoses in the U.S. It is considered to be “up to 50 times stronger than heroin and 100 times stronger than morphine”; thus, even small amounts of fentanyl can be deadly. 2 Pharmaceutical fentanyl has been prescribed for severe pain after surgery and with medical conditions such as cancer pain. Pharmaceutical fentanyl can be given as a patch, shot, or lozenge. Illegally manufactured fentanyl is found in liquid or powder form and is commonly mixed with other illicit substances or hidden to look like over-the-counter medications. Fentanyl is linked to a high number of overdoses and deaths. Between 2017 and 2021, fentanyl was involved in 52% of overdose cases in the military.5

Combating the Epidemic: Prevention and Treatment

The risk of overdose increases significantly when drugs are contaminated by or combined with fentanyl. Since it is difficult to taste, smell, or see fentanyl in other drugs, an individual may not know that fentanyl is present. Fentanyl test strips, used to detect whether fentanyl has been mixed with another drug, are available and can help prevent overdose. However, caution should be taken since these strips may not detect all forms of fentanyl, including carfentanil.2

Fentanyl is addictive and binds to the body’s opioid receptors in the brain, which control emotions and pain. Like natural opioids, fentanyl’s effects include drowsiness, confusion, difficulty breathing, unconsciousness, overdose, and death.3

How to Respond to an Overdose and Stay Informed

Individuals who use opioids as prescribed, those who abuse them, and persons in the general public should be aware of the signs of overdose as life-saving measures, such as halo one, are available. Signs and symptoms of an opioid overdose include small, constricted pinpoint pupils, loss of consciousness, slow or weakened breathing, cold or clammy skin, and discoloration of skin. When encountering someone who has overdosed, contact 911 immediately and administer naloxone when available.2

We recommend that persons using any form of opioids, and those who are likely to have contact with individuals using opioids, carry naloxone, which is now available over the counter and can be obtained at a pharmacy, through mail order, or through community risk reduction programs. Training for administering naloxone and learning about the opioid overdose epidemic is available, and additional information can be found through the VA’s Opioid Overdose Education and Naloxone Distribution Program (OEND), state or county health departments, GetNaloxoneNow, the CDC, and the American Red Cross.

The Military Health System and Defense Health Agency provide resources for opioid overdose education and naloxone distribution, including information for patients and caregivers. Additional toolkits and naloxone distribution videos are also provided by the U.S. Department of Veterans Affairs.

Resources

1. Centers for Disease Control and Prevention (CDC). “Understanding the Opioid Overdoes Epidemic”. Last modified June 17, 2021, https://www.cdc.gov/opioids/basics/epidemic.html
2. Centers for Disease Control and Prevention (CDC). “Fentanyl Facts”. Last modified September 6, 2023, https://www.cdc.gov/stopoverdose/fentanyl/index.html
3. National Institute on Drug Abuse (NIH). “Fentanyl DrugFacts”. Last modified June 2021. https://nida.nih.gov/publications/drugfacts/fentanyl#:~:text=Naloxone%20is%20a%20medicine%20that,require%20multiple%20doses%20of%20naloxone
4. Bennett, Alex S et al. “U.S. Military veterans and the opioid overdose crisis: a review of risk factors and prevention efforts.” Annals of medicine 54,1 (2022): 1826-1838. doi:10.1080/07853890.2022.2092896. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9262363/
5. Myers, Meghann. Military Times. “Fentanyl deaths among troops more than doubled from 2017 to 2021”. Last modified February 15, 2023, https://www.militarytimes.com/news/your-military/2023/02/15/fentanyl-deaths-among-troops-more-than-doubled-from-2017-to-2021/

A theme for September’s Recovery Month is “Recovery is for Everyone.” It sounds nice, but is it really true? We’re all impacted by mental health and substance use conditions in some way, whether we live with them or know someone who does. But with 74 million adults and 5 million adolescents in America living with a mental health or substance use condition,[1] is recovery really for everyone?

Where do you stand?

Do you think recovery is possible for a person given a diagnosis of schizophrenia? Is recovery possible for someone in active heroin addiction?

If you think recovery is possible for them, do you expect recovery for them?

Think about it for a minute.

Recovery for me

I am a person in recovery. At the beginning of my journey, I was a teenager with a bright future ahead of me who had been given a mental health diagnosis. It was easy for others to hold hope for me because my accomplishments were a recent memory. Recovery was possible and expected for me.

