If I stated that I was suffering from a serious and debilitating disease, such as cancer, and that I was going to cure that disease with only will power and positive thinking, most people would look at me like I was crazy — and rightfully so. According to the American Cancer Society, “there’s no good evidence to support the idea that these interventions [such as positive thinking] can reduce the risk of cancer, keep cancer from coming back, or help the person with cancer live longer.”
Nonetheless, this is exactly how we, as a society, approach issues related to mental health and substance use disorder, two conditions that often co-exist. We often label these conditions as personal weaknesses rather than diseases. And, nowhere is the harm from such misnomers more pronounced than in the military and veteran’s communities.
According to a new study released by American Addiction Centers, “alcohol abuse and binge drinking are higher among vets who identify as depressed compared to those don’t. In many cases, addiction can become a coping mechanism for trauma and depression.” The study continues, “only half of returning service members who need treatment for their mental health actually seek care, and substance abuse continues to mark a growing concern among both enlisted and retired members of the armed forces.”
So, how do we help veterans who are suffering with substance use or mental health disorders?
First, we must address the social stigma attached to asking for help, particularly as it relates to military culture.
“I thought the definition of a man was to beat my chest and say, ‘I got this,’” states Tommy Rieman, an Iraq War veteran and Silver Star recipient who struggled with both depression and substance abuse after separating from service. Rieman, who now works for the Charlotte-based organization, Veterans Bridge Home, a non-profit that seeks to assist veterans transition to civilian life, reflected on his personal challenges overcoming military culture, adding, “if you want to look at yourself in the mirror and be happy, you have to learn how to ask for help.”
Although significant progress has been made since the Vietnam era in acknowledging and treating mental health and substance use disorders, American society as a whole continues to struggle with the stigma around mental health.
As elaborated on in a 2011 Government Accountability Office Report about VA Mental Health services, veterans often experience “[p]erceptions that as a result of accessing mental health care they will be viewed negatively by others such as peers or employers. For example, veterans may feel that by accessing mental health care they will be perceived as weak or having lost control.”
Unfortunately, little progress has been made since the issuance of this report eight years ago. Feelings of fear of being perceived as weak continue to be enhanced by a culture that centers around rewarding bravery and heroism. “For military veterans . . . there’s a sense that addiction equals weakness, failure or a lack of morals, and for years, it’s been ‘treated’ with punishment,” adds Dr. Paul Little, an Air Force veteran who once struggled with opioid addiction.
Second, we must also realize that substance abuse and mental health issues are diseases, just like more tangible conditions such as cancer or heart disease, and that these diseases are often intertwined with more complex physical and neurological conditions, as opposed to personality defects such as weakness.
For example, in the case of many veterans, one of the most common causes of substance abuse is one of the least discussed — traumatic brain injury (TBI).
“Many professionals overlook the fact that addiction and mental health disorders stem from TBI,” states Dr. Chrisanne Gordon, a physician who specializes in physical medicine and rehabilitation, and Chairwoman of the Resurrecting Lives Foundation, a non-profit that assists veterans, “with TBI, the neural pathways are disrupted so the thought process becomes chaotic. The injured person tries to normalize the brain by either putting it to sleep with alcohol or opiates, or awakening it with stimulants such as caffeine or amphetamines.”
Nonetheless, at VA and elsewhere, a greater emphasis is often placed on treating PTSD or mental health alone, rather than treating the underlying cause such as TBI. Although TBI can be difficult to diagnose, doing so early in a veterans’ treatment can alleviate mental health issues such as depression and substance abuse that complicate long-term rehabilitation.
Finally, if we want more veterans who are suffering, including from mental health and substance use disorders, to access care, we must make it easier for them to do so. According to a recent study by the National Academies of Sciences, Engineering and Medicine, many veterans who were eligible for VA health care were unaware of that fact, did not know how to get services, or found the VA’s appointment system “burdensome” and “unsatisfying.”
Next week, on June 6th, the VA is set to unveil its new community care access standards, which will hopefully help with alleviating this concern. According to the agency, it is ready to implement its new access standards on time and without major mishaps.
Only time will tell if the MISSION Act implementation will truly assist veterans with access to care. However, in the interim, we can continue to help veterans by erasing stigma around mental health and substance use disorders, by treating them as we would any other condition that requires medical treatment.
Rory E. Riley-Topping served as a litigation staff attorney for the National Veterans Legal Services Program (NVLSP), where she represented veterans and their survivors before the U.S. Court of Appeals for Veterans Claims. She also served as the staff director and counsel for the House Committee on Veterans’ Affairs, Subcommittee on Disability Assistance and Memorial Affairs for former Chairman Jeff Miller (R-Fla.). You can find her on Twitter: @RileyTopping.