Stress disorders, drug abuse, little help for troops

MichaelMoore.com


Latest News

http://www.michaelmoore.com/words/latestnews/index.php?id=8475
November 26th, 2006 6:57 pm
Stress disorders, drug abuse, little help for troops


As repeat tours of Iraq wear on U.S. forces, government struggles to
provide mental health care; many say they take refuge in drugs.

By Anne Usher / Austin American-Statesman

WASHINGTON Military personnel on multiple and extended tours of
duty in Iraq and Afghanistan are being diagnosed with post-traumatic
stress disorder at rates that probably will match or exceed the rate
among Vietnam veterans, government officials and veterans groups say.

The war in Iraq, with often-hidden enemies and explosives, has left
many service members particularly vulnerable to combat stress and is
driving the abuse of drugs and alcohol both in Iraq and at home,
military health experts say.

Yet many veterans and on-duty troops are not getting the treatment
they need.

As of August, more than 184,500 returning veterans had sought care of
all kinds through the Department of Veterans Affairs, and about one
in six of those had been diagnosed with post-traumatic stress
disorder, a rate expected to climb since it can take months and
sometimes years for the condition to manifest itself.

Symptoms include anxiety, sleeplessness, flashbacks and extreme
wariness, a recipe that can strain relationships and make it hard for
those suffering to get or keep jobs.

Jesus Bocanegra, a 24-year-old former Army sergeant with an infantry
company based at Fort Hood, says he is haunted by countless shots he
fired at Iraqis while serving as a scout in Tikrit in 2003-04.

The McAllen native says he lost track of how many civilians died in
the crossfire when he squeezed off rounds at Iraqi insurgents.

"How the hell was I capable of that?" he says now.

Back home and plagued with anxiety attacks, he said he tried to close
himself off from the world by drinking to the point of passing out.
He said he progressed to marijuana use and then cocaine.

"The only way to sustain yourself day to day is to keep yourself
drugged up," he said. But "it made it worse."

Eventually, he said, he stopped taking drugs and visited a VA clinic.
Seven months later, a psychiatrist there diagnosed him with post-
traumatic stress disorder and gave him pills, dispensing medications
in five-minute meetings every three to four months. A clinic employee
verified his diagnosis and said that with 400 to 600 patients a day,
"every doctor is overbooked."

With no VA psychotherapists in his area at the time one has since
been added Bocanegra sought help from a support group called Vets
for Vets.

"It's good to have someone to talk to," he said. "It's the only thing
that keeps me going."

Married for just under a year, he is unemployed but hopes to return
to school.

He said he is focused now on his mental health and on touring with
other veterans to push for improved services for vets, many of whom
he says are also suffering from post-traumatic stress disorder.
Disability benefits of $2,500 a month help keep him afloat.

Up to 29 percent of troops returning from Iraq and Afghanistan will
suffer from post-traumatic stress disorder, predicts Col. Charles
Engel, a clinician at the Walter Reed Army Medical Center. As of
August, the VA had diagnosed 63,767 discharged veterans with a mental
disorder and 34,380 with post-traumatic stress disorder.

Experts say the rate of the disorder among Iraq veterans could well
eclipse the 30 percent lifetime rate found in a 1990 study of Vietnam
veterans because military personnel are being deployed longer and
more often to Iraq and because greater awareness of the disorder
among doctors will lead to more diagnoses.

Some statistics show the cases climbing fast. The number of Iraq and
Afghanistan veterans who have sought help for readjustment concerns
including post-traumatic stress disorder doubled between October 2005
and June 2006, according to a recent survey of 60 VA-run centers by
the Democratic staff of the House Committee on Veterans Affairs.

That increase has made it only more difficult to get quality care,
the survey found.

Among active-duty military personnel who served in Iraq, 35 percent
used military mental health care services in the year after coming
home and 12 percent were diagnosed with a mental health problem, a
study published in March in the Journal of the American Medical
Association found.

Veterans groups fear that the VA won't be able to handle the high
proportion of service members seeking such help once they are
discharged. They note studies showing that though post-traumatic
stress disorder can resolve itself in some people over time, its
symptoms can worsen if not treated quickly.

The Department of Veterans Affairs says it has enough resources to
offer treatment for post-traumatic stress disorder and substance
abuse to all of the roughly 160,000 service members now in Iraq and
Afghanistan once they are home.

Dr. Ira Katz, deputy chief patient care officer for mental health for
the VA, noted that there are 200 veteran readjustment centers
nationwide and that mental health counseling is available over the
Internet.

As part of unprecedented efforts on its part, the military in
September 2005 began giving returning troops a questionnaire aimed at
catching early signs of the disorder. Questions include whether they
have nightmares, are feeling emotionally numb or super alert, or have
physical reactions such as breathing trouble when reminded of a
stressful experience. In January, the military put in place a
secondary screening test to check for similar symptoms.

But nearly four in five returning troops who may have been at risk
for post-traumatic stress disorder were not referred for further
mental health evaluation, according to a study released in May by the
Government Accountability Office, the investigative arm of Congress.
About half of those diagnosed with a mental health problem got care,
but fewer than 10 percent were referred through the military's new
screening program, the JAMA study in March showed.

