Veterans: Challenges Back at Home Veterans returning home from combat and military deployment face a number of challenges trying to acclimatize to civilian life. Chief among these challenges is coping with psychological and emotional trauma of battlefield experiences and the toll it takes on their mental health. Far too many of them self-medicate by turning to alcohol or controlled substances, and the human cost is staggering. The problem of addiction is one that plagues veterans, but a number of resources and drug rehab options exists to help men and women in uniform rebuild their lives.
Effects on Families The families of veterans fight a number of battles on their own. They may not see their loved one for months and years at a time, not knowing if their parent, spouse, sibling, or child will make it home. For those who do make it back, the horrors of war are not left on the battlefield. The effects of post-traumatic stress disorder, traumatic brain injuries, and combat-related substance abuse can strike at the heart of even the tightest knit of families. This rehab guide for addicted veterans and their families can answer questions about drug and alcohol treatment and therapy for soldiers and the people who love them.
According to the White House Office of National Drug Control Policy (ONDCP), surveys conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) from 2004 to 2006 found that 7.1 percent of veterans had developed a substance use disorder.1 ONDCP writes that service members deployed to Iraq and Afghanistan face the risk of problems stemming from compulsive abuse of controlled substances.
This is especially true for soldiers who have experienced combat. ONDCP quotes the National Institute of Drug Abuse (NIDA) as saying that alcohol and drug abuse is strongly associated with exposure to scenes of violence in combat that make individual soldiers deeply afraid for their personal safety and wellbeing. One in four veterans of the Iraq and Afghanistan campaigns reported feeling symptoms of a mental health disorder. One in six veterans experienced symptoms of post-traumatic stress disorder (PTSD), such as intrusive thoughts and memories of the traumatic event they witnessed or experienced, feeling constantly tense and alert, and generalized anxiety and depression about their trauma to the point it negatively impacts their daily lives.
Other risk factors for addiction among veterans include insomnia (or other disruptions of regular, normal sleeping patterns), traumatic brain injuries (where the head is impacted so violently that the brain is pushed up against the skull, causing damage to nerve fibers), and problems in relationships.2
ONDCP warns that soldiers may be at risk for suicide as a result of addiction and co-occurring mental health disorders. In 2008, one in eight soldiers reported using illegal drugs or consuming prescription drugs off-label or for non-medical reasons in the previous month.
According to Psychiatric Times, veterans who return home after combat operations have high rates of substance abuse that may co-occur with PTSD, traumatic brain injury, chronic pain, and other trauma exposure. 3
Heavy drinking has long existed in military culture, but recent deployments to Iraq and Afghanistan have seen a spike in reported rates of consumption of controlled substances.4 In 2007, the Journal of the American Medical Association (JAMA) published the results of a longitudinal assessment on mental health problems of 88,235 combat veterans taken immediately on their return from deployment to Iraq and 3-6 months afterwards. The assessment showed that between 12-15 percent of soldiers tested positive for alcohol problems.5
In another JAMA article, a study of veterans who were recently deployed and had experienced combat, showed that 53 percent of these veterans engaged in binge drinking.6
Researchers writing in the journal of Drug and Alcohol Dependence stated that soldiers who were exposed to life-threatening scenarios (where their life or the lives of others was at risk) and “atrocities” were strongly associated with a positive alcohol abuse screening. The researchers surveyed 1,120 soldiers who had been recently deployed. Twenty-five percent tested positive for dangerous levels of alcohol consumption, and 12 percent showed behavioral problems related to their alcohol consumption.7
The issue of witnessing scenes of death, violence, and other acts of war has led to more than three in four veterans reporting post-traumatic stress disorder as a “service-connected ailment,” according to the Wounded Warrior Project, a veterans’ service organization that was founded after the September 11 attacks.8
Despite PTSD’s ability to afflict anyone – soldier or civilian – the condition is still widely regarded as a “soldier’s illness,” since men and women who have experienced combat on the battlefield are more likely to develop it.
