The Future of PTSD Treatment Is Already Here. Why Can’t Veterans Access It?

[00:00:00] Good morning, everyone, and welcome to the At the Waters Edge Podcast, where we look for insights beyond the headlines and take a practitioner's view on national security and geopolitics. It's the 25th of June, 2026. Let's get started. Now, today we have our final installment in our ongoing series exploring post-traumatic stress disorder and treatment and care for veterans. Some folks have been asking, why are you covering a feel-good topic like PTSD treatment on a channel dedicated to national security and geopolitics?

[00:00:25] And it's simple. Veterans health is a national security issue. It's not a feel-good topic. How you treat soldiers, airmen, Marines, sailors who come home from war directly impacts your ability to recruit and train the next generation. Also, innovations developed treating the wounds of combat directly impact the health and safety of the society at large. Now, in our last installment, we talked to Jesse Gould from the Heroics Heart Project.

[00:00:55] He runs a nonprofit where they're taking veterans and sending them overseas to retrieve treatment with psychedelic drugs that are illegal to access largely here in the United States. Now, that's changing, but at a snail's pace. What does it actually take to take an innovative treatment like psychedelic drugs and move it from novelty to mainstream practice? Well, for that, we're going to be talking to Dr. Jessica Keller from Emory University.

[00:01:21] Emory University has been on the cutting edge of studying psychedelic drugs as a treatment for PTSD in a clinical setting. A necessary step to get this out of the chat rooms and into doctor's offices around the country. So what does it take to mainstream a new treatment? What bureaucratic hurdles are in the way? Are there funding issues, regulatory compliance issues? How does the university even get access to the drug they need to do the treatment? How does the sausage get made? All very important questions. Really excited to have this conversation.

[00:01:51] With that, let's get to Dr. Keller. All right. Well, good afternoon and welcome to the podcast. How are you doing today? I'm doing great. How are you doing, Scott? Doing well. Thanks for being here. Now, for folks who aren't familiar, can you introduce yourself in your own words to the audience? Yeah, I'd be happy to. My name is Dr. Jessica Maples Keller. I am a clinical psychologist and associate professor of psychiatry and behavioral sciences at Emory University School of Medicine, based here in Atlanta, Georgia.

[00:02:21] Nice. So, heard for some folks at the Wounded Warrior Project that Emory University right now is doing some really interesting work with psychedelic drugs and treating PTSD. Yes. Could you briefly give us an overview of what it is y'all got going on down there? Absolutely. I would be thrilled to. If it's okay with you, first, I'll step back and tell you about our Emory Veterans Program generally and then tell you a little bit about our psychedelics work, if that's okay? Sure.

[00:02:46] So, Wounded Warrior Project is a supporter of our clinic. It's called the Emory Healthcare Veterans Program. And we provide a two-week intensive outpatient treatment program for post-9-11 veterans and service members. So, a really special thing about this program is, first, it's open to any post-9-11 veteran and service member who's eligible at no cost to them. So, there's no cost to the veteran, and we can fly people in from all over the country, put them in a hotel for two weeks.

[00:03:16] So, I always like to really highlight this program because it's a really special and effective treatment. So, we like to kind of get the word out to anyone who might benefit. And the reason it's a two-week treatment, I'll explain a little bit. So, within PTSD, the good news is we have several really effective treatments. So, they're under kind of an umbrella term of trauma-focused therapy. So, there are things like prolonged exposure therapy or cognitive processing therapy.

[00:03:43] And the way those treatments are traditionally done are you come in once a week for several months, and you do treatments that really focus on processing the traumatic event. So, with prolonged exposure, you do something called an imaginal exposure where you talk through the trauma memory with your therapist. And in vivo exposures where you're kind of approaching things in your day-to-day life that remind you of the trauma and bring up fear.

[00:04:10] So, as you can imagine, those treatments are pretty tough to do, right? Like, part of PTSD is a desire to avoid the memory of the trauma or reminders because it's so upsetting. And within the treatment, we're asking people to do just that. So, in this typical format where you're coming in once a week for several months, the unfortunate reality is a lot of people aren't able to finish treatment. So, we see people dropping out, sometimes up to 50% of people. So, that's a real problem, right?

[00:04:39] Like, if we're trying to help everyone get better, the fact that, like, maybe half of people aren't going to actually finish treatment is very concerning. So, within the Warrior Care Network and the Emory Healthcare Veterans Program, that's why we do these two-week intensive models. So, instead of asking people to kind of lead their busy lives once a week and kind of go into this really upsetting thing to talk about, they fly in, travel in, spend two weeks with us, and therapy is their focus for that full two weeks.

[00:05:09] And we give them a lot of support in completing this treatment to make sure that everyone is able to complete it and get as much benefit as possible. So, within these, they're called intensive outpatient or mass treatment models. What we know is that they're very effective overall and over 90% of patients actually complete treatment. So, we're able to really engage almost everyone in the full treatment process.

[00:05:37] So, we've been doing research for over a decade now looking at MDMA. And now we have some work looking at psilocybin. So, these are both psychedelic substances. So, they bring on different subjective effects where there's kind of alterations in your experience of yourself, of the world, of others. Some people report feeling strong emotions. Some people report thinking or seeing kind of visual experiences. Experiences, there's a wide range of things people feel on them.

[00:06:06] And while we've been doing kind of this gold standard PTSD treatment program, there's been more and more research suggesting that MDMA combined with supportive therapy is safe and effective for PTSD. So, a group called the Multidisciplinary Association of Psychedelic Studies or MAPS conducted two phase three trials

[00:06:28] showing that three doses of MDMA with supportive therapy before, during, and after was safe and was more effective than three placebo sessions with therapy. So, we had been doing some work for a while looking at how MDMA impacts something called fear extinction learning, which is a translational construct that's really relevant to PTSD treatment.

[00:06:56] That really supports this idea of combining MDMA with the treatment we do, which is called the prolonged exposure therapy, where people do the imaginal and vivo exposures. So, within our model, it's a one-time dose of MDMA in the context of that two weeks of prolonged exposure. So, on the first day, there's a therapy session where you get to know your therapist. You, you know, talk about MDMA effects, talk about MDMA support strategies.

[00:07:24] And then the next day, so the second day of treatment, we do the one-time MDMA session. So, you're with your two therapists for six to eight hours. And in our model, you actually do those trauma memory exposures during the MDMA session. So, the idea that it can kind of really supercharge what people are able to get out of treatment. And then after the dosing, every day, you proceed with kind of that standard gold, gold standard prolonged exposure treatment program.

[00:07:52] So, we've been doing an open label trial, which means that everyone received 100 milligrams of MDMA. We've been running that study within mass prolonged exposure for a couple years now. And we are about to start two randomized trials looking at MDMA in combination with exposure therapy. And we are starting a study combining psilocybin with exposure therapy. So, that's a kind of overview of our standard treatment and then what some of our psychedelic models look like.

[00:08:22] Okay. So, this other organization, would you call them, MASC? MAPS. MAPS. Yeah. Okay. Was it multidisciplinary? Association of Psychedelic Studies. Multidisciplinary Association of Psychedelic Studies or MAPS. MAPS, yep. Okay. Okay. Cool. So, they've been studying this and they had a three-dose treatment and you guys are testing out a one-dose treatment. Yes. Is that due to the condensed nature of your program or was three doses too much? How did you decide to cut it to one?

[00:08:51] Great question. So, the MAPS model and our model are pretty different. Where the MAPS model really focuses on the MDMA as the treatment. So, in their model, they view it that MDMA kind of unlocks someone's what they call inner healing intelligence and that that allows the healing from PTSD. So, the therapy is more supporting the MDMA experience.

[00:09:16] Our model is quite different in that we view prolonged exposure is the treatment. So, trauma-focused therapy is the intervention we're doing. MDMA is augmenting or enhancing outcomes. MDMA is a good question. So, it's an empirical question, right?

[00:09:34] But we think that two to three doses likely might not be necessary if you are providing that gold standard PTSD treatment that we know most people get significant clinical benefit from. The other reason is you can kind of think about the MAPS model, you know, it's like three all-day dosing sessions with two therapists plus nine therapy sessions.

[00:10:02] So, when we think about the idea of trying to eventually disseminate and provide these treatments at scale, it's going to be a real challenge to provide those treatments at scale. And we actually see that. So, a couple years ago, Australia legalized clinical use of MDMA. And that's what they've seen is that it's, you know, been safe and effective. And an issue is there's a very large wait list. I think they have thousands of people on their wait list.

