Soldiers drink alcohol.
They have for thousands of years -- to celebrate, to forget, to fortify themselves for the next day's battle. In the Iliad, Homer recounted feasts and games flowing with wine and spirits. Indeed, for most young people, whether in or out of uniform, alcohol is a drug of choice. So it should be no surprise that some men and women fighting in Iraq and Afghanistan for the past eight years come home and use alcohol, marijuana, and any other drug that they can get their hands on. What is surprising is what we do about it.
Last month, The American Journal of Psychiatry published an article that could change our minds. The study involved 300 women suffering from both PTSD and drug abuse. The time-honored approach for such a combination of problems has been to treat the alcohol abuse first, and then cope with the trauma. The line of reasoning -- erroneous as it turns out -- was that the emotional turmoil of treating the PTSD would only aggravate the drug and alcohol abuse. Surprisingly, the reverse turned out to be true. Researchers found that, contrary to current practices, intense treatment of PTSD helped to sober up the subjects.
Sounds like common sense, but lots of common sense has been marginalized by academic medicine and the hunt for hard facts. The old approach had a certain kind of logic, but it was the logic of something mechanistic, rather than psychologically nuanced. Extrapolate from these 300 women to literally thousands of soldiers, suffering from PTSD and self-medicating with drugs or alcohol (or both). By adhering rigidly to their ideas about "best medicine," and in fact working in best practices, clinicians may have caused more harm than good.
The soldiers talk straight about their combat experiences and how hard it is to pull themselves together when they come home to their families and friends. At least 25 percent of them report suffering with feeling edgy, nightmares, headaches, pain, guilt and sadness. All the side effects from the hardships of war that often and inevitably lead to the collateral damage of troubled families or divorce.
These men and women will tell you that they drink alcohol -- often too much -- as the cheapest, over-the-counter medication they can find in order to simply live with themselves and their loved ones. Alcohol is a drug they know. It is legal and it has had proven efficacy since high school. Less than half of those who need treatment actually get it because, despite genuine efforts to destigmatize mental health problems, the military reflects society at large when it comes to handling psychological issues. Add to that -- shortages, and shortcomings in the availability of treatment. Often, mental health professionals cannot get hired, or when soldiers do see psychiatrists, they are often just prescribed antidepressants. These medications work sometimes, but many young people find the side effects unacceptable. The medicines cause problems with sexual functioning, sleep, and not feeling "like yourself." What these men and women want is a chance to talk, and time to adjust. And often a stiff drink will make the nights easier and the intrusive thoughts more manageable.
Military medicine conforms to the best practices in civilian and academic health care, and often leads in developing and promoting new treatments. Current practice involves what is referred to as "partitioning" the treatments for psychological problems, substance abuse, and associated medical conditions like blast concussion and pain. What that means is that each practitioner -- the neurologist, the psychologist, the psychiatrist, the addiction counselor -- work in their separate silos. Patients shuttle from therapists to drug counselors to physician specialists who prescribe medicines for multiple problems. Only rarely are the treatments and the patient all brought together under one roof. Only rarely is the whole human being appreciated and understood not as a collection of symptoms and problems, but as a complex individual who has faced unbelievably difficult challenges.
That's the hidden lesson in this study of PTSD and substance abuse. The treatments and the patients do better when there is a team approach and everyone is working together. There are no silver bullets for most neurobehavioral conditions, including substance abuse. These problems don't respond to highly technical interventions like putting stents in coronary blood vessels because we are more than a collection of our diagnoses, more than a list of specialists' problems.
Ironically, we have been through all this before. After Vietnam, thousands of soldiers came back with PTSD, which wasn't even a recognized condition then, and many were abusing all sorts of drugs and alcohol. With the Reagan build-up in the 1980s, we started aggressive and broad programs across all the Services to educate soldiers and leaders, and identify and treat problems with drugs and alcohol. We had almost a dozen residential centers, and numerous intensive outpatient programs. Then along came managed care and the super-specialization of medicine that has brought us to our current state of fragmented treatments. The casualties of those treatments, like the casualties of our wars, often appear in VA hospitals, homeless shelters, and unemployment lines.
The best thing we could do for the thousands of Americans in uniform now, who often return troubled by their experiences, is to apply some common sense to their healing, common sense that has been given medical legitimacy by a randomized controlled study and peer reviewed article in a prestigious professional journal. The message, however, is simple: put a human face to the itemized list of medical conditions and build up lots of multidisciplinary, integrated care programs that get to the heart and soul of where these soldiers live. Soldiers will drink when they return from combat. They are likely to drink even more when they must wrestle with memories and troubling emotions. They will do "dumb stuff and get into trouble." Let's not be judgmental about what happens. Let's not cling to the old orthodoxies of how to provide help. But let's address the underlying trauma first, and then see if other problems don't get resolved more quickly.
For more information, visit www.pbs.org/thisemotionallife
Stephen N. Xenakis, M.D. is a practicing psychiatrist, who retired from the Army as a Brigadier General after 28 years of active service.
Above all else, these soldiers are humans, not just his or her diagnosis. I agree that you have to get to the root of it all, which is often the trauma.
The military culture is a separate distinct sub-culture of human society and it's overall behaviour can be viewed as somewhat insane, of course some services are more disturbed than others with say a high balance of sanity in the navy and a low in special forces of which ever variety.
