Military culture impacts treatment of SUDs in veterans

To effectively treat substance use disorders in the veteran population, clinicians first need to understand the ways in which military culture differs from civilian life, according to Joseph Reis and Craig McLean of Logistics Health Inc. The pair shared insights from their combined 50+ years in behavioral health Friday at the National Conference on Addiction Disorders (NCAD) in Denver.

Reis, director of health services at Logistics Health, noted the increased strain placed on active personnel and veterans of recent military operations. Nearly one-third of the 2.43 million U.S. troops to serve in Operations Enduring Freedom, Iraqi Freedom and New Dawn have been deployed multiple times.

“This is a huge deal. When I got deployed, you knew you were going once,” said Reis, whose 20 years in the military included a tour of duty in Operation Desert Storm. “Now, you have to keep reusing same troops. Oftentimes, they are re-deployed after just six months.”

Citing several studies, Reis and McLean shared some of the effects of those tours on veterans: Nearly 20% of those who served in the aforementioned operations later screened positive for PTSD, and of more than 200,000 active duty and reservists surveyed in a separate study, 13.1% suffered from depression, the second-most common health problem faced after tinnitus.

While illicit drug use among military personnel is relatively low compared to the civilian population (2.3% reported being past-month users vs. 12% of civilians), a larger percentage of military reported being heavy and binge drinkers (8.8% vs. 5.1% of the general population), with 56.7% of Marines reporting they have engaged in binge drinking within the past month. When looking at the increased use of alcohol, however, it is worth noting the military population is younger overall than the civilian population.

Pain reliever prescriptions written by military physicians, meanwhile, quadrupled from 2001 to 2009 to almost 3.8 million. Reis attributed this spike to combat-related injuries and the strains of carrying heavy equipment accumulated during multiple deployments.

For clinicians looking to work with veterans and active military, McLean, a behavioral health specialist who performs pre- and post-deployment mental health reviews with military personnel, said that in addition to understanding the culture in which those patients lived, clinicians must also acknowledge their own feelings about the military.

“You need to recognize your own biases first if you are going to work with these folks,” McLean said. “If you have negative feelings about the military, they will see through you in five minutes.”

McLean also recommended conducting thorough evaluations that include assessments for sleep disturbance and TBI, screenings which might not be immediately applied to civilian patients. Veterans battling sleep disturbance can use alcohol to self-medicate, while TBI can result even from far-off explosions that send out concussive waves.