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Soldiers, PTSD, and Addiction (part one)

For over nine years we have produced a staggering number of combat veterans. We continue to fail in supporting successful transitions in coming home and in advancing their careers (civilian or military). The failure of our government to acknowledge, diagnose, and treat Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) is well documented. What is less prominent in our societal awareness is the high degree of drug and alcohol abuse and addiction amongst deployed and returning veterans.

The National Institute on Drug Abuse (NIDA) reported a slew of disturbing research findings in 2011. Rates of alcohol and opiate abuse amongst active and recently returning vets have skyrocketed. Specifically, the abuse of opiate prescription medicines reportedly increased over 600% between 2002 and 2008. Typically we expect that such numbers, though staggering, are underreported as they tend to be based on self reports.

In the June 13th addition of the BDN, Jackie Farwell reports that the Veterans Administration (VA) is adding six mental health professionals for the care of vets in Maine. This is a drop in the proverbial bucket. While it is a positive step, it does nothing for those north of Augusta and it does little to address the increasing problem of substance abuse and addiction amongst vets in Maine.

What we most need to do in supporting military personnel who live with mental illness and/or addictions lies in the hands of the military and federal government and as such is unlikely to occur. Military personnel face a number of potential losses if they seek treatment for PTSD or any type of substance abuse. They are likely to lose security clearances and the possibility of further promotions even after successfully completing treatment. These enormous disincentives must be removed.

Here in Maine, what we really need is an integrated model that combines the efforts of the VA with community based health care providers – especially in mental health and substance abuse. The existing system fails to even advise vets of what their options are and who they might seek services from. Never have I felt more naive than when talking with folks at Togus about how my staff and I could support local military and their families. It was explained to me that if these folks sought me out and if I completed a barrage of forms correctly, then treatment MIGHT be approved on a case by case basis but there would be frequent reviews to ensure treatment was still needed. Holy crap. Managed care is evil and even they don’t require that much of us.

It saddens me to be a member in good standing of the national organization, “Give An Hour.” We are clinicians who DONATE time to military personnel and their families who are not able to afford treatment. The fact that such a need exists is deplorable.

The longer I live and work as a clinician, the more I hate politics. I see the need for public policy changes and I see the importance of advocacy, but moreover what I see is human suffering that is perpetuated by societal, institutional, and personal denial. We seem to have learned nothing from past wars in terms of how to care for soldiers in need.

I have known many exceptional men and women who transformed in the course of military service. They gained respect, knowledge, skills, and ability. They also became part of a culture that necessarily embraces black and white thinking, demands stoicism, and abhors weakness. The use of alcohol is not only normative in military culture, it is celebrated and all but demanded of those who serve. It becomes a coping skill for many and the numbness alcohol provides often becomes a welcomed respite for those who find it impossible to forget, relax, or adjust. For many who have survived traumatic events, feeling numb is as good as it gets. If you find it difficult to understand why so many vets turn to drugs and alcohol , consider that living with PTSD is similar in many respects to the experience of what it’s like to be in a combat situation:

You know intellectually that you are home but nothing feels right. You’re hyper vigilant – aware of every sound around you. Every sense you have is tingling. You are acutely aware of your environment and subconsciously you are constantly scanning for threats to your well being. You’re physically prepared for any possibility. You have not slept well in forever. Adrenaline courses through your veins at random intervals though you have no use for it. Your G.I. system is a wreck. Your brain goes 100 mph. Your short term memory is gone. You find it difficult to process even simple information. You’re beyond frustrated. Everything seems like a huge effort and your moods swing wildly from one extreme to the other. What you feel most is anxious, ashamed, and angry but you’re a good soldier and you hold it all in.

Regardless of what we do abroad we owe far more to those who serve/ed.

I will offer more on this topic in a follow up blog. Please email me with questions, concerns, and contributions.

“Signs read “Support the troops bring em’ home!” “No more innocent victims!” but when a homeless veteran asks for spare change you’re too busy protesting to even listen And I’m no different I live in conflict and contradiction” – Eyedeas and Abilities “Smile”

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