[00:10:31] So, that's why we're kind of within medicine in general, right? We want to use the minimally effective dose. So, we want to use like the lowest amount that gets you where you need to be. And we think that maybe a one-time dose is enough within combination with gold standard treatment. And it will hopefully allow us to eventually to get this treatment to more people. Gotcha. So, previous research, MDMA was a standalone treatment with therapy supporting the experience.

[00:10:59] You guys are looking at it as enhancement to existing treatment models. Exactly. Until like what we know from lots of studies is like the gold standard best treatment for PTSD. Okay. And what was that? The inner healing model or inner healing function? What was that? So, MAPS's model focuses on inner healing intelligence. Okay. That sounds like something straight out of like 1960s Woodstock hippie bullshit.

[00:11:27] When did this go from flower power to apparently on its way to mainstream medicine in the United States? That's a good question. So, well, it's interesting how you said it like Woodstock into the therapy room. Actually, the history of it is that there was therapeutic use of MDMA and psilocybin concurrently at the time of and actually predating like Woodstock era.

[00:11:56] So, there had been like longstanding interest in things like psilocybin or LSD within therapeutic contexts. And then those were then placed on Schedule 1, meaning that the U.S. designated that they did not believe them to have medical use and could no longer be used therapeutically. So, then at that point, people were kind of looking for like, okay, what's another medicine we might use within the context of therapy to help people? And they kind of look to MDMA, right?

[00:12:23] Because something kind of unique about MDMA is it has what we call pro-social effects. So, a lot of drugs kind of make people go inward or detach from people. And MDMA, a lot of people who take it report feeling more connected to others, feeling more empathy, feeling more sociable. So, that's a potentially really good property of a drug that we're trying to combine with therapy, right? Like helping people trust and engage in the therapeutic process.

[00:12:53] And it has a shorter half-life. So, it's potentially more clinically manageable. So, then there was an influx of MDMA therapy work going on, including both like, you know, research being published about it as well as this being used in kind of ongoing clinical practice. And then MDMA was then placed also on Schedule 1, leading to restrictions in using it clinically.

[00:13:20] But MAPS, the organization we were talking about, has really been the trailblazer of bringing it back into the therapeutic context in a research way since the Schedule 1 restriction. So, basically, for over two decades now, they've been doing some of this pioneering research, looking at first the safety of MDMA, and then looking at, you know, phase 2 trials, looking at it combined with therapy, phase 3 trials, looking at it combined with therapy.

[00:13:49] So, MAPS was really the trailblazer kind of pushing forward this clinical research on MDMA. And then in 2024, they submitted it to the FDA for a potential approval for clinical treatment of PTSD. And at the time, I think most people expected it would be approved because there had been two phase 3 trials showing it was safe and effective.

[00:14:17] And the FDA actually declined to approve it and cited that more research is needed and cited a few kind of criticisms of the research that had gone on so far. So, yeah, it's now kind of up in the air. There, I think there are continuing conversations between MAPS and the FDA. Psilocybin recently, a phase 3 trial, some of the results were shared. So, psilocybin also might go up to the FDA for possible approval soon.

[00:14:45] So, it's a very exciting time in this field, and things could change a lot over the next few years. Gotcha. And so, you're currently doing MDMA, and so you're starting psilocybin soon? Yes. We have a clinical trial looking at psilocybin therapy for PTSD, and we actually have just started enrolling. So, that one is also open, but we haven't treated our first person yet. Are there negative side effects that need to be watched out for?

[00:15:14] Are there screening criteria that would determine if someone's even a candidate for this? What are the pros and cons here? What are the tradeoffs? Very good questions, because that is something anytime I do an interview, I like to really emphasize that, like, clinical use of psychedelics is very different than recreational use. There are a few reasons why.

[00:15:32] So, the first is that within clinical research, we're using pharmaceutical pure MDMA or psilocybin, whereas we know in recreational use, often when people are using psychedelics, it might be kind of cut with other substances. And people recreationally often use it, you know, knowingly in the contact with other substances, maybe with alcohol or things like that. So, it's pharmaceutically pure.

[00:15:57] However, it also, you know, we do very involved medical and psychiatric screening. So, some of the contraindications, so things that would make us say, hey, I don't think psychedelic therapy is a good fit for you. One is if someone has, like, current psychotic symptoms or disorders.

[00:16:20] So, if you're having those symptoms, it's probably not a good idea for you to do psychedelics, which kind of can lead to these alterations in your experience of things or could see potential visual stimuli. So, it's not a good fit for that. Another big one medically is, like, cardiovascular issues. So, if you have unmanaged or significant cardiovascular issues, particularly MDMA, it does have some amphetamine properties.

[00:16:43] So, we kind of, so for someone to be in our trials, you go through a full screening, a full psychiatric assessment, and a full medical assessment, including a physical, an EKG to actually test how your heart is doing, blood labs. So, we kind of do a really thorough look to make sure someone's a good fit before we would enroll them in the study. Gotcha.

[00:17:14] And also, everyone you're studying is a veteran of the post-9-11 error or there are non-veteran studies going on in parallel? Great question. So, our open label trial actually was open to anyone with PTSD. So, we saw veterans and civilians. And then, right now, we have two MDMA trials. One of them will be specifically with active duty service members. And that one is a collaboration with Dr. Alan Peterson and his team at Strongstar in Texas. And then, our other one will be open to veterans and civilians.

[00:17:44] And then, our psilocybin study is specifically for Georgia veterans. Gotcha. Do you see a difference in the effectiveness of different treatment models, including psychedelics, between the veteran population and the non-veteran population? Great question.

[00:17:59] So, in the psychedelic space, so, like, there hasn't been, like, studies directly comparing, but there has been studies looking at veterans and first responders that did show, you know, similar effects. So, like, large effect sizes and good safety profiles. In our open label study, we enrolled both veterans and civilians. And so, we've done analyses looking at it.

[00:18:26] And it's equally effective in both groups. But, again, with all the caveats of in the open label study, it's a pretty small sample. So, so far, we've enrolled 15 people. So, a small sample, we need more research. We need bigger studies. But for now, it seems like in our model, people see huge reductions in their PTSD. And that's true for both veterans and civilians. Gotcha. So, for background, I've been reading The Body Keeps the Score. And I got my copy here.

[00:18:55] And there's this really cool part in the beginning of the book where he talks about a study that they did with Prozac and PTSD. Veteran and non-veteran, about 30 people each. And they give him an eight-week trial. And I'll just read the quote here about the results of the trial between the veteran community and the civilian community. At the conclusion of the study with Prozac, they say, surprisingly, however, the Prozac had no effect at all on the combat veterans at the VA. Their PTSD symptoms were unchanged.

[00:19:21] The results have held true for most of subsequent pharmacological studies on veterans. While a few have shown modest improvements, most have not been benefited at all. What's the deal with psychedelics where they are appearing to have such a large effect compared to other, you know, non-Schedule 1 substances that have been tried for decades now? So, great question.

[00:19:45] So, I mean, one thing that is helpful to kind of be aware of is PTSD is somewhat unique in that in the clinical practice guidelines, so across all the clinical practice guidelines for PTSD, the first-line recommendation is trauma-focused therapy. And medications are recommended either second or if trauma-focused therapy isn't available.

[00:20:09] So, what that means is that the scientific literature suggests that trauma-focused therapy is the most effective treatment for PTSD above and beyond the pharmaceutical options that we have at this time. So, things like sertraline or peroxetine, you know, in general show lower effectiveness for people with PTSD compared to trauma-focused therapy. So, that's one thing to be aware of is that unfortunately, and you know, like they can help somewhat,

[00:20:39] and there are other medications that can help PTSD or associated factors. But what we know is that, like, therapy is really the most effective thing for PTSD. And to your question about kind of what might be the difference between psychedelics and standard psychotropic medications, psychedelics are a really different medicinal approach to PTSD in which,

[00:21:02] if you think about most medicines that someone might be prescribed for PTSD, so something like an SSRI, those medications are kind of dampening or bringing down the overall emotional response. So, psychedelics are quite different in that in psychedelics, people are connecting to their emotional experience. So, it's doing a very different thing.

[00:21:31] And the idea of a medication helping you connect to your emotional experience is very in line with what we do within therapy for PTSD. So, you know, PTSD is a disorder of avoidance. People want to avoid thinking about the memory of the trauma, doing things that remind them of it. And that makes sense, right? Because those things make them feel bad. No one likes to feel bad. But in the long term, when you continue to avoid those things, it reinforces that fear, it increases that fear response, and it makes your life smaller.

