Commentary: We Must Do Better in Helping Veterans with Alcohol and Drug Problems

The United States did a dreadful job in recognizing and addressing the alcohol and drug problems of Vietnam era veterans. In shameful fact, a significant percent of the nation’s homeless men are Vietnam—and now Gulf War—veterans who never got the help they needed when they got home. Research has shown that the start of heavy alcohol and drug use in Vietnam veterans was associated with exposure to violence in Vietnam. For many, drinking and drug use escalated rapidly as they self-medicated with alcohol and drugs to calm Post-Traumatic Stress Disorder (PTSD)-related arousal, increased rapidly when they came home and became a chronic and unremitting addiction.

As the wars in Iraq and Afghanistan wind down, we cannot allow this to happen again. The warning signals are loud and clear. Homelessness in recently discharged veterans is starting to rise. Some communities have established special Veterans Courts to deal with sharp increases in drug, alcohol and violence-related charges involving new veterans. More than 2.5 million men and women were deployed to Iraq and Afghanistan. More than 400,000 were deployed three or more times. About 25 percent of the men and women returning from combat in these areas have reported unhealthy use of alcohol, including regular heavy drinking after they got home. Soldiers, especially those in the Reserves and National Guard, have reported significant increases in drinking after they returned compared to their drinking patterns before they were deployed. Misuse of prescription pain medication has more than tripled among active duty military in recent years. As was true in Vietnam, the onset of heavy drinking and drug use has been closely associated with direct exposure to violence.

We can do better this time for a number of reasons. New evidence-based behavioral and medication-assisted treatments and recovery approaches for addiction and PTSD can help many returnees—if we get them into help, stable housing and jobs. The Veterans’ Health System is significantly better equipped to provide effective addiction, PTSD and mental health treatment and is expanding rapidly. However, many returnees live far from Veterans Administration (VA) facilities so the VA cannot do the entire job. Finally and perhaps most important, the Internet, mobile and social networking revolution has made it possible to reach returnees and engage them wherever they are, whenever they are ready to receive help. We no longer have to wait for the veterans to come to us for help. We can go to them.

I have been privileged to be working with a team at Boston University and the Boston VA that recently completed a successful randomized clinical trial of a web-based, self-administered intervention to help returnees from combat reduce unhealthy drinking and PTSD symptoms. Individuals, recruited through Facebook ads, reduced daily and heavy drinking and experienced a decline in PTSD symptoms compared to the control group. Now, with support from the Bristol Myers Squibb Foundation and the VA, we are moving as fast as we can to make the program freely available to all returnees.

Much more needs to be done. Active duty personnel who develop alcohol or drug problems need to be able to get treatment and recovery support without risking their careers. Addiction is a disease, not a chain of command disciplinary matter. Military treatment programs need to use the full range of evidence-based treatments including medicated-assisted treatment when appropriate. Reserve and National Guard members were heavily deployed in the Iraq and Afghanistan war zones. Their rates of unhealthy drinking with negative consequences have gone up even more than career military. However, they face special hurdles in getting help. Many are still in Reserve or Guard units and thus unable to get help in the VA. But they can’t get help from military treatment programs either because they are not on active duty or live far from military medical facilities. Community-based treatment may also be unavailable or inaccessible. This is clearly not fair. Barriers to treatment and recovery for Reserve and Guard members must be removed.

Access to VA services also needs to be dramatically expanded. In my opinion, the evidence of an association between exposure to violence and subsequent alcohol and drug problems is so strong there should be immediate access to treatment and recovery, rather than an elongated process to determine if and how much of a service-related disability the returnee has or financial screening that may require a veteran to pay substantial co-payments to get VA care. These delays and co-pays are unfair to the veteran, and costly to the government, because the research from the Vietnam era shows that long delays in getting treatment contributed to lifetime disability.

David Rosenbloom, PhD, is founder of Join Together and Professor at Boston University School of Public Health.          