This means that even months and years after witnessing or experiencing a traumatic event, a soldier may:
Between 2005 and 2008, the abuse of prescribed painkillers and medication increased at a rate that is double that of the civilian population. Female veterans have an exacerbated problem, since women have a genetically higher response to fear than men; thus, women feel the symptoms of PTSD or similar traumatic disorders to a greater extent. For that reason, women are twice as likely as men to be diagnosed with PTSD, and one in nine women has a positive diagnosis for post-traumatic stress disorder.10
Unsurprisingly, female veterans abuse their prescription medications at a rate that is more than four times that of the civilian population, partially because of their heightened fear response, but also because women face unique challenges in treatment that family members should be aware of. Women have the added dimension of childcare responsibilities that may be a source of stress. Even so, female military veterans commit suicide almost six times more than women who are not in the military. This is largely due to 10 percent of female service members being raped by another soldier. In addition, 13 percent of women in the military are subject to unwanted sexual contact, per the Pentagon.11
The Fix explains that these conditions are ripe for the development of substance abuse. Over time, drugs and alcohol replace normal and healthy methods of dealing with the stress and nerves of post-traumatic stress disorder. While many veterans turn to controlled substances as a way of protecting themselves against the emotional and psychological toll of PTSD, the chemical effect of the drugs on a damaged psyche (one that is primed for addiction) leads to the soldier eventually relying on the substances to simply make it from one day to the next.
Other methods of coping with stress, such as spending time with friends and family, participating in hobbies, and aiming to achieve personal goals are abandoned. The drugs and alcohol go from being the primary method to being the only method of protecting oneself against the emotional numbness and intrinsic fear caused by post-traumatic stress disorder. Of course, substance abuse causes its own problems; and, in the absence of healthy strategies of dealing with those problems, the soldier finds comfort yet again in the abuse of drugs and alcohol.12
In explaining the relationship between PTSD and addiction, TIME magazine writes of a study conducted by the National Drug and Alcohol Research Center at the University of New South Wales in Australia, where more than 66 percent of the 103 participants in the study had addictions to multiple substances and had experienced trauma during childhood. Almost half of the participants reported being sexually abused.13
One of the biggest addiction challenges facing veterans comes from opioids – among them, benzodiazepines, drugs that suppress the central nervous system. Benzodiazepines have been proven very useful to treat anxiety and insomnia, making individuals relaxed and drowsy. This can be useful to veterans who are paralyzed by the fear and helplessness of post-traumatic stress disorder, but benzodiazepines are also known for becoming habit-forming in their own right, especially for people who have mental health conditions that render them prone to addiction.14
This has led to the Department of Veterans Affairs advising medical practitioners against prescribing benzodiazepines like Valium and Xanax due to “growing evidence for the potential risk of harm.”15 The Army Surgeon General warned that treating PTSD with benzodiazepines was not worth the risk, with a clinical assistant professor of pharmacy at the University of Michigan College of Pharmacy saying that benzodiazepines might even increase the severity of post-traumatic stress disorder symptoms. Since there is a danger of withdrawal symptoms with taking benzodiazepines, these symptoms can exacerbate pre-existing PTSD effects and also impede the progress of other methods of PTSD treatment.16
Nonetheless, doctors from the VA still prescribe benzodiazepines like Valium and Xanax to 33 percent of returning soldiers with PTSD, partly due to a “massive prescription drug epidemic” at the VA and the Department of Defense. A psychiatrist and author told the International Business Times that the rise of the pharmaceutical industry influenced healthcare decisions made at the very top of the military complex. Dr. Peter Breggin has testified before Congress about the “over-drugging” of veterans, and he says that the practice of prescribing prescription drugs to combat veterans upon their return from deployment has become rampant. A 2012 investigation by the Austin-American Statesman of drug purchases made by the Department of Defense found that prescription medication expenditures increased from $3 billion in 2002 to $6.8 billion in 2011 – or more than 123 percent, making the military the single biggest purchaser of pharmaceuticals in the United States.17
After the September 11th attacks, the military spent $2.7 billion on just antidepressants. In September 2013, data from the VA showed that the number of patients treated by the organization since 2011 was up 29 percent; opiate prescriptions, however, had increased by 259 percent.18
A doctor in charge of the Opioid Safety Initiative at the VA calls it a “national problem,” saying that even though prescriptions for narcotic painkillers have reached astronomical levels within and outside the military, combat veterans have more pain to deal with than most other people.