[00:22:01] So, in therapy, we're helping people process what they've been through, connect to their emotions. So, that's why I think psychedelics are a really unique opportunity to combine them with therapy in a way that's really synergistic and not just two things kind of operating separately and potentially, like, numbing the overall emotional response. You mentioned the current treatment for PTSD and what the scientific literature recommends.

[00:22:27] And how much of current PTSD treatment that exists out there, you know, outside of what y'all are doing down there at Emory trying to innovate, is actually based off of scientifically valid literature because you guys are testing a Schedule I substance, which by definition is not supposed to have any medical use, and it's having tremendous impact. And I was surprised when, you know, I was dating my wife and she was graduating from nursing school some decade or more ago,

[00:22:55] and she talked about this, you know, transition to evidence-based medicine. I was like, what do you mean transition to evidence-based medicine? What is medicine based off of? So, just at a macro level, how much of current PTSD treatment that a veteran walking into a VA center to get is going to be based off legitimate scientific research, and how much of it has been, let's politely say, influenced by other factors? So, that is such a good question.

[00:23:21] And actually, to answer your example of like, if you walk into the VA, you're actually more likely to get evidence-based therapy for PTSD than you are in any other treatment context. So, basically, years ago, the VA system did like a nationwide rollout where it was like, hey, if we know that prolonged exposure and cognitive processing therapy are the most effective treatments,

[00:23:45] then we need to kind of train our workforce and provide those treatments, and that's the expectation. And so, in the VA system, you're much more likely to get evidence-based treatment for PTSD. Again, of course, not saying it's a perfect system, and, you know, some people have wait lists. Sometimes, also, like I was talking about earlier, sometimes people just drop out and kind of it's too hard for them to go on an outpatient basis.

[00:24:11] In the non-veterate VA world, in like civilian world or people who don't have VA benefits, you're much less likely to receive evidence-based treatment for PTSD. So, you know, and that's due to kind of several factors. So, there's a lot of providers who just aren't trained in doing evidence-based treatments for PTSD. Some providers just prefer doing different treatments.

[00:24:40] So, yeah, I think it's, to me, kind of a concerning thing is that it is pretty hard for people to access what we know is, at least at this point, the best treatments that we have for PTSD. That's actually pretty scary. Damn. So, y'all are doing this work down at Emory. You're doing studies. Psychedelic drugs appear to have an effect.

[00:25:02] I got to assume that one of the long-term goals of the research you're doing is to get psychedelics approved as a mainstream therapy for PTSD so that more people can access this. You know, how do you construct a study that is convincing enough that the FDA, who's not necessarily known for being progressive and innovative, gives the rubber stamp of approval to roll this out at scale?

[00:25:29] How does this go from being a good idea to being public policy? And starting now, like, how do you build the study? Mm-hmm. Great question. So, for us, like, I will, we will not be the ones submitting it to the FDA. So, currently, MAPS, that's something they're working on. And then, within psilocybin, there's a few groups working on it. But Compass Pathways is the one that recently had their phase three trial.

[00:26:00] So, the answer of how they do it is, like, it is a massive undertaking that requires essentially huge financial investment. So, these are, you know, that's a big focus of, like, what their company does is running these large-scale clinical, very expensive, very time-consuming trials that are specifically set up to then submit to FDA for FDA approval. So, on my end, I'm not setting up the studies for FDA approval.

[00:26:29] What I'm setting them up for is to test scientifically what is the optimal treatment approach for MDMA treatment for PTSD and how we can use science to try to figure out how do these things actually work, what is MDMA actually doing that might be helpful for people, and hopefully figuring out who is the best treatment, who is the best fit for these treatments. So, that's a concept you might be familiar with called personalized medicine,

[00:27:00] where, to kind of give an example, like, if you went to a cancer treatment center and you had cancer, you don't just go in and they wouldn't just say, like, oh, you have breast cancer, so here's the treatment, right? They say, like, oh, you have breast cancer. So, we, like, you know, did a blood-based biomarker test. You have these biomarkers. We did a genetics test. You have this genetic marker. You know, you have these demographic factors, which, you know, based on the empirical literature, for you specifically with all this information, this is the treatment plan.

[00:27:28] So, to me, long-term, that's where we need to get with PTSD. For right now, it is more of a, like, okay, you have PTSD. Here's the treatment we do. But what a lot of our research tries to do is within our clinical trials to collect data, both psychological data as well as biological, neurobiological, physiological data, so that we can try to figure out what are things that can tell us what is the best treatment for a specific individual in getting that treatment to them as quickly as possible.

[00:27:58] Gotcha. How do you decide who gets into these trials? So, the main thing is we, people reach out and we screen them, and if they are eligible to proceed, then they can be in the trials. So, it's like, you know, we have inclusion and exclusion criteria. I will say with these trials, we often get a lot of interest, so we often have a wait list. So, it's kind of just like us working our way through this wait list and screening people and seeing who's eligible.

[00:28:28] Another thing about these trials is a good bit of people won't be eligible due to some of those medical and psychiatric factors. So, it actually, like, it takes a lot of time screening people because we do this really thorough screening, and then some people aren't a fit for it. But if someone's a fit, then they proceed with, you know, getting treatment under the study. Gotcha. So, how many people can you treat at one time, and how many eligible participants try to get in?

[00:28:58] Great question. So, I mean, at one time, we can treat maybe, like, one or two people a week. How many people are trying to get in? A lot. Right now, we kind of, like, just started being able to screen for the psilocybin study. So, right now, we're about to start three large-scale trials.

[00:29:23] So, essentially, we've, like, had people kind of waiting to be screened, and now we're, like, just starting with psilocybin. Unfortunately, for one of our MDMA trials, we thought we'd be able to start this month, but the drug shipment was delayed. So, like, that screening delayed a little bit. So, yeah, we're working through screening and timelines. When you're treating one to two people a week, what's a large-scale trial?

[00:29:53] As far as, like, so a large-scale trial, so a phase three trial, that is, the phase three psychedelic trials are multi-site and have many, many different sites. Okay. So, you're treating one to two people at Emory, but there's other sites that are feeding into the same data set.

[00:30:11] So, ours would be, like, a pretty large single clinical trial, but the phase three is, like, a way bigger trial where, like, the companies are running at, like, you know, maybe dozens of sites. And, like, for Compass Pathways, they're all over the world. So, it's a really massive, large-scale one.

[00:30:31] So, at most individual sites, probably usually one person a week would be, one dosing session a week would probably be the throughput. But since they have so many sites, it's more people. Versus at our site, you know, one of our trials is just us, and then one is the collaboration with Strongstar. So, like, there's a bit more capacity, but not nearly the number of people or the number of sites as, like, a multi-site phase three trial.

[00:31:01] Okay. So, there's multiple sites, even outside the Warrior Care Network that Wounded Warrior Project runs that are participating following the same screening criteria and treatment protocol? No. Not. So, for the big multi-site phase three trials, we do not, I don't lead those. Those are, we've been a site for some of those. So, we were a site for the Compass Pathways. With our research, it's one study, two of the studies are just our site, so it's just us.

[00:31:28] And then the third one is just us in one other site. Okay. How do you convince an institution like Emory University to get involved in something like treating psychedelics when they're still a class one narcotic or class one substance? You know, how does that pitch go and how long does it take to get academia to sign on to this? Good question.

[00:31:53] I think for us, a part that was really helpful is, so, one of my main collaborators in all of this work is Dr. Barbara Rothbaum. And I also work with a larger group of, like, really outstanding clinical scientists who have researched PTSD for essentially decades and done, like, really rigorous work on PTSD treatment, on PTSD biology.

[00:32:19] So, I think that helped is that, like, it's a group that Emory knows has for a very long time conducted ethical, safe, thoughtful, and impactful research that advances our ability to treat PTSD. So, I think that really helped is that, like, you know, that trust being there and the experience of running really complicated clinical trials.

[00:32:43] Because I will say running psychedelic clinical trials are very complicated, as you can imagine, especially being a Schedule I substance and all of the kind of intricacies of that. So, I think that probably really helped. And then the other part is our first study we set up, it was a study looking at MD main fear extinction in healthy adults. So, I think, you know, like, doing that study first before we started doing a psychedelic study focused on one of these emotional disorders.

