A War on Home Soil for Veterans
A War on Home Soil for Veterans
This article will discuss how veteran substance abuse hurts our troops when they return home. And we will discuss the way that we can help them overcome their substance use disorders.
At the height of his career and after 22 years of service, Teddy Lanier was at an optimal point in his professional life. Lanier had a long career in the Army Special Forces. Those with an outside perspective would see a decorated soldier and role model for young men and women looking for a career in military service.1
Perspective is only reality to those at a distant vantage point. Lanier was experiencing a different war, one within himself. Many of his friends and colleagues were unaware of the pain and struggle that accompanied his personal life. It wasn’t until he experienced difficulty performing a simple task while working in his civilian career that he made a choice for change. Lanier sat down with those he worked for and admitted he is a veteran living with substance abuse.1
Lanier’s story isn’t much different than the 1.1 million veterans struggling with substance abuse disorders. In Lanier’s case, he was struggling with addiction to pain pills and alcohol. The addiction to pain pills started with a prescription following a simple dental surgery. This type of prescribing process is similar for military personnel and often begins with an opioid medication following an injury during deployments.
Of the 1.1 million veterans living with a substance disorder, 25% have struggled with illicit drugs, while 80% struggled with alcohol abuse. About 7% of the 1.1 million veterans struggle with both. Veterans aren’t the only military population impacted by substance abuse, active military members are as well.
Before diving into the detail of veteran substance abuse, let’s look at active military substance use disorders. We’ll look at addiction in active military personnel because a high number of veteran substance abuse cases began during active duty.
In the active-duty military substance abuse occurs, but with different dynamics. The actual numbers of military members living with a substance use disorder could be more than reported. Currently, reports indicate that 5.4% of all military personnel are heavy drinkers while 1% across all branches are currently abusing illicit drugs. Approximately 4% of active-duty service members reported misusing one or more prescription drug types.2
Unfortunately, abusing substances in an active duty environment comes with consequences. If a soldier admits to substance abuse and enters rehab, it may limit his deployment availability and work options. Also, asking for this type of help goes against the warrior ethos. Both of these examples put pressure on the service member and could result in the service member’s avoiding much-needed help for a substance use or mental/emotional problem.3
In typical work settings in civilian life, seeking help is a private decision; while in the military, leadership determines the timeline, how to evaluate the service member and when they can return to duty. With these situations in mind, it’s hard to land on a clear number of active-duty members abusing substances.
What is clear is the historical problem of veteran and military alcohol abuse, illicit drugs, and tobacco use. Heavy drinking has been an accepted practice for a long time and is synonymous with the military work culture.
Drinking has been used for recreation as well as to reward members’ hard work. Aside from those instances, drinking is used to ease relationship tensions, but also to promote camaraderie. The encouragement of these activities is perceived as innocent but can play into substance abuse patterns.
Illicit drugs like cocaine, heroin, marijuana, and misuse of prescription drugs have been tracked to the best of the military’s ability. An increased misuse of prescription drugs seems tied to pain reduction, lessening fatigue, and coping with battle. The modern origins of veteran substance abuse stemmed from the Vietnam War in the late 1960s and ’70s. Heroin and opium were widely used in Vietnam to combat boredom and the panic that accompanies battle.4
In today’s wars, easy access to illicit drugs is no different. An Army soldier deployed in Afghanistan found access to these drugs rather simple. The locals knew military substance abuse was common and they would bring the drugs inside the base or sell to soldiers outside of the base. Drugs like Xanax and Percocet were readily available and easy to find.
Misuse of prescription drugs has become a national issue in civilian and military life. The increase in prescriptions to alleviate chronic pain among service members who have been injured in wars throughout the 2000s has come to the attention of military leaders. Soldiers that receive prescription drugs legitimately for service injuries have three times the risk of misusing prescription pain relievers compared to those who did not have a prescription.5
Deployments remain a risky environment for our military service members. From the days of the Vietnam War, illegal drug use during deployments was common. When active duty veterans had experienced high rates of use of marijuana, narcotics, heroin, and opium to today when service members find ways to cope with the trauma of living in such a stressful environment. Following serious injuries, military members seek pharmacological intervention for their injury-related pain and more serious injury can lead to prescription drug abuse in the military.
An Army soldier deployed to Afghanistan during Operation Enduring Freedom described his experience with prescription drug use during deployment. In his experience, military doctors developed a type of care plan which included extended doses of Vicodin, OxyContin, and Tramadol. This combined with alcohol use increased the risk of overdose. Service members could easily get prescription pain drugs while deployed. Dosage quantities could be as much as 460 opioid pills at a time. Opioid dependence can happen after just five days of taking prescribed opioids, so the risk of addiction is high.
Over the years the Department of Defense has developed varying policies on how to handle substance abuse within the service. The military’s history with veteran substance abuse is often exacerbated by deployment and combat environments.
Policy directives mostly began in the Vietnam era. Currently, policy discourages substance use, but zero-tolerance policies may discourage military members from seeking treatment for drug abuse. Zero-tolerance policies can create an environment of fear. Instead of encouraging soldiers to get help for substance use disorders, it encourages drug use to go untreated.
Active duty military members can find themselves developing an addiction to drugs as they start their social reintegration when returning from a deployment. Fitting back into civilian life can be difficult due to the vast changes in their work and personal environments, making drug use more likely.