Even on the battlefield, soldiers would be “shoved” a bottle of pain medications, then given Adderall to keep them alert when the drowsiness of the opioids started to set in. “No matter what you needed,” writes NPR, “there was a pill.” Soldiers inevitably start to withdraw, and then are prescribed more medications to help them through the withdrawal.
One soldier profiled by NPR (who finished his last deployment with a “chest full of medals” and a Bronze Star) says how he faced being dishonorably discharged from the military for failing urine tests. His marriage ended, he couldn’t find a job, and he lost his house. His parents kicked him out of their home for stealing money to get more drugs. Even after being given an honorable discharge for his 17-year service and three combat deployments, the soldier couldn’t get a job at a local sandwich shop because the manager was worried his PTSD would make him “snap.”19
Notwithstanding efforts by the Department of Defense to curtail the trend of widespread opioid prescriptions to veterans who have a high risk for developing a substance abuse disorder (such as hiring more therapists, increasing training measures, and reviewing cases of multiple prescriptions), there remains an increase in the consumption of opioid prescription medications by veterans. A study published in the journal Pain found that 2 percent of veterans who were given opioid medications for their chronic pain developed an addiction to the painkillers. Furthermore, the researchers believe that a pre-existing psychiatric disorder afflicting the veterans predicted the development of their addiction.20 Another study, this one published in the Journal of Opioid Management, discovered that between 2003 and 2007, rates of opioid use for pain management among veterans between the ages of 18 and 30 had increased.21
Post-traumatic stress disorder (PTSD) tends to grab the headlines when talking about the mental health challenges faced by veterans, but it is not the only threat to soldiers on the battlefield. A 2008 article published in JAMA found that up to 30 percent of veterans returning from deployment in Afghanistan or Iraq suffered a traumatic brain injury (TBI) during their service.22
A traumatic brain injury (TBI) is the result of violent impact to the head, causing the brain to be forced against the inside of the skull, causing nerve fibers to tear.23 Studies have found that 10-20 percent of people who receive a head injury or TBI go on to develop an addiction following their injury.24 The Journal of Neurotrauma explains that the connections in the brain that are responsible for the release of neurotransmitters that manage feelings of pleasure (and the anticipation of
pleasure) are disrupted because of the effect of TBIs, in a way that is strikingly similar to how drugs also disrupt those connections.25
While anybody can suffer a traumatic brain injury – from a professional athlete getting injured in competition to someone falling down a flight of stairs at home – rates of alcoholism or drug abuse among the military population were 2.6 times greater than the general population for mild TBI, and 5.4 times greater for moderate TBI.26 A study published in the New England Journal of Medicine looked at the connection between traumatic brain injury, post-traumatic stress disorder, and chronic pain; it found that among soldiers who had been recently sent to Iraq, those who had TBI were much more likely to develop PTSD than soldiers who did not have a head injury that led to TBI.27
One reason for the alarmingly high suicide rates is combat stress, but another key factor that leads soldiers to potential addiction and suicide is sexual trauma experienced in combat. A psychologist tells CNN that military victims of sexual assault or rape are six times more likely to later attempt suicide than those who were not targeted in those ways.