Today, I have a successful career, an advanced education, a home, and a deep connection to my community. It’s easy for people to expect recovery for me because I’ve proven it’s possible.

But in the middle of my story is endless years of pain and despair. My teenage accomplishments quickly became overshadowed by more diagnoses, hospitalizations, failed medication trials, and a disability determination. The longer my struggles continued the harder it was for me and the people around me to believe my recovery was possible. An expectation of recovery was replaced with low expectations of my abilities, personal responsibility, and chances for a meaningful life.

The irony is that these low expectations quickly became more distressing for me than any symptom I was experiencing. It was the lack of expectation for recovery in my life that brought the soul-crushing despair that nearly ended my life.

Measuring down

My experience is not isolated. It is common to determine someone’s ability to recover based on internal and external factors and then act accordingly. These factors may include a person’s income, education history, employment, housing, support system, family culture, ethnicity, and geography; the number of times they have been in rehab or failed medication trials; and the number of diagnoses, type of diagnoses, drugs used and number of physical health comorbidities. The list could be endless.

Now let’s go back to the scenarios above and add a few more details:

Do you expect recovery for the man you pass at the bus stop who is experiencing homelessness, who hears voices and who has no education?

What about the woman you see at the park who uses street drugs, whose kids are in foster care and who is unemployed. Do you expect recovery for her?

Recovery for everyone in action

Expecting recovery for everyone requires an unwavering commitment to the belief that recovery is possible for every person, no matter their diagnosis, treatment history, or current and past circumstances. The next step after believing recovery is possible is taking action on that belief through communicating with hopeful, empowering language, encouraging risk-taking in the pursuit of recovery, and focusing on strengths versus perceived deficits.

At the systems level, expecting recovery for everyone means:

• Providing equitable recovery opportunities through services and supports, including beyond traditional treatment delivery systems
• Outreaching to engage Black, Brown, LGBTQ+ and other marginalized communities
• Transforming practices and environments to reflect recovery-oriented principles

If we all believed that recovery was for everyone, it would radically change our communities and service delivery systems for the better. It would send a message of hope and save lives during a time when suicide rates in the U.S. have increased 30% from 2000 to 2020.[2]

Imagine what would change if we believed recovery was for everyone.

Join the conversation

We are pleased to host a free webinar, “What I would tell my younger self: Conversations about hope, recovery and the “S” word,” on Wednesday, September 14, 2022, at 3:00 p.m. ET. Register today to hear our presenters share the advice they would give to their younger selves to better navigate mental health and substance use challenges, and engage in the conversation!

Visit MagellanHealthcare.com/Recovery for resources to use and share this Recovery Month and beyond.

[1] Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health

[2] National Institute of Mental Health, “Suicide” information

The stress of COVID-19 can present many challenges to those who are in recovery. In particular, social distancing is limiting people’s ability to get support from friends, family, and support groups.

Connection to others in recovery is a big part of the solution for many in recovery. Meetings make people feel supported and understood in ways nothing or no one else can. With much of the world under orders to quarantine or shelter in place, people in recovery can struggle to maintain a connection to their support groups. The good news is many recovery groups are scheduling virtual meetings, and that number is increasing each day.

Below are links to information about virtual 12-step and non-12-step meetings. These meetings take place in a variety of ways: over the phone, in online community posting forums, in social media groups, and through video.

Also, if you have a sponsor, peer specialist, or other special relationship, maintain that connection through text, email, phone, and FaceTime, or Skype.

12-Step Programs 

• Alcoholics Anonymous (AA; aa.org): For regularly scheduled virtual meetings, visit aa-intergroup.org and click on Online Meetings.

• Narcotics Anonymous (NA; na.org): For regularly scheduled virtual meetings, visit www.na.org/meetingsearch. In the NA Meeting Search box on the right, select “Phone” or “Web” in the Country field drop-down list.

• Al-Anon (for families and friends of alcoholics; al-anon.org): For regularly scheduled virtual meetings, visit al-anon.org/al-anon-meetings/electronic-meetings.

• Nar-Anon (for families and friends of addicts; nar-anon.org): For regularly scheduled virtual meetings, visit www.naranon.com/forum.

Other Programs

Some in recovery prefer non-12 step programs. Listed below are a few organizations who provide virtual support.

