Veterans & Their Families: A SAMHSA Priority (Part
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 life.
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 abuse.
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 than males.
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.
One 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 their
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.
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
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 a week.”
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 the
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
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, and
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 with them.”
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.”
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