Treatment options are available for active-duty military. The programs are dependent on the military branch and deployment status. Drug and alcohol treatment centers are located throughout the United States and range from private, government-funded, and those covered by military insurances. Military members are encouraged to know the options available to seek treatment and get help.
Returning home with a substance use disorder can cause incidents of domestic violence, homelessness, incarceration, and suicide.6
Adjusting back into American life away from a deployed environment gives veterans many challenges. Service members describe the problem of military alcohol abuse after returning from deployment, following them into their civilian career. Military members describe managing their pain and psychological struggles through alcohol and other substances. Using a range of substances is a way of coping with the experiences of military life.
Veteran alcohol abuse has been associated with interpersonal violence and, more specifically, domestic violence. Data shows a high likelihood of violence when heavy drinking is involved.
Social reintegration can be a struggle when moving back into civilian life from a deployed environment. Some veterans will turn to drugs to deal with these struggles. Like civilians, veterans with substance use disorders have an increased risk of homelessness and incarcerations.
More prevention measures need to take place to prevent substance use issues from turning into life-threatening ones. Findings show the need for more suicide prevention efforts among veterans and active-duty personnel alike. Veterans who are living with substance use disorders are more than twice as likely to die by suicide than their colleagues. Women tend to have an even higher rate of suicide when accompanied with a substance use disorder.7 The highest suicide risks are among those who are misusing prescription sedative medicines, commonly prescribed for surgeries or pain management.
Despite efforts by Veterans Affairs and other agencies over the past 20 years, rates of substance use disorders in veterans continue to rise. Veteran substance abuse impacts interpersonal and professional relationships and increases rates of suicidal thoughts and attempts. Let’s discuss why efforts have failed to curb veteran substance abuse.
Veterans experience higher rates of chronic pain, traumatic brain injuries, sleep disorders, and post-traumatic stress disorders. The intense environment veterans are exposed to in deployed environments and the difficulty in their social reintegration show us why our nation’s veterans are at risk of developing substance use disorders. Veteran substance abuse often stems from injuries and conditions the veteran received during active-duty. The easy access to pain pills to keep soldiers on-duty contributes to substance use disorders at home.8
PTSD and suicide are serious health concerns among service members and veterans. The link between PTSD symptoms and suicidal thoughts and behavior is well documented in the military. Suicide is currently the leading cause of death among active-duty military personnel. PTSD symptoms can erode the quality of social support for veterans.
An Army veteran who served in Operation Iraqi Freedom explained the mental and emotional health challenges that lead to alcoholism while in the service. When alcoholism is combined with PTSD symptoms from seeing traumatic events a service member has a high probability of not being able to perform his duty properly. They may use substances as a way to make it through difficult times.
Sometimes their support network diminishes as those in a veteran’s social network view them as unreliable, leaving the veteran at risk. Veterans with overdoses were more likely to have a history of psychiatric illness with a majority of the overdoses being intentional and most of the overdoses were from medications prescribed to them.
Substance abuse and mental health disorders are a concern in the military and not only affect the professional lives of our service members but also their personal lives. Treatment is crucial to the support of our veterans looking to improve their lives. VA resources are available with various treatments for veterans across the United States.
The VA is the largest health system in the nation and provides mental health treatment for more than 1.1 million patients with mental illness or substance use disorders. There are various care regimens and levels of care for veteran substance abuse. Levels of care include screenings, outpatient counseling, intensive counseling, residential care, detoxification, relapse prevention, and managed care. Following treatments for veteran substance abuse, self-help groups are available. Many private and state funded programs can also meet the needs of veterans. Veterans can access care from VA facilities. If VA resources aren’t available veterans can get approved to receive outpatient services within their communities. Veterans can access support through the Substance Abuse and Mental Health Services Administration.
Therapies for veteran substance use disorders can include medical detox which is often considered the first step in the recovery process. Inpatient rehab programs are available in hospitals, residential treatment facilities, or as stand-alone programs. Detox and rehab facilities remove barriers that trigger veterans living with substance abuse. Programs can include medical care, medications, and support groups like 12-step meetings. Other treatment options include outpatient and inpatient care.
Medication-assisted treatment programs are becoming more widely used due to the recent funding influx from federal and state governments. Medication-assisted treatment uses medication along with counseling services to treat substance abuse.
Medication-assisted treatment or MAT programs are approved by the FDA. Research shows they can successfully treat substance use disorders. MAT is primarily used in the treatment of opioid use disorders like heroin and prescription painkiller misuse.9 Other MAT programs focus on alcohol misuse using a similar process but with different medications. When a MAT program is combined with therapies, research shows these programs are clinically effective.
Numerous resources are available for veterans and active duty service members struggling with issues associated with their time in the service. From transitional programs to suicide prevention resources.
Each branch of service has its own transitional programs to assist veterans in their path back to civilian life.
States and communities all over the United States have programs that help veterans acclimate back into civilian life like Military OneSource, programs led by the VA, and the Department of Labor.
States and counties across the United States have programs for veterans living in homelessness. There is a VA Resource for homeless veterans and homeless projects like Wounded Warrior Homes. Many communities offer solutions for the nation’s veterans that are living in homelessness in their cities.