[00:33:13] And setting up a first studies, it took a really long time. But that's not just at the institutional level. The actual main part is really with a Schedule I substance, you know, you're needing to engage with, like, multiple external agencies. So, the DEA, the FDA, multiple, you know, or systems within Emory. So, it's kind of like the first time you're setting up a Schedule I trial. It's going to take a long time. It's going to take longer than you think.

[00:33:41] But you're setting up the infrastructure and processes and, you know, of getting it through those systems. Is there like a standard bureaucratic process to get approval for this? Or is it like fighting uphill against a bunch of stigma and nonsense to get folks to sign on? So, there's, I mean, you go through the standard processes.

[00:34:06] So, like within Emory, you know, anything I do within research, I need IRB approval from Emory. So, you're submitting, like, here's the protocol. Here's what we're going to do. And then it's kind of a back and forth. And then, you know, there's standard procedures to apply for, like, DEA, the DEA setup necessary to do these trials. Often, it just takes a while to, like, actually get these things set up. Yeah. There are processes.

[00:34:36] They just take a while. All right. So, do you get any pushback from, like, state politicians or anyone like that trying to figure out, like, why Emory University is researching flower power stuff? Because, I mean, Emory is great, but Georgia is not exactly known for its progressive drug policies. And the state legislature is quite active. Quite active. So, the state of Georgia last year provided us funding for psychedelic therapy for veterans. Really? Yeah.

[00:35:03] So, I give the Georgia legislature a huge, you know, credit for. And I think, you know, I think people really care about treating veterans and supporting veterans.

[00:35:18] And I think in the past five to ten years, there's just been really this huge influx of evidence showing that these interventions, again, when they're done thoughtfully and carefully and in clinical and safe context, that they're really, you know, effective and safe for people with PTSD. And I think there's also a lot of demand in the veteran community for these interventions.

[00:35:43] So, like, as the word has gotten out that these are potentially really effective for people, there's a lot of demand. And I think a lot of veterans feel dissatisfaction about, like, why can't we be given these treatments? And there's a lot of veterans who are flying to other countries to access them. And, you know, there are places you can get them internationally. But it might not be a clinical context. It might not be a kind of regulated context.

[00:36:08] So, I think there's a lot of growing interest in advocacy in the veteran space for, hey, we should be doing what we need to domestically to provide these treatments in a safe and, you know, clinical context for veterans who are interested. What do you think it says about the medical system that, you know, a veteran community needs to hear hype about a drug treatment from, like, the Joe Rogan podcast and stuff like that and God bless them.

[00:36:36] But they get hyped up from the manosphere and then they go demand access to treatment and then they're flying to other countries to get it. And, you know, medicine in the U.S. is still catching up. Like, this seems, like, painfully obvious from folks from the outside. Why is this whole process so slow and painful? Yeah, I mean, I think there's probably several different parts of that.

[00:36:58] So, first, our, broadly even outside of psychedelics, our, like, drug development approval processes are very long and bureaucratic. Our scientific processes are quite long. I think there are ways that we could speed things up across the board. I think specific to psychedelics, there is, I think, you know, stigma and fear.

[00:37:27] I think, you know, people have maybe impressions of them that more bring up Woodstock or bring up, you know, like, genuine issues that happened in the past of people on psychedelics. And, you know, that we should be clear, I, there are potential risks. First, remembering that potential risks and outcomes are different in a recreational context compared to a clinical context. There still are potential risks in a clinical context.

[00:37:55] To me, I think we should kind of approach them like we do any medicine in the field. Of all medicine have a risk and benefit profile. We can't expect psychedelics to be the only ones that aren't allowed to have any level of risk, right? In all of medicine, we are trying to increase the benefits and decrease the risks. And I think, yeah, they're, they're, I think some people do. They make, they make them a bit nervous.

[00:38:22] And I think, to me, the answer to the valid piece of we should be careful with these medicines is funding and supporting rigorous and thoughtful research on them.

[00:38:35] You know, that we like do, there are, we do want more information about these things, but let's like really fund and get that information in safe ways that treat our patients really well, rather than people having to kind of potentially fly over all over the world and do these things in a different context in which we don't know what's going on. And when we're not going to be able to kind of track what's going on with you. What are the biggest barriers to studying this?

[00:39:00] Is it lack of interest, lack of funding, lack of studies, just this long bureaucratic process? Like if we were going to lean on something to move this research forward faster, what's the biggest bottleneck we could go after? So a big one is certainly funding. So, and there's been shifts in that. So now we're seeing more state level funding and federal scientific institutions funding psychedelic research. But historically there wasn't a lot of that.

[00:39:28] So psychedelic research was generally funded through like philanthropic or private foundations. And then the other thing that is probably a big coin is in general research is expensive. Clinical trials are expensive, but being schedule one makes it significantly more expensive and it takes much longer. So that like, you know, it's harder to get funding for it and the costs are higher and it's like a big delay to kind of get the work going.

[00:39:59] So I think those are big barriers. But, you know, it's also like legal and classification of just like the fact that it's a schedule one substance. The fact that, you know, how these things have been viewed by funding agencies historically has been a barrier. Marijuana is about to be a class three substance here. I forget the timeline, but that's being, you know, removed down the list. Is there anything out there indicating that psychedelics might get moved down the list out of schedule one and to schedule something else?

[00:40:25] Yeah, I think it's really there are a lot of ways that the FDA could could approach what happens if they do consider an approval. So I think it's it's really up in the air what then would happen.

[00:40:38] And, you know, they could also do something like, you know, have a strict monitoring process required if you provided these treatments clinically or starting off with that only specific clinics that had kind of certain experience and infrastructure would be allowed to provide them.

[00:40:58] And there could be like post approval research and tracking or kind of this idea of like, OK, let's do a slow rollout and keep a close eye on how this is going once we we once we allow it in a clinical context. Gotcha. So you mentioned before. I'm curious, Scott, what do you think? I know you're a veteran. Like, what do you think barriers to these treatments becoming more accessible might be? Oh, I mean, Sigma and a very slow bureaucratic process.

[00:41:26] And let's be clear, there is not a barrier to treatment for anyone with a plane ticket who likes to listen to podcasts. So this almost seems to be like a distinction without meaning because folks are going to do this anyway. It's like telling teenagers to not have sex. I mean, you can say it, but you should also probably pass out condoms like at a certain point. There needs to be an adult conversation.

[00:41:44] And this falls into the very large category of things about the federal bureaucracy and particularly Congress and the ramp cowardice in that institution on a number of issues playing out in real time in veterans lives. So to me, this is all in that wider umbrella of incompetent Congress. That's a whole nother conversation. I was having a fun conversation, not a fun conversation, a troubling conversation about the Iran war this morning with Professor Allen Chicago. Rob Pate.

[00:42:15] Anyway, so you talked about the risks associated with psychedelics. What are the genuine concerns that people have about psychedelics, particularly in a recreational context that folks should be aware of? So in a recreational context, so one risk is be aware that, you know, we know there's research on like testing purity and recreational drugs that often. What you think you might be taking is not that or is cut with other substances.

[00:42:44] So that's a big risk, right, is that it might be cut with things and sometimes it's cut with unsafe things. So, you know, engaging in drug testing services if those are accessible to you. So, so another risk, you know, like, like I said, MDMA has cardiovascular possible risks. So, and sometimes people have cardiovascular issues that they're not aware of. So like within our trials, you know, we do the HE and sometimes we have identified that someone had a cardiac issue that they weren't aware of.

[00:43:15] Or if you're aware of it, just kind of be mindful that MDMA there is a risk associated with that. There also are a potential concern for like psychological risks. So, especially within recreational uses, an idea within psychedelics is called set and setting.

[00:43:35] So it's this idea that your mindset going into the experience and your setting, so your physical environment, the sociocultural environment, really impact your experience of the substance, which is quite different, right, from other ones. Like you take an SSRI wherever you take an SSRI and you don't really think about the room you're in.

[00:43:53] But if you, you know, if you are intoxicated on another substance and you take a high dose of a classic psychedelic in a setting that might be kind of stressful or you're not surrounded by supportive people, you might have a tough time with that, right? Versus like if you're taking something, you've kind of thought about it, prepared for it, you're in an environment where you feel comfortable, you're with people that you feel supported by.

[00:44:21] So that's one consideration too, is like just the psychological impact that if someone has kind of a bad experience, some people call it like a bad trip, that can be a challenging experience of its own. And then some people report like related psychological difficulties after the experience from that. And then like some, you know, like potential risk of like feelings of depersonalization or derealization after the experience.

