What’s the impact of multiple deployments and repeated traumatic stressors on service members? Why are a significant number of military personnel experiencing psychological injuries following their deployments? What treatment options are available? What’s being done to help advance the field of traumatic brain injury (TBI) and psychological health?

If these questions are on your mind, consider reading the special edition of “Military Medicine.” Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) subject matter experts and others share updated research to better understand current psychological health and TBI conditions affecting the health, occupational and personal functioning of service members and veterans. Published by The Association of Military Surgeons of the United States (AMSUS), the journal identifies effective screening tools, diagnostic technologies and treatments for major areas of concern like posttraumatic stress disorder (PTSD), depression, substance use disorder and TBI.

	U.S. Air Force photo illustration by Senior Airman Mike Meares

Lt. Cmdr. David Barry is a subject matter expert on alcohol and substance abuse/misuse at DCoE.

For many, drinking alcohol in moderation isn’t a problem. For others, keeping within appropriate limits can be challenging. So what’s appropriate drinking? And how do you know when your drinking is excessive or risky? Many have misconceptions about the answers to these questions. Primarily young adults believe that as long as they don’t get too sick, black out or drive while intoxicated, their drinking is appropriate. However, not remembering events from the night before, experiencing hangovers and getting sick are all signs of excessive, unhealthy drinking.

Whether at a party or at a bar, it’s easy to unintentionally engage in excessive drinking, since the alcohol content is not always apparent. A standard drink is equal to one 12-ounce beer (5 percent alcohol), five ounces of wine (12 percent alcohol), or a 1.5-ounce shot of 80 proof alcohol. So, drinks like a “large” 20-ounce beer from a restaurant, the microbrew with a kick, or the strong-mixed drink from the bar are greater in alcohol content than one standard drink.

	Download the Co-occurring Conditions Toolkit mobile app and then share your feedback. (U.S. Army photo by Brian Gebhart)

We want to hear from you! Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) created an easy way for you to share your thoughts on the Co-occurring Conditions Toolkit: Mild Traumatic Brain Injury and Psychological Health and corresponding mobile app for smartphones and tablets. Your feedback will help us make improvements to the tool kit and app and other psychological health and traumatic brain injury (TBI) products.

Did the tool kit improve your capacity to manage patients with mild TBI and co-occurring psychological health conditions? Based on your experience with the tool kit, share your thoughts about everything from advantages and disadvantages to recommendations and suggestions for future TBI clinical resources and tools. Take the online survey today—it only takes a few minutes. This survey is voluntary and your responses are anonymous.

Treating patients with mild traumatic brain injury (TBI) can be challenging because TBI symptoms can sometimes resemble a number of psychological health conditions. Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) developed Co-occurring Conditions Toolkit: Mild Traumatic Brain Injury and Psychological Health to provide guidance on the assessment and management of patients with the co-occurring conditions of concussion, post-traumatic stress disorder, pain, depression and substance use disorder.

The tool kit is a user-friendly, comprehensive clinical guidance tool for primary care providers, featuring evidence-based clinical practice guidelines and recommendations from the Departments of Defense and Veterans Affairs. It provides tips for an effective first appointment; guidance on clinical assessment; treatment recommendations; medication information; and patient education websites.

Dr. Vladimir Nacev

Dr. Vladimir Nacev is a retired Navy and board certified clinical psychologist specializing in child and adolescent psychology. He has served overseas and spent most of his time in clinics and hospitals providing clinical services to service members and their families. He is a subject matter expert on alcohol and substance abuse prevention at DCoE.

As a child growing up in three different cultures, I learned the value of being cosmopolitan—learning the difference between having an opinion and holding a judgment, between having a choice and making a decision. Years later when I became director of an inpatient alcohol rehabilitation clinic, I conveyed the message that while drinking alcohol is a choice, the amount of alcohol we consume may not always be under our control. For some, drinking alcohol is a high risk factor with serious consequences that may need to be avoided.