Veterans & Their
A SAMHSA Priority
|Former Army Sgt. Abel Moreno (above)
is one of two recent veterans sharing stories of the road
home to civilian life.
By Beryl Lieff Benderly
When Sgt. Dean Nist returned home to rural Somerset,
PA, after Marine Reserve combat service in Iraq that
included the battle of Fallujah, he found dealing with
civilians difficult. “I ordered my wife and kids
around like they were my Marines,” he recalls.
Across the country, in Tucson, AZ, former Army Sgt.
Abel Moreno returned home after combat service in both Iraq and Afghanistan. Initially, he found himself unable
to land a job that paid enough to support his family.
The challenges facing Sgt. Nist and Mr. Moreno, along
with troubling wartime memories and feelings of isolation
from the civilians around them, added up to major stress.
Before long, both veterans were using alcohol heavily
to deal with the pressures of readjustment to civilian
With some 700,000 of their comrades now back in the
United States, similar issues confront active duty military
personnel, returning veterans, and their families and
communities across the Nation.
To help, SAMHSA is making the reintegration needs of
returning veterans a top priority in Agency efforts
to promote mental health and to prevent and treat substance
Combined data from SAMHSA’s 2004 to 2006 National
Survey on Drug Use and Health (NSDUH)
have documented that more than 20
percent of veterans age 18 to 25 suffered serious psychological
distress in the preceding year, with females more vulnerable
According to a NSDUH report, one-quarter of veterans
age 25 and under had suffered from
substance use disorders in the preceding
year, with those from low-income families
especially vulnerable. The two disorders
co-occurred in more than 8 percent
of the veterans age 25 and under,
and those in families earning less
than $20,000 per year again faced
the highest risk. (See “Statistics
on Veterans’ Mental Health”.)
While emphasizing that “the Department of Veterans
Affairs (VA) has the lead on providing services to veterans,
and the Department of Defense (DoD) has military medical
facilities all around the country,” SAMHSA Administrator
Terry L. Cline, Ph.D., sees an important role for SAMHSA
in helping returning veterans and their families.
role is to ensure that mental health
providers in the community are aware
that VA provides ready access to high-quality
mental health services.
In addition to leveraging SAMHSA’s existing resources
and collaborating with DoD and VA, SAMHSA offers a wealth
of knowledge and information about substance abuse and
mental health that can inform the efforts of community
providers attempting to assist returning veterans and
Dr. Cline recently signed a decision memorandum establishing
returning veterans and their families as one of SAMHSA’s
priority populations. As a result, this population will
be included in all relevant announcements of grant availability,
and applicants for SAMHSA grants will be strongly encouraged
to address veterans’ issues.
The decision also makes returning veterans and their
families one of SAMHSA’s Matrix program areas
and assures attention to their needs over time throughout
SAMHSA’s major, ongoing programs.
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Consequences of Trauma
“Anyone who has been in combat experiences trauma,” says
A. Kathryn Power, M.Ed., Director of SAMHSA’s
Center for Mental Health Services (CMHS). Because the
current conflicts lack clear front lines and rear guards,
they are especially problematic, she adds.
In addition to the horrors of war, longer and multiple
deployments, uncertainty of the length of deployments,
and the relentless tension of counterinsurgency warfare
compound the stress.
“Many people can deal with trauma in a very normalizing
way. They can respond and act with resilience,” Ms.
However, post-traumatic stress disorder (PTSD) affects
a substantial number of individuals and can seriously
interfere with a person’s ability to function
on a day-to-day basis.
Sgt. Nist remembers a friend employed in a metal shop. “Every
time they drop a sheet of metal, he just about goes
through the roof,” Sgt. Nist says. “He’s
severely into alcohol and misses 2 or 3 days of work
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With the help of family members and friends, Sgt. Nist
and Mr. Moreno got their lives back in order. Now, they
are committed to helping other returning veterans do
Nist returned home after Marine Reserve
combat service in Iraq. He now serves as
president of his local military family support
very fortunate in our town to have mental
health providers who want to help,” he
Sgt. Nist, now a member of the Pennsylvania National
Guard, serves as president of the Somerset County Military
Family Support Group, a voluntary organization. He also
was instrumental in organizing a local veterans’ center.
Mr. Moreno is a staff member at Vets4Vets, a nonprofit
organization providing peer-to-peer services to Iraq
and Afghanistan veterans.
Each wave of veterans, whether from World War II or
Iraq, forms a special “brotherhood” with
its own language, set of experiences, and feeling of
community, Mr. Moreno says.
Many issues are similar across the generations, but
effective services for veterans require understanding
the particulars of their generation’s experience.
“Veterans need a place to talk about feelings,
to decompress, and also to know that others out there
are feeling the same things,” Mr. Moreno says. “That
keeps people from becoming isolated, self-medicating,
For care providers who lack a military a background,
familiarity with the former service members’ culture,
jargon, and concerns is an important element in building
trust, adds Sgt. Nist.
“We’re very fortunate in our town that
our mental health people here asked us, ‘Will
you teach us how to understand you?’ ” Sgt.
Nist says. “They told me, ‘We are not veterans.
We are not going to pretend to know what you’re
going through. We want to learn from you so we can help
others.’ The first thing they need to do is let
the veterans know they’re willing to help them.
Then, they need to learn the language [and] how to deal
Arne Owens, M.S.S.M., Senior Advisor to the SAMHSA
Administrator, agrees that providers “need to
have some understanding of what the military is about
and how it is organized, to be able to tell the difference
between a sergeant and a sergeant major. Most people
who haven’t been in the military don’t understand
those things. Community care providers don’t need
military expertise or experience,” he adds, but
rather familiarization with military culture. “We
see a role for SAMHSA in helping to build that cultural
competence and familiarization. We’re looking
at ways to educate and share information.”
See Also—Article: Part 2 »
Resources for Veterans »
Short Report »
Administrator's Message »
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