I'm as patriotic as the next person (my family is 3 generations military, with one buried at Arlington) but at a certain point we're going to have to face the reality, which is, people aren't meant to kill other people, and as long as we keep asking our best and brightest to do it, they're going to come back needed a lot of help.
The question we need to ask ourselves is this - if we're not willing to kill someone ourselves, why are we so willing to have other people do it?
Elements in the world wanted and wars and wars were given to them. Perhaps some folks might care to consider not only other responses but also that military actions, past and present, may very well be the reason for continued attacks upon this country. Perhaps a continuation of foreign policies/military actions may very well be counter to the interests of not only the citizens of this country but others as well.
Clearly, there are select people and organizations that were behind the attacks of 9-11 that needed to be dealt with in an appropriate fashion. Perhaps the response was the reason this country was attacked in the first place. Considering the pile of bodies, perhaps US foreign policy needs to be looked at as closely and with as much concern as individual health care. Perhaps then, US soldiers would not be experiencing the current wars they are confronting not only physically in the flesh but in their minds, and souls.
PTSD, sodliers self medicating, behavior issue are all symptoms of US Foriegn Policy, economic and military. The sooner it is confronted and changed, the sooner the graves can stop being dug for soldiers who have been sacraficed. Otherwise, we are just pissing in the wind.
The author dedicated almost three decades of service to the people of America both by protecting our interests and healing our sick and wounded. He suggests a compassionate, well-reasoned solution to one of the biggest problems facing veterans. I'm not a fan of US foreign policy either, but why make this your soapbox?
The soldiers are caught in the middle, and at some point many of them realize that they are not really defending the folks back home (and nowadays, they are making us less safe) -- and that causes many more problems as they deal with the conflict between what they are ordered to do and what their heart and head tell them not to do.
Yes, it is nice to see some in the military, retired included, take a little different angle on dealing with those damaged from combat and such is a nice change of pace from when soldiers were put to sleep following tours of Vietnam. I have spoken to medics who were involved in such activities in San Diego and watched him cry his eyes out in the process of sharing. Yeah, you might not like foreign policy but unlike you there are those out there who are directly dealing with the impact of policy while you simply do not like it. Health care changes are def. in order but most def. has also served as a distraction from two wars that have continued to churn bodies.
I have tremendous respect for members of the military especially considering the b.s. from REMFs who give orders then retreat for vacation as often as possible.
In a field filled with "professions" with too much knowledge and insufficient experience and "practitioners" with too much experience and insufficient theoretical education, there are deep seas of confusion that damage the millions of drug users who either seek or are forced into the drug-industrial complex of care.
"Are you experienced? Have you ever been experienced? I have. "
Simplistic all-purpose answers to complex problems make things worse. We must begin by listening to one another and respecting one another. All that goes away as soon, as the rubber stamp of diagnosis leaves it's big red stain on a human being.
I don't know what the military has been doing in more recent wars, but definitely soldiers would be better off relaxing with some weed than with alcohol. Of course, someone who decides to stay high from marijuana (or anything else) 24 hours a day will have problems regardless. But as a recreational drug, it should be the drug of choice for troops for very practical reasons. Alcohol is really bad on so many different levels - but it's just more familiar to all generations and so is more acceptable.
Seems that tuff love technique of hammer the crooked nail straight is all the army knows.
Please include Dependents in the “abuse†category. As the oldest son of a career soldier of multiple tours, I can testify to this. It would be less difficult to deal with if Vets only took it out on themselves but family experience PTSD as well.
As well meaning as some civilians are, it is impossible to conceive the look in the eyes of those who have served in combat. Beyond the alcohol and drugs, the abuse of the family from verbal to physical-threats of physical is a reality for Dependents that needs to be included along with alcohol, drugs, themselves. Imagine, if you will, being a Dependent in the home of a combat Vet.
I do not condemn anyone for medicating themselves nor do I condemn those who take their lives as my cousin did following his tour in Vietnam. These wars have gone on so long that they have become part of the “environment†and civilians have become desensitized to them and the term “PTSD.â€
I learned from what I experienced between 65-83, Soldiers drink smoke as they prepare and wait to die and to try to forget the killing and carnage witnessed. Even on this site, things have become way too sanitized and some way too sensitive. Those soldiers who have posted should be saluted, and I do. However, the ones with a bottle and pistol in each hand are the ones that concern and trouble me as do Dependents who are not included.
It is top heavy in interviews from Officer's Dependents for various reasons some of which may be because the woman who wrote is was a Colonel's Daughter. I tracked her down and was actually able to speak with her since she had recently regained the publishing rights.
She sent me a copy and sat down and read it. I affirmed conclusions I had come to on my own. It was interesting to see an entire book devoted to one's first eighteen years of life. I wrote her a response that was not well recieved but oh well. I told her it was top heavy in interviews from Officer's Dependents and seems she did not like that too much. It is however excellent work and pretty much the only book on the subject. Officer's daughters and a male from the enlisted side did not have the same privaleges and issues.
The term "Military Brats" does a disservice to those from that culture. She did not share the view.. If you want a taste of what that side of life is like, it is def. worth reading and most likely, after reading it, one would understand why some of us from that culture find the term "Brats" not only offensive but does not begin the reflect how it is living in such an environment. Enlisted Ranks considered Officer's kids "Brats" however.
www.realherosjourney.com
Medicine does evolve, thank heavens!