• SMART Recovery (for people with addictive problems; smartrecovery.org): To find online forums and meetings, visit www.smartrecovery.org/smart-recovery-toolbox/smart-recovery-online.

• LifeRing (for people addicted to alcohol or drugs; lifering.org): To find online video meetings via Zoom, visit www.lifering.org/online-meetings.

• Women for Sobriety (for women facing issues of alcohol or drug addiction; org): For information on the online community, visit wfsonline.org.

For more information and tips, visit MagellanHealthcare.com/COVID-19.

People from all walks of life drink to cope with stress from work. While the rate of alcohol abuse varies by industry and occupation, no workplace is immune. In the short term, drinking can result in feelings of relaxation, but ongoing reliance on alcohol to manage stress often leads to physical and psychological problems.

Prevalence of Binge Drinking

According to the 2017 National Survey on Drug Use and Health (NSDUH), 26.4 percent of people ages 18 and older reported that they engaged in binge drinking in the past month, and 6.7 percent reported heavy alcohol use in the past month. Binge drinking is defined as having 5 or more drinks within 2 hours for men, and 4 or more drinks within 2 hours for women. Heavy alcohol use is defined as binge drinking on 5 or more days in the past month, or 60 days a year.

Binge drinking has been on the rise over the past twelve years, particularly in women ages 30 to 44. While most excessive drinkers don’t meet the clinical criteria for alcohol dependence, binge or heavy drinking can still take a toll on workplace productivity, health, and relationships.

A Paradoxical Effect

Using alcohol to relieve stress and anxiety can have a paradoxical effect. Drinking may provide temporary feelings of relaxation, but habitual use alters the balance of chemicals in the brain that regulate mood. Alcohol can contribute to and worsen symptoms of depression, anxiety and other mental health disorders, and it can interfere with sleep. It becomes a vicious cycle: the person drinks in response to stress, feels worse later on, and turns to alcohol again to avoid dealing with painful feelings instead of learning healthy coping skills.

Drinking to self-medicate can also have serious health consequences. Heavy drinking is linked to higher risk of developing an alcohol use disorder or alcohol addiction, characterized by tolerance, withdrawal symptoms, strong cravings and an inability to cut down on drinking. Other medical conditions associated with excessive drinking include heart and liver disease, stroke, high blood pressure and cancer. Long-term alcohol use can also cause neurological problems such as cognitive deficits and dementia.

Impact on Employers

Most people who drink excessively or have an alcohol use disorder are employed, and many try to hide the problem. Nevertheless, U.S. companies lose billions of dollars a year due to lost productivity, workplace accidents and injuries, absenteeism, and illness related to employees’ alcohol and drug use.¹

An Employee Assistance Program is a valuable resource for employers. EAPs are designed to address work-related stress, substance use, mental health issues and other problems that negatively impact employees’ well-being and job performance. Besides offering confidential counseling and referral services for employees, EAPs can provide a range of health promotion activities and help for supervisors dealing with troubled employees.

¹”National Drug-Free Workplace Alliance.” National Drug-Free Workplace Alliance, https://www.ndwa.org/drug-free-workplace/industry-statistics/.

By Sam Srivastava and Mostafa Kamal

This week, the federal government took a significant step forward in helping address the opioid epidemic with the signing of the nation’s first comprehensive opioid legislation.

The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act addresses a broad range of Medicare, Medicaid, public health and law -enforcement issues and aims to advance the recovery landscape for individuals living with opioid use disorder (OUD) and other substance use disorders (SUDs).

As longstanding advocates for access to mental health and substance use disorder treatment and services, we’re deeply appreciative of the bicameral, bipartisan work of the Congress to successfully drive this critical effort forward. The legislation contains a number of impactful policies we at Magellan Health, and many others, have pushed for, including those recommended in our testimony to Congress this past spring. These critical policies promote clinically appropriate opioid prescribing, support opioid misuse prevention, and enhance access to evidence-based treatment and recovery services.

The signing of this law marks a significant milestone and step in the right direction, and we believe there are several ways it has the potential to address some of the day-to-day challenges of the nation’s opioid epidemic. Three key areas stand out.

Safer prescribing patterns. The SUPPORT for Patients and Communities Act encourages the use of safe and effective alternatives to opioids for pain management, which – in addition to clinically appropriate prescribing practices – are key in breaking the cycle of prescription opioid misuse. These include the establishment of grant programs incentivizing the use of non-pharmacological opioid alternatives, the required implementation of safety limits for opioid prescriptions, new electronic prescribing requirements in Medicare, and beneficiary screening requirements in initial Medicare prevention exams, to name a few.

