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.