Developing mental health care that works for soldiers and vets

A report by the Institute of Medicine has found that abuse of alcohol and other drugs in the armed forces is rising to the point that it’s a “public health crisis.”

The report calls for more “evidence-based” practices in treating addiction in soldiers and vets.

Drinking has always been part of the military culture. Just look on YouTube and you’ll find thousands of videos of drunken soldiers — falling over, laughing, fighting, dancing, wasted.

Add to this tradition stress from two wars, multiple deployments, and war-time injuries, and you have a poisonous mix, says psychiatrist Charles O’Brien.

“What’s new, and that’s one of the reasons that Congress asked the Institute of Medicine to set up this committee, is that there is a lot of problems with prescription opioids now, but always, the major problem is alcohol,” he said.

O’Brien of the University of Pennsylvania chaired the Institute of Medicine committee that wrote the report about high substance abuse rates in the military.

Addiction apparent among patients at VA hospital

At the Philadelphia VA Medical Center, David Oslin sees the fallout. Oslin heads behavioral health services at the hospital where his staff also deals with an aging population of Vietnam vets with very high rates of addiction.  He admits that treating those with long-term addictions and other mental health disorders is tough.

“Our success rates are not great, so we’re always looking for new and better ways to treat folks,” he said.

A key is to catch the problem early, he says. That means being vigilant about addiction when providing regular health care.

“We make screening a routine part of the process in primary care, just the same as you’d ask somebody about smoking, exercise, weight problems, any of their health issues,” explained Oslin. “So you try to not make it something that stereotypes them and ostracizes them.”

Oslin says when these routine screenings detect that someone is a problem or binge drinker, but not a serious addict, counseling can continue in the same setting, and still be effective.

“We don’t put them into treatment, in the sense of addiction treatment, we provide counseling services in primary care, and actually, a lot of it we do over the telephone with essentially a hotline,” he said.

Oslin says the VA conducts a lot of research in-house, which is an advantage. “It’s making the organization more nimble,” he said. “We can relatively rapidly translate research findings into clinical practice because we’re all part of one system.”

Try as it might, one problem the Veterans Affairs system always faces is that many vets are reluctant to seek mental health care of any kind. Add to that the deep-seated distrust many have of the VA.

Veteran Marine and author Mike Scotti says soldiers tend to trade horror stories about bad treatment at VA hospitals, and are reluctant to confide in staff there. “When it’s something as intimate, as revealing as this darkness that’s boiling inside of you, it’s very easy to just say, ‘I won’t go there because I don’t trust these people,'” Scotti said.

Bringing more veterans in to help

One way the VA is trying to gain veterans’ trust is by hiring more veterans through an initiative to increase the veteran employee rate from 30 to 40 percent.

Emmanuel Estacio, who served 20 years in the reserves, now is a counselor at the Philadelphia VA.

He says when soldiers come into his office and see evidence of his service — pictures of him in uniform, certificates — they feel more comfortable.

“They see that I have at least shared some experiences with them, that we have been in a uniform together at some point,” he said. “Even if they are not in the same branch that I was in, they feel like they can let their guard down a little bit. They can trust that I will not steer them into the wrong direction.”

Taking a look at other approaches

Scotti’s book “The Blue Cascade” chronicles his mental health struggles after serving in Afghanistan and Iraq. He didn’t seek services at a VA hospital — but rather used his military training to address his depression and heavy drinking.

“Taking the initiative, maintaining focus, maintaining discipline, and understanding how discipline can break down, thought discipline, and so I absolutely relied on the training we got as Marines,” he explained.

He says in order for VA mental health and addiction treatments to appeal to vets they should be offered in a more military way.

“I would really have it as a group therapy, and I would have a combination of the physical and the emotional,” he said. “So I would do group runs, where you are getting the cardiovascular, I would have it outside, in the sunshine.”

Oslin says research studies are now under way that look at incorporating exercise into the VA’s treatment arsenal — one more tool in serving a growing and complicated population.