Our experience demonstrates the power of these and other safe-prescribing interventions—such as the Centers for Disease Control and Prevention’s prescribing guidelines, which Magellan has already implemented—to reduce opioid misuse rates.

Americans consume 80 percent of all opioid painkillers produced worldwide—and the risk of addiction after just four or five days of treatment is high. Opioid prescribing rates have decreased in recent years thanks to nationwide efforts to ramp up provider education. Yet the supply of prescription opioids remains high – approximately 66.5 opioid prescriptions for every 100 Americans in 2016 – reflecting the work still needing to be done.

By exploring alternative therapies to pain management, including non-pharmacological digital therapies, we can eliminate the risk of opioid misuse and addiction, and also equip individuals living with chronic pain with the tools and resources needed to live healthier, more vibrant lives.

Boosted access to evidence-based treatment. One of the most effective, evidence-based treatments for OUD is medication-assisted treatment (MAT)—considered the gold standard for reducing the risk of overdose and death. When combined with psychosocial interventions, like cognitive behavioral therapy and contingency management, and recovery supports, including peer and family, MAT empowers the recovery journey while building resiliency.

Increasing access to MAT is critical to promoting recovery and preventing relapse. Today, while 900,000 U.S. physicians prescribe opioids, fewer than 35,000 physicians are certified to prescribe buprenorphine, one of three medications approved to treat opioid addiction.  Even fewer of these actually participate in prescribing MAT and, as a result, access to care is often limited or stigmatized. The SUPPORT for Patients and Communities Act expands providers’ ability to prescribe MAT, including by expanding eligibility for certification to new provider types. With stigma also playing a role in the lack of widespread adoption of MAT, this provision is a solid and necessary step toward expanding access to treatment.

Reaching underserved communities. The SUPPORT for Patients and Communities Act facilitates telehealth options for OUD treatment. In communities with limited resources for one-on-one OUD recovery support, telehealth services or a combination of virtual and in-office services provide the basis for the most evidence-based, person-centered and well-rounded approach to treatment. The package also authorizes pilot programs to provide temporary housing services for individuals recovering from OUD. We believe this is crucial to supporting those living with OUD and other SUDs, especially in rural and underserved communities, return to healthy and vibrant lives.

 The SUPPORT for Patients and Communities Act provides practical policy solutions necessary for addressing this national crisis. From expanded treatment options, to more effective care coordination, to improved prescription drug monitoring programs used to enhance detection and prevention of opioid misuse in real time, this legislation is an important step in the right direction.

We applaud Congress and the Administration on this bipartisan effort and important law, which will have a deep and lasting impact on health for generations to come.

 About the authors:

Sam Srivastava is Chief Executive Officer of Magellan Healthcare, and Mostafa Kamal is Chief Executive Officer of Magellan Rx Management.

“Strung out. Looking for the next fix. A full time job that doesn’t pay, but just takes.”

That’s how one of Magellan’s Recovery Support Navigators defined her addiction to opiates. She has since overcome the stranglehold of addiction and is now in long term recovery.  Her experiences, and those of her fellow Recovery Support Navigators, provide the credibility needed to influence their peers who are still struggling with addiction and mental illness that recovery is possible and that desperation does not have to define a life.

An estimated 20.2 million Americans live with a substance use disorder[1]. That’s the population of my home state of Florida. Of that, 2.1 million Americans live with an opioid disorder. Similar to serious mental illnesses, substance use disorders can be difficult to address. Those with the lived experience of walking the path from hopelessness to wellness are experts at engaging individuals with the services and supports that foster the recovery process. Stories of changed lives are not the only proof.

A January 2018 study of our internal recovery support navigation program at Magellan Health found statistically significant improvements for individuals living with substance use and mental health disorders. A key component of the Magellan’s internal peer support program is meeting people where they are. The first engagement with members often happens in an emergency room, inpatient setting, or on the streets. Members then choose where future meet-ups happen. Often, that choice is in the comfort of their own home.  If they are experiencing homelessness, the member chooses a safe place.