To that point, the Los Angeles Times writes that female military veterans commit suicide at a rate that is nearly six times the rate of non-military women, as previously mentioned. Even though men are more likely than women to take their own lives, the findings are “staggering” in the words of an epidemiologist and suicide expert at Northeastern University. The Times carried the story of a 24-year-old woman named Katie Lynn Cesena, who reported being raped by a fellow soldier (the Pentagon estimates that 10 percent of female service members have been raped, while 13 percent experienced unwanted sexual contact). Cesena’s experience forced her out of the Navy, and she received treatment for post-traumatic stress disorder at the VA Medical Center in San Diego. She lived in fear of the man she accused of raping her and his friends, according to her mother. The man was never charged with any crimes, and Cesena took her own life in 2011.28
Iraq and Afghanistan Veterans of America is an advocacy group founded in 2004 “to improve the lives of Iraq and Afghanistan veterans and their families.” A survey conducted by the group in 2014 found that over 30 percent of service members thought of committing suicide, while 47 percent of respondents said they knew a veteran of the Iraq or Afghanistan campaigns who attempted suicide.29
A veteran of the Iraq War who started a non-profit group called Stop Soldier Suicide anticipates a “tidal wave of suicides.” Between 2006 and 2013, more than 890,000 people called the Veterans Crisis Line.
The combination of trauma, mental health disorders, and substance abuse exacts a very real toll on veterans. At least 22 soldiers commit suicide every day, amounting to a soldier taking his or her life every 65 minutes. One of them, reported by CNN, was a man named Levi Derby, who killed himself in April 2007. His mother said that Derby was traumatized by watching an Afghan girl die by stepping on a landmine a few feet in front of him. Upon Derby’s return to Illinois, he isolated himself from his family (his mother reported “a vacant stare in her son’s eyes”) and went AWOL after being called up for a tour of Iraq.30
According to News21, veteran suicide rates are twice that of the civilian population: 30 in 100,000 soldiers take their own lives, while only 14 of every 100,000 civilians do the same. From 2005 to 2011, the suicide rate for veterans increased by an average of 2.6 percent every year. Even though veterans account for 10 percent of the population of the United States, one in five suicides across the country is that of a soldier.31
If family members believe that their loved one has a substance abuse problem upon return from deployment, it is vital to encourage the individual to seek help as soon as possible. As difficult as the prospect (and subject) may be, waiting it out to confirm a suspicion, or hoping that the problem will resolve itself, never works. It merely gives time for the addiction to deepen, making life with the addicted loved one more and more difficult, and making treatment that much more of an uphill climb.
For family members of veterans, there are numerous signs that a spouse, parent, sibling, or child is suffering from PTSD, substance abuse problem, or combination thereof.
Veterans suffering from PTSD may experience:
Red flags of a drug or alcohol abuse problem may be:
If family members notice that their loved one is exhibiting these signs, they should move quickly. In the event that initial questions about substance abuse are rebuffed, or a brief period of sobriety is followed by more alcohol or drugs, it may be necessary to stage an intervention, both for the veteran’s sake and for the sake of the family.
An intervention is not simply a case of family members confronting their loved one about addiction. As explained by Mayo Clinic, it is a structured, planned process wherein the people who have been most affected by the substance abuse make clear how the addiction has hurt them and their relationship. A good intervention will also present veterans with a tangible, realistic, and immediate plan to make long-lasting and significant changes in their lives.34
To that effect, the family should have a plan in mind before commencing the intervention. They should have researched, and selected, a rehabilitation and treatment facility that they feel will be the best fit for their loved one and present this at the intervention. To not have chosen such a facility beforehand will sabotage the intervention, as it undermines the gravity of the entire operation. The Independent reports that interventions that are immediately followed by a professional course of substance abuse treatment and mental health therapy enjoy “exceptionally high” recovery rates in excess of 50 percent.35
A doctor or a professional interventionist can guide the family in narrowing down the options for the best location to send their loved one for treatment.
