A Baylor University graduate student is collaborating with a research group at the Waco Veterans Affairs Medical Center to study how substance abuse affects veterans with combat-related mental health conditions.

Sarah Martindale, a doctoral student in psychology and neuroscience at Baylor, is looking into the collective impact of post- traumatic stress disorder, traumatic brain injury and substance abuse among Iraq and Afghanistan war veterans.

She began the study in April, dubbed Project NECCO, in partnership with the Center of Excellence for Research on Returning War Veterans at the Waco VA hospital.

“We’re still realizing the impact of the wars in Iraq and Afghanistan, and we don’t know how these things together look,” Martindale said. “We know how PTSD and TBI look, and how that affects neuropsychological functioning in veterans, however, we don’t know a lot about PTSD and substance use in veterans and the same thing with TBI and substance use.”

Martindale said some studies have shown that up to 44 percent of Iraq and Afghanistan war veterans who have PTSD also have experienced a traumatic brain injury. But there are no statistics on the number of veterans who may be dealing with all three conditions.

About 20 percent of Iraq and Afghanistan veterans have PTSD, and about 15 percent have had traumatic brain injuries.

Martindale has completed neuropsychological assessments on 18 veterans so far for Project NECCO, which stands for Neuropsychological Evaluation of Comorbid Conditions in OEF/OIF/OND veterans. The acrononyms in the title refer to the officials names for the wars in Afghanistan and Iraq.

She has recruited veterans through the VA hospital and the Veterans One Stop, a downtown-area clearinghouse of resources for veterans. She aims to evaluate 125 veterans by this fall and begin analyzing the data.

The assessments include a 90-minute neuropsychological exam, as well as a self-report packet veterans complete detailing issues with PTSD, substance use, and quality of life issues.

Sara Dolan, a Baylor associate professor of psychology and neuroscience, is supervising Martindale in the research. Dolan primarily focuses on addiction research, but is a clinical neuropsychologist and has collaborated with the Center of Excellence on other studies focusing on PTSD and TBI.

Dolan said the findings of the study could help clinicians better determine what patients are dealing with, resulting in improved treatment for veterans. For example, PTSD and TBI can create similar cognitive and behavioral problems like sleep disorders, anxiety, depression and irritability.

Also, the symptoms for each condition may not occur immediately after a traumatic event or brain injury, which can further delay a proper diagnosis. The Army is piloting a blood test to detect TBI, but both are usually diagnosed through psychological assessments.

Overlapping symptoms

“The symptoms of all three overlap so greatly, so we’re trying to figure out cognitively in the brain, what overlaps between the three and what distinguishes the three, so that when a solider comes in for treatment, he or she can get a proper diagnosis first, and then we can start to build a treatment plan,” Dolan said.

Sandra Morissette, who leads the assessment research core of the Waco VA’s Center of Excellence for Research on Returning War Veterans, said there’s been some interest in developing treatment options that can address conditions like PTSD and TBI simultaneously. But such a breakthrough is likely a long way into the future.

“It’s still to be determined whether that can be done,” Morissette said. “Right now, the focus is on treating each condition individually, dealing with the PTSD, alcohol use, etc. But when all three exist, clinicians need to be aware of it to be able address the challenges they collectively bring to the table.”

Morissette said the project is an example of an increasing number of collaborations with Baylor on mental health research for veterans and their families. Some past research projects conducted with Baylor faculty members include Project SERVE (Study Evaluating Returning Veterans Experiences) and the Military Families Coping Project.

She also is an associate professor at the Texas A&M Health Science Center, which sends students to the Center of Excellence for internships and research partnerships.

“Bringing multiple agencies together is really important in helping veterans reintegrate into the community and finding ways that we can do better to help them,” Morissette said. “Working with veterans is a specialty in some regards. You need to know what their experiences are in the same way you work with other specialty populations. I think Baylor has shown great initiative in making training in working with veterans a priority.”