The study compared utilization of services six months prior to receiving peer support services and six months following the completion of peer support services. Seventy-five percent of the members in the study had a co-occurring mental health and substance use disorder and 50 percent had a co-occurring substance use disorder, mood disorder and psychotic disorder. The study found that members in Magellan’s internal peer support program cost the health plan significantly less in the six months following completion of the peer support program than members who only had care management or who did not receive any intervention from the health plan. The study also found that six months after completing peer services, peer support decreased emergency room and inpatient hospitalizations.

The role modeling by a peer specialist of a life lived well in recovery is evidence for the individual struggling that there can be long term sustainment of recovery. In addition, the data from this study replicates prior findings that peer support has a lasting impact on the lives of those living with substance use and mental health disorders.

[1] Substance Abuse and Mental Health Services Administration. (2017). Mental and substance use disorders. Retrieved from https://www.samhsa.gov/disorders

Post Traumatic Stress Disorder, commonly known as PTSD, comes in many forms and affects children and adults alike. Early descriptions of PTSD are found throughout literature. The hallmarks of war-related PTSD were described in Homer’s The Iliad. Shakespeare wrote of the symptoms in Henry IV and A Midsummer Night’s Dream. In recent times, books such as The Things They Carried (Tim O’Brien) describe the effects of war and the risk for PTSD-related suicide. Movies such as Ordinary People and Mystic River portray the effects that loss and abuse have on families and individuals. The daily ease of access to images on the internet and television puts the fodder for PTSD in front of all exposed to electronic media. We have only to listen to the news to learn of all the possible inputs that can cause PTSD—the tornado that sweeps through a Midwest town, atrocities happening to people in places such as Syria, beheadings, and stories of abused children. PTSD can affect one individual at a time, or a lone event can bring PTSD into the lives of many with a single swath.

Prevalence of PTSD in the U.S.

PTSD is common. The lifetime prevalence of PTSD among adult Americans is 6.8 percent (National Comorbidity Survey Replication). For adolescents, the six month prevalence was estimated to be at 3.7 percent for boys and 6.3 percent for girls (Kirkpatrick, 2003). The prevalence is much higher among Veterans. Men and women who had served in the Vietnam War have a lifetime prevalence of 30.9 percent and 26.9 percent, respectively. Studies of Gulf War Veterans reported a current prevalence of 12.1 percent, and 13.8 percent for Veterans of Operation Enduring Freedom/Operation Iraqi Freedom (Kang, et al 2003; RAND Corporation 2008). Unfortunately, PTSD is often underdiagnosed in the medical setting—with symptoms being attributed to a “normal” response to a trauma, misdiagnosed as depression, or altogether missed because of the physical presentation of the condition.

PTSD Symptoms and Impacts

PTSD symptoms are not limited to only the emotional, but also bring physical impairment in many forms. The condition affects those people supporting the individual with PTSD, often causing distress to family, friends, and colleagues. It is important not to approach PTSD with a single point of view — the victim of a natural disaster may have different experiences and risk factors than a combat veteran, for example. What is the same, however, is a set of symptoms based in some form of exposure to a traumatic event, resulting in significant distress and impairment in an individual’s ability to perform in her or his roles, whether within family, employment, or other social units.

No matter the cause, the response to a traumatic event is similar, whether described in the 8^th Century BC, or in 2016. In 2013, the American Psychological Association updated the criteria used to diagnose PTSD. According to current diagnostic criteria, the diagnosis of and symptoms attributable to PTSD must include at least one month of:

• Direct exposure to a stressor; witnessing the stressor in person; indirectly learning of a loved one exposed to a violent or accidental circumstance; and/or repeated or extreme indirect exposure to aversive details of the event, typically by a professional exposed to the stressor (e.g. first responders)
• Persistent and intrusive re-experience of the event through memories, nightmares, flashbacks (e.g. dissociative reactions), distress after exposure to a reminder of the stressor, and physiological reactivity after exposure to a trauma-related stimuli (e.g. jumping up after hearing a door bang unexpectedly)
• Avoidance of distressing trauma-related stimuli, including thoughts or feelings, and/or trauma-related external reminders such as situations or people
• A negative effect on thoughts and mood, including an inability to recall features of the trauma; persistent negative beliefs; persistent and distorted self-blame and/or blaming others; persistent negative emotions such as fear or anger; diminished interest or pleasure in activities; feeling detached or estranged from others; and having a persistent inability to experience positive emotions
• Alterations in physiological arousal or reactivity including irritable or aggressive behavior; self-destructive or reckless behavior; hypervigilence; exaggerated startle response, problems in concentration, and/or sleep disturbance
• Distress or functional impairment in relationships, social, and occupational roles