[00:44:47] Like I mentioned earlier, if people have a history of psychotic disorders, that can be a potential risk is that there's some consideration that like classic psychedelics might kind of increase risk for further psychotic symptoms if someone has a vulnerability to psychotic disorders.

[00:45:09] So those are some of the kind of psychotic disorders.

[00:45:37] We don't have controlled data usually that are like really tracking that carefully where we would be able to say, hey, here's like the base rates of these outcomes if you do them recreationally. But within clinical trials, we do track those things kind of systematically and carefully. So within clinical trials, some of the most common things that come up are things like dry mouth, feeling some anxiety during the psychedelic session. Some people feel some nausea. Some people feel a headache.

[00:46:06] But in most people, those experiences are transient. So basically you have them for a few hours of the dosing and then they resolve on their own. Okay. So how effective are the screening criteria you use for selecting folks that are not going to have these negative experiences? So for the things we're like quite concerned about, very effective. So, you know, like in our trials, we haven't had any serious adverse events.

[00:46:38] I would say it is a complicated area of research of like, you know, what do you consider a negative outcome? Because sometimes psychedelic experiences are can be challenging and therapeutic. So that's something that we kind of give work with people in advance of the session to be aware of is that like. We don't know what's going to happen in any psychedelic session, right? We know possible effects that can come up. But everyone's experience is different.

[00:47:08] What comes up and the intensity of what comes up. So some people can take like these active pretty high doses and they really only feel a little bit. Some people take the same dose and have just like really intense experiences. They're really altered. So we kind of work with people in advance to prepare them to try to help them get to a place where they're really open to kind of what comes up to them and helping them understand and kind of getting their sense of their expectations.

[00:47:37] Because it's been interesting. There's like so much more interest and lay attention to psychedelics in the past few years. But what we see now is, you know, there's a lot of like very specific ideas of what it's like out there where sometimes then people come into clinical trials and it's like, oh, great. I want to like see this vision or I'm going to have this religious experience and talk to God where we have to kind of work with people on like we don't know what's going to happen in this dosing session. Right. And like we don't want to go in with a really specific idea and then you potentially get disappointed.

[00:48:07] And one piece of that is sometimes people expect like a really positive euphoric experience and that might happen, but it might not. Some people experience some anxiety. Some people feel grief. All sorts of emotions can come up. And we have ideas of what is therapeutically helpful. We don't really know from the data what is happens on the dosing. That specifically is what helps people get better.

[00:48:31] But that's part of like the preparation work before a psychedelic session is helping people understand that like they could have lots of different experiences and that some of them might feel quite hard, you know, and that that's not a bad thing necessarily or a wrong thing. While we also still want to keep an eye on challenging things so that we're kind of tracking it for research purposes. And so we know.

[00:48:53] So my colleague, Dr. Roman Flitzky does really great work trying to kind of figure out how can we better figure out what is an adverse event in a psychedelic session? Because right now we kind of use the standard adverse event collection that is used in all clinical trials when we know that psychedelics bring things up that might be quite different.

[00:49:12] So like one example is like spiritual experiences, you know, where it's like, what if someone is an atheist and then they do psilocybin in a clinical trial and they have a connection to God? And then that actually feels disturbing to them. You know, that like there's these there's these really kind of complicated, nuanced things that I think we need to spend a lot more time on kind of thinking about and figuring out how to assess them.

[00:49:37] So we can give people really full informed consent about what what they can expect from a psychedelic experience and how they can best prepare for it. The point that a challenging experience can actually be very therapeutic is a very interesting one. I don't think it's one that folks are necessarily, you know, have top of mind when they start thinking about psychedelic drugs. Yes. So how then do you measure the positive impact of psychedelics?

[00:50:02] You know, what data have you collected that give you confidence that the psychedelic drugs are actually improving outcomes for veterans? How do you determine that? So we look at several things. So in general, since we're looking at PTSD, all of our studies will always use it's called the CAPS-5, the clinician administered PTSD scale, which is the kind of gold standard of PTSD clinical assessment. So all of our studies include that.

[00:50:30] And it's always conducted by a clinician who didn't treat the person. So that's an important thing is like within research, we want to keep people like blinded because, you know, if you're my patient, then like I know a lot about you and I, of course, hope and want you to be a lot better. I know, you know, what your MDMA or other drug session was like.

[00:50:54] So we have someone who didn't work with him and doesn't know anything about their treatment do that to try to get a more objective view of how the person is doing. But then in addition to that, we also collect, we call them like secondary outcome measures to try to look at things associated with PTSD that we know are meaningful to people. So things like how does your depression improve? How does your level of functioning improve?

[00:51:20] How does your relationship functioning improve? So we try to look at it kind of a more broad picture, especially with psychedelics. There's some of the data suggests that like psychedelics, like for psilocybin with depression, sometimes it seems like a better treatment.

[00:51:41] And sometimes it actually seems kind of comparable to a standard antidepressant on the main depression outcome, but then has greater effects on those secondary outcomes. So things like flourishing or quality of life or overall well-being that psychedelics might help people more so with those than our standard treatments. So we look at those. And then in our work, we also look at physiology. So PTSD is a very physiological disorder, right?

[00:52:10] Startle response, physiological cues to trauma stimuli. So we look at how their physiology may or may not change over the course of treatment. And we also look at brain imaging. So we want to get a sense about, OK, what's going on neurobiologically that is that can give us clues about how MDMA is actually helpful for these things.

[00:52:34] And another benefit of those more objective biological measures is that, you know, there's a lot of criticism in psychedelic research that there's, you know, people come in really excited about psychedelics. And then they, you know, really want them to work. And often the investigators really want them to work. And it's hard for it to stay blind.

[00:52:55] So while the studies are double blind, not everyone, which is interesting, but majority of people can guess whether or not they got MDMA or placebo in a controlled study. So that kind of disrupts the blinding process if someone has a pretty good idea of what they got. So that's a criticism of it is like, well, if you know you got MDMA and you like want MDMA to be helpful, then do you just kind of respond saying that it is?

[00:53:20] So that's why we're also really excited about these objective biological measures, because like, you know, your own expectation. It's like, let's look at what's happening in your brain and see if there's differences between MDMA or placebo and like what that can tell us scientifically and about how to kind of optimize these treatments and make sure we get them to the people who could benefit the most. Gotcha. So if you had to put a number on it, like what's the percentage improvement that the psychedelic drugs offer over traditional gold standard therapy?

[00:53:50] So great question. Their psychedelics for PTSD have not been compared to gold standard therapy before. And that was actually one of FDA's criticism. So our upcoming trials will be the first studies comparing gold standard trauma focused therapy with and without MDMA. So placebo controlled. So seeing like above and beyond.

[00:54:18] So to be determined, what is above and beyond gold standard treatment? Okay. We're coming close on time, but is there a country out there that does a good job of this that America should be looking at copying? That's a great question. So a veteran comes to you and says, I just went on a trip to do MDMA somewhere else. Is there a particular country you're hoping they said they went to?

[00:54:50] Like, oh, you went there? Oh, that was probably good for you. Probably Australia, because that's the country that has a legally approved clinical use. So they're kind of like a couple years ahead of us. I think they're giving us really good information about how to test and eventually disseminate these treatments. The other thing that is probably interest of interest is like with psilocybin, we actually within the U.S. have state level differences.

[00:55:16] So Oregon has now legally approved psilocybin treatment in state run like healing facilities. So that is an interesting thing is that like within the U.S. you actually can travel and engage in legal psilocybin. It's like not exactly treatment. It's different than clinical use, but it is like, you know, provided in a context and there is screening and there is monitoring.

[00:55:45] And then like Colorado is setting up psilocybin being able to be legally provided. So I think it's going to be a really interesting time right now where we have states kind of testing out different models of psilocybin care that are, you know, to varying degrees different than what we do clinically. So, so, so yeah, I would say probably Australia for now, but there could be great options that are being developed right now within the U.S. Okay.

[00:56:16] Well, let's put a little thought experiment. You know, we have today and we have a day where hopefully this is mainstreamed and available for veterans and civilians alike across the country based off robust evidence. You know, what is the thing that gives you the most hope towards reaching that day? And what's the thing that gives you the most concern about not getting there either at all or as quickly as we should?

[00:56:40] Um, one thing that gives me hope is that like, you know, if you had told me a decade ago where we would be now, I wouldn't have believed it. So I think remembering that things can unfold differently and more quickly at times, um, than you might expect. Um, the thing concerns me, like one thing is, um, is cost.

