Veterans Return Home to Face Another Kind of Battle
Alcohol is the most widely abused substance among post-9/11 veterans of the wars in Iraq and Afghanistan, according to several reports reviewed by News21.
The extent of other substance abuse — particularly prescription drugs — is not entirely known. While several reports paint different pictures, the increasing number of active-duty soldiers and veterans who are being prescribed potentially dangerous drugs is a cause for concern for some veteran health professionals.
“The current generation of veterans faces a much more dangerous and wider array of substances that are readily available,” said Andrew Saxon, a psychiatrist at the Department of Veterans Affairs hospital in Seattle, Wash. His specialty is addiction and substance abuse.
A 2010 study by the VA found that 21.8 percent of male and 4.7 percent of female Iraq and Afghanistan veterans abused alcohol. Yet a 2012 study sponsored by the VA and published in the American Journal of Public Health — using the same survey questions — found the rate of alcohol abuse among Iraq and Afghanistan veterans to be 41.4 percent for men and 17.0 percent for women. That study noted “this discrepancy might suggest that the context of the VA clinical setting could lead veterans to underreport their drinking in routine screening, resulting in underestimates of the severity of the problem.”
Changing the way the survey is taken could help, one researcher said.
“In the actual clinic, people might be reluctant to admit to having alcohol problems,” said Sue Eisen, author of the 2012 study and principal investigator at the Bedford VA hospital outside Boston, Mass., “and that was why we might have found a higher rate of alcohol problems. Our survey was much more anonymous.”
Alcohol was the primary substance of abuse for 50.7 percent of veterans ages 21 to 39 seeking treatment in non-VA hospitals. That compares to 34.4 percent of non-veterans, according to a 2012 report by the federal Center for Behavioral Health Statistics and Quality.
Six percent of veterans from Operation Enduring Freedom in Afghanistan and from Operation Iraqi Freedom who enrolled in VA health care reported suffering from alcohol dependence and 5 percent suffer from other drug abuse, according to a 2013 Congressional Research Service report. However, many of them may have avoided reporting alcohol or substance abuse, and about half of Iraq and Afghanistan veterans are not enrolled in VA health care, according to the Congressional Research report.
Similarly, Eisen found in her study that 3 percent of Iraq and Afghanistan veterans suffer from drug abuse, though she noted that her survey had a small, self-selecting sample of veterans.
The military began cracking down on illicit drugs in 1981, when urine tests were mandated for all personnel. Illicit drug use detected by urinalysis among active-duty soldiers hovered around 1 percent between 2007 and 2011, compared to a self-reported rate of nearly 28 percent in 1980, according to a 2011 Department of Defense report. The Pentagon examined only 20 percent of urine samples for opiates such as oxycodone, codeine, morphine and oxymorphone. The Defense Department mandated in 2004 that all drug tests would screen for heroin, because of concerns over deployments in Afghanistan, the largest producer of poppies, the plant that yields heroin. Beginning in 2012, Pentagon screenings tested troops for hydrocodone, a derivative of codeine and the primary ingredient in Vicodin, and other common pain medications.
For one vet, the battle continued at home — with the bottle.
After three days of drinking, Scott Branscum was able to sleep for a few hours. When he awoke, the 35-year-old former Air Force flight medic mistakenly thought someone had broken into his house. He grabbed a loaded shotgun, yelling at his fiance to hide in the garage and call the police. After he cleared every room in the house, his fiance sat him down. Something was wrong.
Branscum had returned in 2008 from deployment in Iraq. Initially happy to be home, his war experiences, however, were setting in. The nightmares proved so unbearable that he turned to drinking.
“I knew it, but I hadn’t realized it. I knew deep down inside that something was going on,” he said. “If you drink enough, you don’t have nightmares.”
While alcohol is used most when veterans self-medicate, the rising use of prescription pain relief in the military and the VA system has prompted calls for change. For example, pain-reliever prescriptions written by military physicians quadrupled to nearly 3.8 million between 2001 and 2009, according to the National Institute on Drug Abuse.
That increase was cause for concern in the military. In 2009, Eric Schoomaker, then-surgeon general of the Army, led a task force comprising all services and the VA to address the issue. The resulting 2010 report found that “pain medications are relatively inexpensive, patients readily accept their use, and they require minimum time expenditure on behalf of the provider and patient,” but that “the possible over-reliance on medications to treat pain has other unintended consequences, however, such as an increase in prescription medication abuse.”
“What we see nationally now is a problem with overuse of opioids and prescription narcotics, (which) is occurring in the military as well,” Schoomaker said in a News21 interview.
Some VA doctors and mental health professionals are concerned about increasingly long-term prescriptions for opioid painkillers, which include Oxycontin and Vicodin.
“That increased use has occurred despite any available empirical data showing their effectiveness in treating chronic pain,” said Ben Morasco, a VA clinical psychologist in Portland, Ore., noting that there have not been any long-term studies of the effects of prescription painkillers.
Yet many veterans who have wounds that might require prescription painkillers might also have psychological wounds, such as post-traumatic stress disorder, which can increase the likelihood of substance abuse. According to the VA, one-fifth of veterans diagnosed with PTSD also have a substance-use disorder.
Injured soldiers “are coming back and they’re being discharged and then resuming services in the community or the VA, and they’ve been taking medications for multiple years. And we don’t really know how safe that is. That needs to be determined,” Morasco said.
Alcohol and substance abuse play a major role in putting soldiers and veterans at risk for suicide. In one study conducted by the Army in 2010, 45 percent of non-fatal suicide attempts from 2005 and 2009 involved alcohol and drugs.
Realizing he had a problem, Branscum sought treatment and was diagnosed as having PTSD. He checked in to the PTSD clinic at the VA hospital in Little Rock, Ark., where he joined other veterans who struggled with similar issues. Though a welcoming environment, Branscum said there was a culture of drug abuse among some patients.
“They were abusing drugs to the point where they were jeopardizing other patients’ progress,” he said, referring to prescription drugs. “It was everywhere. I could have purchased whatever I wanted within 15 minutes of being there.”
Some patients in the clinic continued down that path. Others checked themselves out within days of being there. But Branscum turned his life around.
“It was actually amazing. I credit me being the kind of person I am today from a lot of things I learned there,” he said.
“There’s that mentality of, ‘I don’t need to ask for help with this.’ It’s hard to admit to your family members and loved ones when you actually do need help because they have this picture of you in their mind of this tough guy who can handle anything,” he said.
“When in reality, you’re a human like everyone else.”