What PTSD Feels Like

PTSD doesn’t always occur immediately after the traumatic event. In fact, in some cases, the diagnosis may not be made for up to six months with the gradual onset of the full symptoms. Some individuals with PTSD develop dissociative symptoms as the primary feature of the condition. Those affected describe a sense of being an outside observer or detached from oneself (depersonalization), and/or the sense that things are not real or are distorted (derealization). See the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition for a detailed description of the diagnostic criteria for PTSD.

Unfortunately, PTSD predisposes affected individuals to other behaviors that can be emotionally and physically harmful. Persons with PTSD are more likely than persons without PTSD to develop alcohol use disorder (AUD) and substance use disorder, including tobacco, pain medications, and illicit drugs. Nearly half of people with PTSD can suffer co-occurring depression. Physical symptoms and conditions associated with PTSD include cardiovascular conditions such as hypertension, pain, gastrointestinal symptoms, and musculoskeletal symptoms.

While it is very difficult to predict who will develop PTSD, some factors may increase the risk of developing the symptoms, including:

• Getting physically hurt during the trauma
• Seeing another person get hurt or killed
• Having childhood trauma
• Having a sense of horror or helplessness during the trauma
• Having little or no social support after the event
• Dealing with additional stressors after the event, such as losing a loved one, ongoing pain or injury, or loss of one’s job or home.

Taking Care of Oneself after Trauma

While trauma impacts everyone differently, there are some ways to reduce the risk of developing PTSD. Examples include:

• Seeking out support from other people, including friends and family
• Talking about the trauma soon after it occurs
• Attending a support group with others who may have had similar experiences
• Learning how to acknowledge and accept your actions in the face of the trauma
• Having a positive coping strategy; being able to act and respond effectively despite feeling fear

PTSD does not have a cure, but symptoms can be managed to help an individual function better in day to day life. The recommended treatment of PTSD largely is based on the use of medication and psychotherapy. The earlier treatment is started, the more likely the treatment will have positive effects. Combinations of medication, psychotherapy and support are typically the most effective way to ameliorate symptoms.

Therapy for PTSD

Several therapy types have been shown to reduce the physiologic responses to stimuli, or alleviate intrusive thoughts by teaching a person the skills to identify triggers in order to better manage their symptoms.

• Cognitive behavioral therapy has been shown to be effective in treating PTSD. In addition to educating people of their symptoms, cognitive behavioral therapy can also include prolonged exposure (PE) therapy to address the traumatic event. During PE one gradually approaches trauma-related memories, feelings, and situations that have been avoided since the trauma. By confronting these challenges, PTSD symptoms decrease.
• Novel treatments for PTSD include Eye Movement Desensitization and Reprocessing (EMDR). This is a form of psychotherapy that involves the patient paying attention to a back-and-forth movement or sound while thinking about the upsetting memory long enough for it to become less distressing. During EMDR, one learns about their physical and emotional reactions to trauma, targeting the upsetting memory, discussing the memory, and ultimately focusing on a positive belief or feeling while the memory is in one’s mind.
• Cognitive restructuring or processing therapy helps the affected person work through faulty memories of the trauma, and challenges their interpretations of the event, experience of the event, and beliefs that life is full of ongoing danger. Cognitive processing therapy teaches new ways to handle upsetting thoughts and to develop a new perspective on both past and future.

Other therapies include training in relaxation and anger-control skills, group therapy, couples therapy, family therapy, implementing an exercise program, and sleep hygiene. While often tempting in the short-term, it is essential to avoid self-medication with alcohol or other substances such as pain killers that often are habit forming, and may exacerbate symptoms.

When approaching our programs, we at Magellan recognize the importance of identifying PTSD symptoms early on. We hope to spread the understanding that one’s response to trauma does not reflect failure, or weakness in character. Rather, we believe that raising awareness and understanding of PTSD is essential to tackling this condition, which affects so many Americans. As we move forward in developing and integrating new programs, we are keenly interested in supporting individuals, families and healthcare providers to increase access to resources for PTSD education, treatment and support.

Looking for more information on PTSD support? Click here for a list of resources and tips, or call 1-800-273-TALK if you are in crisis.