Addicted Troops Get Silent Treatment - Page 2

By Katie Drummond 09/16/12

They risked their lives for their country. Now, even as conflicts in the Middle East heat up, drug-struggling vets and active-duty soldiers find they can ask little in return.

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Sean and Sharlene Knapp via author

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Because of the military’s enormous problem with substance abuse, some soldiers and veterans are referred to one of more than 1,000 civilian treatment facilities whose services are covered by TRICARE, the Pentagon’s healthcare program. But services at those facilities are so poorly supervised and audited by military officials—little more than a few pieces of paperwork are necessary to receive federal approval—that one independent investigation, by NextGov, maligned the process as less rigorous than “[what] Consumer Reports applies to the testing of toasters.”

“Trouble is, there aren’t very many senior folks in the military who understand, or care about, treatment for alcoholism,” one retired Army officer, who struggled with addiction, told the publication at the time.

Furthermore, most civilian treatment centers don’t even come close to offering the kinds of care that soldiers and veterans need. One pressing issue, according to Singer, is that most veterans would rather seek treatment from someone with military experience.

“We tried to hire individuals who were either veterans or had experience working with them,” she says of Phoenix House, which itself was founded by a former Navy psychiatrist. “In many instances, we find that a veteran feels like a community member, like they can speak freely, when they’re cared for by someone who knows, firsthand, what they’ve seen.”

Civilian rehab centers are also less likely to offer services that treat what’s often a combination of substance abuse and some other mental health problem, like PTSD, wrought from years of grueling combat and brain injuries. In fact, only eight of the civilian facilities used by the Army have the capacity for this kind of integrated treatment, according to Pentagon documents.

Admittedly, the problem of comorbidity is a treatment challenge that still vexes even clinicians working within the military and the VA. In one 2010 survey of over 200 VA clinicians, respondents noted that treating a veteran with combined PTSD and substance-use disorder was, not surprisingly, “more challenging” that treating one of the issues on its own.

PTSD is also notoriously difficult to diagnose, and some experts believe that is both underdiagnosed (for example, many active-duty soldiers hide their symptoms for fear of retribution) and overdiagnosed (for example, some may exaggerate their symptoms in order to be eligible for benefits. Leading PTSD researchers nationwide are hoping to get $50 million in federal funding to launch a long-term, large-scale trial of veterans to look for biological markers for the trauma syndrome in hopes of clarifying the diagnosis.

“In terms of systems issues, [respondents] reported frustration with a lack of integration of PTSD and substance-use disorder treatment within the VA,” the study notes. “As well as policies that sometimes decrease the quality of care.”

“There aren’t many senior folks in the military who care about treatment for alcoholism,” one retired officer says.

The frequency of addiction and PTSD, when coupled with the inadequacy of treatment, have a predictably dire result. Among the 2 million men and women who have served in Iraq and Afghanistan, suicides are rising at an unprecedented rate. In July, 26 active-duty Army soldiers were reported to have taken their own lives, a three-year monthly high. The number of active-duty suicides this year is on schedule to exceed 2011's count of 165. As for the other forces this year, the Air Force has seen 55 suicides; the Navy, 39; and the Marines, 32, according to the Army Times. The numbers are even worse for veterans, who are taking their own lives at the rate of 18 a day.

To their credit, officials with the Pentagon and the VA are taking steps to ameliorate shortcomings in substance abuse treatment—both access and quality. Among them is the Army’s introduction of financial incentives to lure highly qualified counselors, and the Navy’s groundbreaking plans to initiate random alcohol testing in addition to conventional drug screening.

Arguably most notable is an executive order, signed in late August by President Obama. The order will see the VA hire 1,600 additional counselors within a year, and also assembles a task force that will evaluate mental health and substance abuse treatment, and make a series of recommendations to improve both. “As part of our ongoing effort to improve all facets of military mental health, this order [will]...take steps to meet the current and future demand for mental health and substance abuse treatment services,” Obama’s order reads. “For veterans, service members, and their families.”

For Sean Knapp and his family, however, those efforts aren’t kicking in fast enough. After two years of sobriety, Knapp was recently told that his access to a VA counselor would soon be revoked because of a lack of agency resources. Meanwhile, pending battles over budget cuts in Congress and between the presidential candidates do not bode well for the future of VA health services.

“They told us, ‘You can’t stay in counseling forever,'” Knapp, whose wife Sharlene recently published a book, Blind Devotion, in an effort to help other struggling veterans, says. “But one of the biggest reasons I’m doing well is because I see a counselor in the first place."

Now, Knapp will likely rely on weekly AA meetings and appointments with a civilian therapist to sustain a sober lifestyle, though he says he’d rather meet with someone who, like his VA counselor, has a military affiliation.

“The VA is trying to save money, and I understand that, I guess,” Sharlene says. “But they sent someone somewhere, and now that person is broken. It doesn’t seem to matter to them that all of us, the entire family, is still in recovery. They’re done with us, but we’re not done getting better.”

This is the third in a three-part series on the epidemic of addiction among US troops and vets, the crisis in access to VA services and the chronic lack of leadership and resources.

Katie Drummond is a reporter for Forbes magazine, a contributing editor at The Daily, and a freelance writer for outlets including Wired.com, New York magazine and Prevention.

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Katie Drummond is a is the deputy editor of Medium. She has been a reporter for Forbes magazine, a contributing editor at The Daily, and a freelance writer for outlets including Wired.com, New York magazine and Prevention. You can find her on Linkedin and Twitter.

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