[00:57:08] So that's a big thing is that a lot of people want these treatments and people are working really hard to get them approved. And I think you see this in Australia where I don't remember the exact number, but I think it's like, I don't want to, but like thousands of dollars to get this treatment. So I think that is something that, you know, I don't want it to be all of this work.

[00:57:29] And then in the end, when it's approved, only wealthy people can access these treatments because, you know, wealthy people could access these treatments right now if they want it. Right. They can travel somewhere and get them. They often can engage in, you know, different activities where they want with less likelihood of repercussions.

[00:57:52] So I think that's a big thing is like, I think we need to all be actively working on, okay, but once these are available, how do we actually make sure they get to the people who could benefit? And how do we try to set up equitable access when we know that these are resource intensive and very expensive treatments that there's going to be a lot of demand for? Like I think right now, like Australia has a multi-thousand waiting list.

[00:58:19] Actually, just today, the nonprofit, I think it's called Heroic Hearts. It's like a nonprofit for veterans that helps veterans access psychedelic services internationally. I think they have in the Guardian article said they have a wait list of 2000 people. So like there's a lot of demand for these treatments. So how can we like set them up so we can actually get people access to them and that it's not just like that this small percentage of like very wealthy people get access to them?

[00:58:49] Yep, that is a great point. Well, we're coming to the end of this, but, you know, before we wrap, I really want to thank you for your time. But also, is there anything that I should have asked you about with psychedelics that I haven't asked you about yet? I would say for anyone interested in our studies, our email address, you can email patstudy at emory.edu if you're interested in being screened for the studies or learning more.

[00:59:18] Wonderful. Pat at emory.edu. Patstudy. So patstudy. Yeah. At emory.edu. And then the other thing I always just like to highlight is like remembering we do have effective PTSD treatments now. And particularly for any post 9-11 veterans or service members, please also look into the Emory Healthcare Veterans Program, which provides great treatment and no cost to veterans. Awesome. Links to both of those will be in the show notes for folks that are listening.

[00:59:48] Wonderful. Well, Jess, thank you so much for joining us today. I really appreciate your time. Thank you so much, Scott. It was a pleasure. So, folks, this is the end of our series on PTSD for this year. We're probably going to do this again next year with a whole other host of organizations that we spoke to, but didn't get a chance to get on camera this go around. I'm left with a nagging question, though, as we wrap this up.

[01:00:11] It's been so encouraging and so wonderful to talk to Emory University, Heroic Hearts Project, Wounded Warrior Project, all the other organizations that we'll get on camera for next year about how they're innovating around improving the standard of care for veterans with post-traumatic stress disorder. So many people are so invested in solving this problem. It's tremendous.

[01:00:35] But it seems like in a well-functioning world, in a well-functioning society, these organizations wouldn't have a job because the VA and the DOD, who are mandated to take care of veterans and service members and provide treatment for ailments, would be taking care of all this already.

[01:00:54] Now, is this an example of how America has a robust and innovative and forward-leading civil society that steps in to push the envelope forward when needed? Is this a hopeful story or a tragic one? I'm not sure.

[01:01:21] But somebody could probably answer that question a bit better is the guy that actually got me started on this. It's Walt Piot, retired lieutenant general and current CEO of the Wounded Warrior Project. So let's go back to Walt and get his take on what the current status of PTSD treatment in the United States is and if this whole thing is a story about American society being innovative and wonderful and how blessed we are or the government completely shit in the bed where they should be owning this. Let's go to Walt.

[01:01:52] Well, good morning and welcome back to the podcast. How are you doing today? Good morning to you, too. I'm doing great. So we had a great conversation. I think it was back in December. And you gave me some advice afterwards that sent me off on this rabbit hole of looking into PTSD and veterans care and all the work being done in this space. It's been a really cool trip talking to all sorts of folks in all sorts of places.

[01:02:15] I wonder, from your perspective, though, having worked on this for a number of years, where do you think we are as a veteran community in addressing PTSD? Are we where we should be? Are we behind the eight ball? Obviously, there's more work to be done. But how do you think we're doing? Yeah, well, I think where we are is far better than we have been. I think the last few years have been remarkable progress.

[01:02:40] I don't think we're ever going to be satisfied that we're where we should be, because I think there's always more we can do. But the conversation is much deeper, richer. It's not I don't feel the stigma around it. You feel so many warriors talking about it like it is. It is something that's going to, you know, going to happen if you're going to serve and you're going to see conflict or serve.

[01:03:02] I think a lot of folks like you in special forces started to come out, you know, some of our bravest, toughest warriors and started to openly talk about this. I think that has put us in a very good place because this is not something that's, you know, you know, totally hidden. It is actually really something there. Now, whether people know they're impacted, I think, is another question altogether.

[01:03:28] That remains to be difficult because I think for so many warriors, it may feel normal and then it slowly starts to creep into their lives and little things start to fall apart or go different. You know, and they don't really know that it's related to trauma that they've experienced in the military or out of the military.

[01:03:46] But I think the way it manifests itself, I think we, you know, we could be a lot better in trying to get ahead of that and understanding that this will happen and be more proactive, more pre-traumatic training and awareness, I think would help people as they go through traumatic events as a warrior or as first responders at anybody. You should know that when you experience trauma in your life, you're going to suffer from post-traumatic stress without a doubt.

[01:04:15] You should know that up front. And we should know that in the military, that if you're going to serve in the military, you're most likely going to experience trauma in some shape or form, whether it's in combat or not. It could be in training or an accident or something. So we should be, we should do more pre-trauma event to help warriors regulate and deal with the stress of their service before they experience these events and not just see what happens after they experience.

[01:04:43] Know that when we do go through traumatic events that we need to get help so we can maintain the warrior's readiness and it would help, not just help with their lives, but it would help with our military readiness. And I think warriors would recognize that before it happens and be able to have been a much better place when it does. Yeah, no, non-prevention is definitely worth a pound of cure.

[01:05:04] And it's really interesting to hear about, you know, the experience of, you know, Ryan, who works for your organization and how he lost an arm and a leg in Iraq and he's got PTSD symptoms almost two years later. It's like, how did the folks at Walter Reed not have a preemptive treatment plan in place to help get ahead of that? Because you know, it's probably coming down the line at some point.

[01:05:25] Yes, I think that's why I think today we know so much more, you know, in other conflicts, you know, you just thought it was nobody was impacted until you saw that they were. Now we know that, no, you're impacted. It wasn't just a physical injury. You probably have a traumatic brain injury. So all these things are being thought of in real time.

[01:05:46] Sadly, you know, I think there were many that were missed at that time, but I think now it's understood that there it's and it's not just combat. It's happening in training. It's happening and, you know, using certain weapon systems, the amount of overpressure that you could experience in vehicles or firing large weapons. We now know that that's having an impact and we've got to we've got to be, you know, aggressive against, you know, not putting people in the arms away.

[01:06:15] But when we do in training or in real combat, we know we need to we know that more is impacted than we can physically see. And I think that awareness is much, much broader and richer today than it has been since I, you know, since I served. I think just the last couple of years has been a lot more progress has been made.

[01:06:39] So I'm very hopeful that we're going the right direction, but, you know, where we should be, not until we can get everybody access to treatment and care will we be where we should be. Yeah. One of the really interesting things going through all this was hearing about this wonderful, innovative work being done in nonprofit space, in the veteran community organically, at academic centers like Emory and their health care program.

[01:07:04] But, you know, ostensibly, there's two organizations that are supposed to be dedicated to taking care of soldiers and veterans, Department of Defense or Department of War, whatever you want to call it these days. And the VA. And I'm not sure how I feel about this, but it seems like all the innovative research is happening in the private sector and the government is struggling to keep up with its responsibilities.

[01:07:28] And I'm not sure if this is an example of American civil society stepping up and taking care of a problem. And how wonderful is that? Or is this the failure of government? And it's a tragedy. I'm not sure which way this story should be told. Yeah, I think it's a nonprofit ourselves.

[01:07:51] I think smaller organizations can move faster on certain topics and we can get ahead and figure out, anticipate where problems are. Broadly on any issue at Women of War Project, we see that a lot. But we can't do it to the scale that the Department of War and the Veterans Affairs came. So I think it's a very healthy relationship that I think that the nonprofit and society generally help us with. You mentioned Emory.

