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SAMHSA News - January/February 2008, Volume 16, Number 1


Veterans & Their Families: A SAMHSA Priority (Part 1)

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.

SAMHSA’s Role

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 families.

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. Power says.

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 a week.”

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Military Culture

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 same.

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, and worse.”

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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