To drive that point home, the presentation of a treatment facility is not an offer; it is an ultimatum. Family members should impress upon their loved one that not accepting the plan of treatment and therapy will have consequences, such as revoking visiting rights and access to children, eviction, dissolution of relationships, and termination of financial support, until things change in a permanent, acceptable way.
Since an intervention is an emotionally difficult process for everyone involved, it should only be facilitated with the assistance and moderation of a professional interventionist. Given the unique dynamics of having a veteran in the family, a professional interventionist with previous experience of military service (or that of a comparable field, like law enforcement) will have the best understanding of how to conduct the intervention in such a way that is not confrontational, belligerent, accusative, or demeaning to the veteran. An intervention conducted with such a tone risks pushing the loved one away from the offer of help, driving the person deeper into addiction. In the words of Psych Central, carrying out an intervention without professional oversight can be dangerous and very counterproductive.36
An intervention conducted from a position of love and support, on the other hand, stands a much better chance of convincing the person struggling with addiction to accept the plan laid out by family members.37
It is also possible that before the situation reaches a point where the services of a professional interventionist are required, family members can control a measure of the damage on their own. Skills, application, and patience in this area are best called on if the loved one’s addiction has not gotten dangerously out of hand. Professional treatment is still required, but there are various ways of helping an addicted veteran such that an intervention might not be required. Like everything else in addiction treatment, the necessity of an intervention should be determined on a case-by-case basis.To best help a loved one, family members should educate themselves as much as possible about post-traumatic stress disorder and substance abuse. They should, to the best of their abilities, try to understand what the addicted veteran is going through, and the degree to which they can be there for their loved one. This may mean openly, and sincerely, talking about feelings and relationships; equally importantly, it may also mean accepting that the family member doesn’t want to talk. It may mean spending more time with the individual (for example, accompanying the person to doctors’ visits, support group meetings, and doing things together like exercising). It may mean facilitating a network of family members and close friends, to always be there for the loved one to ensure that the person never has to face the stressful moments of PTSD alone.38
Encouraging an addicted veteran in the family who is dealing with post-traumatic stress disorder could also mean changing habits and behaviors that present a risk for the person, such as using alcohol or drugs in front of the person, engaging in arguments, or being otherwise insensitive to the individual’s mental health state.
It is important for a family to remember that a person with post-traumatic stress disorder lives in constant fear of losing control, and that whatever happened to the person (on the battlefield, in the case of veterans) could happen again. Providing the individual with an environment of stability and security, and being mindful of what the person has to deal with, can go a long way in minimizing the risk and damage of PTSD and a substance abuse problem, and readying the individual for professional treatment.39
Though the situation can seem bleak, there are numerous initiatives and programs to help veterans avoid addiction (whether as a result of overmedication or trauma). As the Veterans Administration (VA) explores other methods of treatment, such as acupuncture and aqua therapy, state organizations are doing their own homework. Sentinel & Enterprise News of Fitchburg, Massachusetts, writes how Charlie Baker, Governor of Massachusetts, participated in a panel discussion to talk about methods of treatment at the Northeast Veterans Training and Rehabilitation Center. Among the points of discussion:
On the other side of the country, Idaho’s Second Judicial District is using the idea of drug courts to help returning veterans who are dealing with trauma and addiction issues. Soldiers become part of the program when they incur offenses, such as driving under the influence, assault, and possession of a controlled substance. Many of the people who need the program have post-traumatic stress disorder, traumatic brain injuries, or other mental health concerns that stem from their military service, with related drug or alcohol dependence.
One sergeant explains how he developed PTSD as a result of his combat experiences, and showed up in court because of a felony drunk driving charge. “Vet court” was difficult initially, but through the program, he gained a sense of understanding of all the trauma and damage in his life. Crediting the program for helping him live his life without alcohol, the sergeant admitted that he would be in jail “or worse” if not for the intervention.The importance of having specialized courts for veterans is highlighted by a court manager, who explains that returning soldiers have experiences and conditions that are unique and cannot be easily handled by regular civilian or military courts. A key element is that veterans who are connected to vet court programs are put in touch with other soldiers, who know full well the toll and struggle of trauma and medication addictions.