[01:08:20] I mean, what a wonderful academic institution, not just for the medical research, but these are some of the best doctors in the world studying this. And when they produce things, people listen to them. Veterans of Affairs listen to them. So one of the things we do really well is network those findings so that people don't have to search them for themselves individually. So that small organizations or, you know, I'm not saying Emory's small. That's a big organization, but compared to the VA in government.

[01:08:48] So private and society can move faster and researching, but those numbers are so small. So when we do find solutions at work and we find warriors that go through some of those programs, we immediately enroll them into the VA so they can sustain that care. So I think it's necessary that we do both. I think it is a success on both society, but also on the government listening to some of these organizations, like not having to repeat it.

[01:09:17] I think we're seeing it coming up now with psychedelics and alternate medications because the Department of War has doubled down on trials. Veterans Affairs have funded trials for next year. All this is happening in real time. So that's I think that's very good news. But I do believe it's a it's a part of scale. And I think when when we when we can find something that works, the problem we can't do is scale it to the size that's needed.

[01:09:44] But the VA surely can and the department surely can. And I think those relationships are healthy. And I think it will only lead to better care by researchers finding what the right care needs to be in the time of it and an access to care done by the by the government agencies that have the size that can scale it. So I'm very optimistic about both right now. And I think the last couple of years we've seen this relationship only get stronger.

[01:10:11] And I think our veterans and our and our active duty warriors will only benefit from that. Yeah, it's some ironic. You know, the VA has got a terrible reputation, some of which probably isn't well earned. Actually heard a lot of great things from folks doing this series about the VA. And so I actually reached out to them to ask them to participate. And their local crew said yes. And then their national office came down and said, nope, absolutely not. Do not do not go talk on that podcast.

[01:10:42] And it almost seemed like a weird corollary to the larger story around the VA and its ability to build trust with the veteran community. Do you think there's lessons that the government should be adopting from organizations like the Wounded Warrior Project more quickly that could help strengthen their reputation and their outreach efforts in the veteran community? Are there lessons there that they should be learning?

[01:11:06] Yeah, you know, you talk to, sadly, there's a negative perception around some veterans. And then there's a very positive perception with other veterans, depending on how they got their care. And people always say, you know, if you've been to one VA hospital, you've been to one VA hospital and they're all very different. And I think some of their reputation is not deserved at all. You know, I just got back from Puerto Rico and the VA hospital there. It's wonderful.

[01:11:31] And it's full of, you know, veterans from all eras, mainly a lot of Vietnam generation getting healthy. And they just think it's the best they get. And they have great access. They're treated, you know, like they're very special. It's just very good to see. And then, you know, but then you hear others. And I've talked to some people in their own family, their children have served. One loves the VA, got all their care from it. The other one just thinks it's too bureaucratic and it's slow to respond.

[01:12:01] So my personal experience retiring was I found them to be very compassionate and very caring. I really did. And the way that the VA reached out to me as a veteran, they didn't know my rank. They just followed up with us. So I think in talking to many former and current VA secretaries, I think they all know that going in. They have a reputational problem and they try to bring caring attitudes to their people.

[01:12:28] What we do at One to Warrior Project, just helping with your VA disability claim with warriors, because it's a very difficult process to do. I mean, anything government, it's a lot of forms. They've added forms to it. And I know I did mine on my own and it was very, very difficult. I think it would have been easier to get a PhD from Syracuse and it would have been to do that. But when I've talked to people at the VA, they were very helpful. And I didn't use One to Warrior Project.

[01:12:55] But when we help warriors and we advocate for them, we find the VA very receptive. And I think sometimes it's just the scale of what they're trying to handle, the amount of claims. Some get lost, some get delayed. But when you build a strong relationship, they get good results. I mean, it's a lot of work. I have a lot of sympathy. But I also focus on the transition.

[01:13:21] And I think the VA can't be, they're not responsible for something that warriors sometimes just don't do. I think if we can help, and I've talked to the department, senior leaders in the Department of War and senior leaders at VA, we can help with that transition because every problem that you're facing as a veteran started when you were in uniform, right? So if we can help you transition right and not just get out, especially young guys, you know,

[01:13:48] and I don't know how it was with you, but when young guys get out, they just go, I'm healthy. I'm fine. I don't need to mess with that stuff. I'll do it later. And then they don't. And then when they start getting ailments and they start to say, this is probably service-related. They don't have the documentation right. And then it becomes a really difficult thing to do. I think if we help with transition and we close that gap between active, not just active duty, but all compos,

[01:14:14] but serving in uniform to then now transitioning to civilian life, if we can close that gap, I think the VA will operate as intended, you know, by our government. And I think that's really the shortfall. And I think some of the negativity, I mean, of course, anytime you go to a hospital, you may be treated really good one day and another day may be bad.

[01:14:39] So I don't, they are big, they are a big organization, but I personally think they haven't earned the bad reputation that many people, you know, place on them. I think it is, it's no other country can do the magnitude and quality of care that the United States can with its VA medical systems. They are really good. Can they get better? Yes. And every, every person we talked to at the VA tells us, help us see where we're not getting it right.

[01:15:07] To include the current secretary and the former secretary told us that too. Tell us where we're not getting it right. And they listen to the nonprofits, especially the veteran support organizations and the military support organizations on ways they could improve. They do listen. I mean, I, I, so I'm hopeful. Is it perfect? No, of course not. No government system is ever perfect, but do they want to get better? I believe they do. And I believe they will. Yeah. I haven't been out of the military now for four years.

[01:15:36] The VA where I live actually does have a very nice reputation with the folks in town. I've never been there because when I was going through the med board process, my army assigned lawyer told me that once you get out, never walk into a VA healthcare center or hospital ever. So even within the med board community inside the army, there's a reputational gap there that I think is undeserved. But having watched my wife who works in healthcare in a local hospital, I can't say it's any better or worse from a bureaucratic standpoint. It seems like healthcare itself is just complicated.

[01:16:06] I think that's a very fair statement. I think the healthcare enterprise, it's just hard. I mean, we're fortunate here in Jacksonville where we have the Mayo Clinic and I went in for, after I first got out of the army and I, I thought they had me confused with like some important person because he treated me so good. And then I realized that's just their quality of care. They focus on the experience. And we adopted that at Wounded Warrior Project.

[01:16:33] We want that warrior to have a good experience no matter who they talk to in Wounded Warrior Project. Because we could be the same way. We could turn somebody off just by, you know, the online system was too difficult or it didn't go through right away or something happened. And we may never know. So that customer service, that relationship, you know, treating someone with dignity and respect for what they've done. I think, you know, the bedside manners, I think every hospital probably has a challenge with that.

[01:17:01] Every medical system might have a challenge with that. But it's, you know, so I'm not sure how to fix that. But I know for us, it's, as a warrior, it doesn't matter who you are, what rank you are, what you did, you served, you know, you're in and we're going to help you because you signed up to protect your country. And we're going to help you transition and get, meet the challenges you could be facing. If we were to circle back, you know, 10 years from now, and hopefully we're all still around and still trying to, you know, do good things for the veteran community.

[01:17:30] What, what, what type of conversation about PTSD and care for veterans do you hope we're having 10 years from now? What successes have we had along the way? So that 10 years from now, this is a, this is a much more encouraging talk and almost a boring talk, hopefully. Yeah. Oh, I mean, I'm, I'm excited, maybe too optimistic and maybe too, maybe being accused of dreaming too much, but I think it's possible looking at the last 10 years and where we are today. I think the next 10 years,

[01:18:01] which should bring about monumental changes from, from pre-deployment, you know, the work I, I did while I was in the army, just on mindfulness and stress regulation. It should be incorporated into all complex careers. I mean, we should be doing that because we know our mind is going to be the thing that's impacted in the course of our duties, whether you're a policeman or an instrument or a special forces officer, your mind is the one that's your best weapon system. And we really don't train it that much.

[01:18:28] So I hope pre traumatic event or pre complexity environment experience, we do a lot more with that. And we understand how stress and, and, and the neuroplasticity in your brain works better. And we're doing things as part of your training, uh, much better. And, and of course, prohibiting those things that are impacting you in training that could cause, uh, damage to your brain or anything that way. And then, then during, and then after, and it just shouldn't be,

[01:18:57] it shouldn't wait till we manifest to see if somebody has PTSD, because you don't wake up in the morning and say, I've got PTSD. I've got to go see a doctor. You know, it, it creeps up on you. Either you're not sleeping right or irritable. It's normally maybe your family member or somebody says, you know, you're just not quite right. You know, what's wrong with you? You get angry all the time. You used to be fun. You used to want to hang out. Now you sit on the couch. So those things creep up instead of waiting for the signs to manifest. We should assume that you,

[01:19:26] you've been through, you know, traumatic event. You're good. And the treatment plans I think would be accessible, cheap and not require, you know, a medical school graduate or clinician that would be, you know, small because where the, where the criteria is hard now is when it requires, you know, a specialist to administer and it's got to be in a certain setting.