6 Responses to Commentary: We Must Do Better in Helping Veterans with Alcohol and Drug Problems

  1. Susan | November 8, 2013 at 12:55 pm

    I work in the addiction field and have for over 25 years. I recently was hired by a dod agency as a social worker/substance abuse counselor. The agency is too bogged down with documentation demands, antiquated policies and mind-blowing multiple computer infrastructures that do not communicate. I am more a slave to the paperwork and antiquated policies than I am a social worker helping addicted soldiers returning from Iraq and Afghanistan. I believe the entire health care system is broken. However, this dod agency takes the cake. If we want to focus on helping the soldier, we need to be able to actually do what we have been trained to do – intervene, case manage, therapy, etc. and have the time to do it.

    • Vic Glaviano | February 3, 2014 at 7:03 pm

      Susan, first off, thank you for trying and continuing to try and help veterans with drug addiction! I am a veteran of Afghanistan, I spent 23 years in the military and a combat veteran of Afghanistan, I am a drug addict, due to injuries from the military, the military started me on prescription medications and ironically after I retired did nothing to help me stop, they told me you’re no longer in active duty, go to the VA.

      I went to the VA, after a couple appointments and the usual bureaucratic runaround, I finally got an appointment with the substance abuse people, I thought, finally maybe I’ll get some help, Wrong!!! I wanted to do an outpatient program so I could keep working and be a productive member of society. They interviewed me and asked if I had lost my job, tried to commit suicide, or been arrested or incarcerated, I said no, I work everyday been diagnosed with PTSD. unbelievably they told me we don’t have those kind of programs, since the cause of my addiction to pain meds was injury and pain, they wouldn’t treat me for addiction. I was stunned and just depressed, left feeling like I am just stuck in the vicious cycle opiate addiction.

      I want to work, I love my , served my country faithfully and want to be productive, nor do I want a handout or %100 disability, although many would.

      So here I am, in my 40′s,an addict, turned down and pushed away by the same government that put me in this position. I am a college graduate, I work hard and want to do the right thing, I fear that one day I may meet one of the VA requirements aforementioned just to get help, God I hope not! Thank god for my loving wife, I just hope, wish, pray that I and many others get the help we need.

      I’m not trying to whine or beg, just want help, thank you and many others that are not in the military but want to serve they country and help , WE DO HIGHLY APPRECIATE YOUR EFFORTS!

  2. Ken Wolski | November 11, 2013 at 10:44 am

    There is evidence that marijuana helps with PTSD. Indeed, Israel uses Marijuana for Israeli Defense Force (IDF) veterans who suffer from PTSD. Several U.S. states recognize PTSD as legally qualifying for marijuana therapy under their programs. Preliminary research is promising.
    Yet in most of the U.S., no veteran, even one whose PTSD has been resistive to all known treatment, qualifies for marijuana therapy, not even for a clinical trial, which has never been done.

    The FDA approved the protocol from the Multidisciplinary Association for Psychedelic Studies for a clinical trial using combat veterans diagnosed with PTSD which is resistant to conventional therapies. However, the federal government has a monopoly on the only supply of marijuana permitted to be used in medical research. On September 16, 2011, the National Institute of Drug Abuse (NIDA) refused to release the marijuana necessary for this FDA-approved clinical trial to proceed, even though the study was privately funded and would cost taxpayers nothing.
    At a minimum, we must at least allow controlled studies of marijuana therapy for PTSD. We owe these veterans no less.

  3. Ken Wolski | November 11, 2013 at 10:42 pm

    “Marijuana saved my life,” Whiter says. “And when I say that, I’m not exaggerating at all. Those medications would have killed me if I hadn’t taken my own life first. The medications that the VA prescribes are killing veterans.”

  4. David Quickel | November 12, 2013 at 8:56 am

    What is being done for the service members who have less than an honorable discharge?

  5. Jennifer Foster | December 29, 2013 at 1:26 am

    Our veterans should receive the best psychological and medical care available for their service to our country. So many of them have such a hard time fitting back into society after serving in war zones, it’s absolutely heartbreaking to see them turning to drugs and alcohol and not receiving the help they desperately need and deserve.

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