Participation in the program, and the promise of its rewards, requires vets to refrain from consuming any drugs or alcohol, attend counseling sessions and group meetings, give the courts regular reports on their progress, and be part of educational, work, or volunteering services. The courts will also engage in mandatory and random drug and alcohol monitoring and testing.
Veterans’ courts also connect soldiers to other rehabilitation services, mental health resources, and sober living programs, as part of their re-entry into civilian life. Those who complete the program can get the legal charges against them dismissed or reduced, which can help them qualify for job opportunities and give them another chance at a normal, healthy life.41
The Justice for Vets program estimates that almost 30 percent of veterans returning from Afghanistan and Iraq have a mental illness that impedes their transition to civilian life.42 War will always exact a toll that reaches far beyond the battlefield, but even as the men and women in uniform have to fight battles they never signed up for, resources and programs like veterans’ courts are there to help them win some very personal wars.
Veterans can do certain things on their own to help them cope with their PTSD, and to stave off the temptation to drink or use drugs to self-medicate. The Department of Veterans Affairs suggests the following:
Develop a support network by getting in touch with other veterans and survivors of trauma, people who understand what PTSD entails, and people who can help protect against feelings of isolation and loneliness. Knowing that there’s someone out there, who speaks your language and knows your pain, can make all the difference in the world. Building such relationships can also help restore trust with other people (known and unknown alike), which is a key component in the treatment of post-traumatic stress disorder.
Exercise has been long known (and shown) to have significant mental health benefits. The National Council on Alcoholism and Drug Dependence says that yoga, for example, helps people develop a personal focus on balance in their mental and physical health (because, according to the Huffington Post on the same topic, addiction is a disease of lack). Simple breathing and stretching exercises can help bring about a sense of mindfulness to the body, shutting out external factors that may be a source of stress or the catalyst for an episode of substance abuse.43, 44
Specialized, trained dogs are known as therapy dogs for a reason. They elicit (and reciprocate) feelings of love and companionship; they respond with unquestioning loyalty to instructions; they do not require the same level of attention as dogs kept as pets; and they provide a good way for veterans to get some exercise, interact with the outside world, and meet other people. Encouraging the veteran in your life to invest in positive and healthy interests is key for any treatment of PTSD, and a therapy dog can facilitate that investment in a life-changing way.45
To support military families, the Department of Health and Human Services (HHS) has compiled a list of resources for veterans and the people who take care of them. The programs listed deal with job-finding websites that are specifically geared for soldiers, such as Special Hiring Authorities for Veterans and Veteran Employment Program Offices.46
Other services include a website to locate federally qualified health centers that provide behavioral health care services and substance abuse programs to veterans, “regardless of their insurance status or their ability to pay.”
Focusing on addiction issues, HHS provides links to the Veteran Crisis Line and Women Veterans and Mental Health, as well as help for service members, veterans, and their families.
Research has suggested that for veterans who have families (especially female veterans), treatment is more effective when they and their loved ones can participate in sessions and therapeutic exercises together. Therapists who are trained in marriage and family counseling will emphasize the importance of when and how to bring up the topics of stress and substance abuse in a military family burdened by the presence of PTSD and drugs. This will be done in a way that ensures each person’s voice is heard, and each person’s emotions and mental states are taken into account.47
It sounds nice in theory, but there are solid results behind the effectiveness of making family members part of their loved one’s therapy. The first three months following discharge from a treatment facility can be the hardest for a newly sober veteran, so much so that those 90 days are when there is the highest chance of a relapse.48
Having a compassionate, enlightened, and informed family unit to return to can constitute a solid support network. This can help ensure that the first three months of abstinence are lived out in accountability, encouragement, and love.