[01:19:55] So therefore you get a long, you know, weight line and we got to reduce that. We got to make it accessible where, you know, perhaps it's even, you know, something over the counter. Now that's 10 years. I don't, I don't know why we shouldn't be thinking of that. You know, I use the word deliberately cure PTSD and it, it doesn't resonate well with folks, but I think if we can provide you a treatment and I think there'll be, there's already a wide range of treatments, but there'll be more in 10 years and they're accessible. And if we give you a treatment,

[01:20:22] someone gives me a treatment and I never experienced those, those bad memories again. And I'm learning only positive memories and I'm learning that this is just a memory. I'm not really in that situation anymore. And it's not haunting me. That sounds like a cure to me. I think we got to get out. We got to see bigger than just manage PTSD because that treats warriors. Like we're some kind of damaged duck or something. You know, we're not, we're, we're people.

[01:20:48] We're people that did hard things and we want to get back into society as leaders and not be a burden to society or, or, or be seen as a threat to society because people look at veterans and say, Oh yeah, he was a real tough guy in the military, but right now he, he can just snap and we don't know, you know, he's just going to lose his mind and lose his temper. No, that's not how a warrior comes home. That may be, that's maybe how warriors come back today or transition out of the military. But for me and a wounded warrior project,

[01:21:17] our goal is to bring every warrior home, mind, body, and soul. And I think 10 years from now, that will be more possible at the point where they're actually coming out of the military or returning from deployment to actually come home and not just back. And they don't bring all that with them. And that, that I think in 10 years, well, I plan on being here and I hope you can ask that same question and play this back and say, well, you said this would be available and accessible and we'd have range of treatments and it'd be cheaper.

[01:21:47] And maybe I'll be right. I do know one thing, the cost of medical care does scare me a bit for the future. I mean, that's the one thing seems to go up. Insurance seems to be less and less willing to pay. And I don't want that to be, the, the, the treatment is works, but it's so expensive that we can't get it accessible to everybody. That, that, that could go that way too. I mean, cause that's what, that's how medical care sometimes go. We're going to do everything we can to make sure that does not happen.

[01:22:17] I think we'll end up on a range of options. Not one, not one method will be for everybody, but we'll figure out which one is right for you. And we'll pursue that. And then to a point where you never have to keep repeating that treatment. That's where I think we'll be in 10 years. Fingers crossed that that's exactly where we are. And we only take five to get there. So what would you say to folks who've been following this series? You know, veterans or family members, interested civilian population. They just want to help out.

[01:22:47] What would you, what would you want them to hear when they, either they themselves as veteran or someone they love and know, they know they have problems. They don't know where to start or what steps to stick next. What would you hope they hear from this? Yeah. I, I hope they know that their loved one is still there. They may not seem like they're there. They may not seem like the same person that went off to war, went off to military service, but that person is there.

[01:23:16] And a teammate told me this herself. Her husband was special forces. He was wounded in one of his deployments and came back and she said, his physical wounds healed. But he wasn't the same guy. And, and I had a hard time living with him. I, I, she clearly said, I, I, I couldn't like the guy. How could I love him anymore? He was mean. And he was going through all these things. And she goes, I didn't know what to do, but she reminded herself why he served. Now I think it's a good thing to remind us all like these men and women,

[01:23:45] they may come back, you know, appear that they're drastically different or they, they're never going to fully be themselves again. That is not the case. It's just, they're suffering from post-traumatic stress disorder, or traumatic brain injury or some other form of anxiety. They're probably drinking too much. You can see the difference. If you can see that that is not the person you love anymore, you got to reach out and get help. And normally I think the family sees it first, but she, she doubled down. She reminded herself, like my husband was a brave warrior. He loved his family, loved his country. He wanted to be, you know, he's a green gray, best there is.

[01:24:15] And she goes, he did that because he loved it. So I decided if he could do that for his country, I can stay. She goes, I didn't know what to do, but I was staying with him. She refused to walk away. She found wounded warrior project. We got her husband to help. He needed. And now he's, now he's still an operator at the highest level in the United U S military. We, it, you can, you can be helped from this. I mean, and I think one day we'll, we'll cure it, but I think what people need to know is that there is help out there and

[01:24:45] there is a lot of good body of work and a lot of good people that can do it, provided you just got to reach out and ask for help because your loved one probably won't. Warriors are pretty good about, we won't ask for help and we won't take help. Two consistent things that every warrior does, but it's a family member or a loved one knows. Hey, that ain't right. You know, dad used to be just a fun guy to be around. Now you're irritable. You sit down on the couch all day. You may be drinking a six pack every night. You know what? That is not normal behavior.

[01:25:15] You know, that's coming back. That's not coming home. That person you love is still inside there and we can get that. We can bring that person home, but you do probably ask, ask for help and they may not like it at first, but eventually you'll get your loved one back. And we, we have treatment plans that involve couples too, because that support network is so very important to, to many, many of us. And it really helps us see it. And sometimes it just takes that family member saying, you know, you're kind of a jerk, man, get some help, you know,

[01:25:45] and it's just, whatever it is that can get them there. But I would tell everybody it's out there. And I would tell the warrior who maybe is a home alone playing video games and his wife or her, or her husband left her and you're losing your job or you're having a hard time holding down day to day responsibility. There's help out there. You know, there's people that love you and care about you and compassion and kindness is a very powerful weapon. And you are a decent human being.

[01:26:14] All you did was sign up to serve your country. And that's an honorable thing. The things you did in the course of that service are not who you are. It's what you had to do as a warrior. So you come back with guilt. Many, the hardest part of surviving combat is just living for many, many else. That shouldn't be the way. It should be how much love and life I have yet to give. There is a way there. You can come home. You're, you know, we lost sadly too many people in combat,

[01:26:42] but we're losing many more here to suicide every single day. More than we lost in Afghanistan, Iraq combined. The numbers are alarming. That's not how a honorable service should end. We can bring every warrior home and we can end veteran suicide. So we, the warriors should know there's help there, that they're loved. There's care. There's care. Even though things are falling apart all around you, you're not alone. And many of us have been there and have been through it. And there is,

[01:27:11] there is a way to find that new path in life of hope and renewed purpose. And for loved ones, they got to know. And for society that doesn't know anyone in the military, volunteer, help, you know, donate to an organization of your choosing that can help provide the care, uh, that these, that these warriors and their families so desperately need. No, that's very well said. Um, yeah, family is absolutely critical for getting home from any of this stuff. Um, but I will just highlight real quick,

[01:27:40] the most important thing you said in that final statement, green berets best there is. That's the official statement from Walt Piat. Uh, rest of the SOCOM community take notice. Take a problem. Take it up with him. Not me. He said it. It's true, but he said it. Yeah. Well, you know, I think so highly of all our special operators, you know, I, what they do every day. And when someone that tough that can go through all the qualifications that you went through, uh,

[01:28:10] we send them to the very, we make them do the hardest things, right? We, we send you to make you do the hardest things. And that's, that's what's tough. I mean, war and, and combat, it's the worst of humanity, but we send our best and brightest to do it because we're not going to accept defeat and we're not going to surrender our liberties of this country, but we can never allow the strategic purpose of war to mask the toll it takes on the men and women. We asked to fight that. We have to realize that is a real impact. No matter how tough you are, you're a seal Marine, a green beret, a ranger,

[01:28:40] whatever, you know, that, that, that will stick to you and there is help and you can be bad and you can truly come home from it and stay in that, you know, those, those really high, high, high organ, those really good organizations. You can stay there and not be forced to have to leave early. Yeah. Well, well, thank you so much for being generous with your time and for making your team available. Really appreciated everything you guys done throughout this entire project and look forward to talking again in the future, sir.

[01:29:10] Yeah. Thanks, Scott. I really enjoyed it. Thanks for what you're doing, bringing awareness to this much needed cause. And we're going to work project. We're going to stay committed to keeping our promise. So thank you very much. We're going to staygue. And see you too.