The Pentagon told the GAO that it generally concurred with the its
recommendations and that a systemic evaluation of referrals is
planned. After the study's publication, however, the Pentagon said it
was flawed because it did not include troops referred to chaplains,
primary care physicians and group counseling. The GAO says the
Defense Department was not able to provide any evidence that those
referrals occurred and still has not provided figures on personnel
who may have since received treatment.

After his first Iraq tour ended in August 2005, former Pfc. Josh
Revak said, a large number of soldiers in his 1st Battalion, 37th
Armor Regiment reported symptoms of post-traumatic stress disorder on
the test, but the commanders "just took it as a joke, and I think
barely anybody received treatment."

The 25-year-old said he asked for help but didn't get psychological
counseling until after a 120 mm mortar landed near him on his second
tour in Iraq in June, sending him back to their base in Germany with
shrapnel through his foot.

By that time, Revak said, several men in his unit had been
disciplined for Valium use.

Medical experts say mental health problems such as post-traumatic
stress disorder and substance abuse are often intertwined.

"When they don't get the kind of mental health screening or
physical history tells us they will turn to coping mechanisms,"
said Steve Robinson, director of government relations for Veterans
for America, a 35,000-member organization.

He says many of the hundreds of troops he has interviewed at post-
deployment sites are addicted to medications given to them in the
field, such as painkillers and sleeping pills. But they are not
getting the therapy that normally goes with such medications,
Robinson said.

Adam Reuter, a 23-year-old former Army specialist, said that after he
was tossed out of a Humvee in an accident in Iraq, a medic handed him
a plastic bag filled with pills and gave him no instructions.

The bag contained four kinds of painkillers, an anti-inflammatory
drug and a muscle relaxant, said Reuter, an Atlanta native who served
with the 3rd Squadron of the 3rd Armored Company from May 2003 until
February 2004. He said he went back for more and developed a
dependency that he is still trying to shake.

Military personnel said they used banned substances as a way to
mentally escape the violence around them. Drugs ranging from
marijuana to prescription anti-depressants are easily accessible in
Iraq, according to interviews with more than a dozen soldiers who
served there.

John Crawford, a 28-year-old former Florida National Guardsman with
the Army's 101st Airborne Division, said soldiers in his unit drank
alcohol, some took steroids, "pretty much everyone took Valium," and
"some did all three."

Crawford said he bought 200 to 300 Valium pills on the street in
Baghdad for $2 as a way to get some sleep between patrols. After
eight months, he built up a tolerance and was taking seven or eight
at a time.

The extent of alcohol and drug abuse among combat veterans is
difficult to quantify. The Pentagon declined to release the results
of announced drug tests specifically for Iraq. The tests are usually
done just once a year.

Army Maj. James Weeden directed a team of 200 specialists dealing
with combat stress in Iraq until he left the country in September.

He says senior officers recognize the strain their troops are under
and in the past year have assigned specialists to address the issue
at remote forward operating bases.

But seeking treatment in a combat environment is difficult. All
travel is risky, and asking for help is seen as a sign of weakness.

Weeden and other medical specialists say that they can treat only the
symptoms of combat stress with anti-depressant drugs and rest,
for example and that troops are sent out of Iraq only when they
have clearly disabling cases of post-traumatic stress disorder.

Commanders want to keep troops in the field, and most service members
say that they don't want to abandon their units.

"We strengthen (combat readiness) because we get them back," Weeden
said.

That desire to keep medicated troops in combat troubles Joyce Raezer,
director of government relations at the National Military Family
Association.

She says U.S. troops some now on their fourth or fifth tour
are bringing "all the baggage from the last deployment into the next."

"The stress is cumulative," she said.

Families are alarmed by military statistics showing that 80 percent
of soldiers who have been flagged with mild symptoms of post-
traumatic stress disorder have been sent back to Iraq and
Afghanistan, many with anti-depressant pills aimed at ensuring they
can still fight. Experts say repeated exposure to combat is the
greatest predictor of whether a person will get post-traumatic stress
disorder and how severe it will be.

When they come home, many seeking treatment say they face steep
hurdles getting help from the government. With a wave of post-
traumatic stress disorder cases arriving, outreach groups fear the VA
will not have adequate resources to treat them and to pay disability
benefits.

The VA is proposing a $339 million increase in mental health care
spending next year, Katz said Tuesday. That would bring total annual
spending on those programs to about $3.2 billion.

Implementation is another question. As of late September, about $42
million of $200 million directed for initiatives to close gaps in VA
mental health care in 2006 had not been spent, the GAO found.

"Requesting more money is a step in the right direction," said Paul
Sullivan, director of programs for Veterans for America, who was a
senior analyst at the VA until he left six months ago.

But he added, "The VA's problems are systemic, and the solutions must
be more comprehensive than simple increases in funding."

He noted the GAO findings that the VA lacked a comprehensive plan to
implement the funding in last year's budget.

About 144,000 of the 589,000 veterans who have served in Iraq and
Afghanistan have already been seen at VA-run Vet Centers for
"readjustment concerns" ranging from depression and marital problems
to full-blown post-traumatic stress disorder.

Forty percent of the 60 centers surveyed in the study by the
Democratic House staff have directed veterans for whom individualized
therapy would be appropriate to group therapy instead.

Dr. Frances Murphy, undersecretary for Health Policy Coordination at
the VA, told a mental health commission in March that the growing
numbers of veterans seeking mental health care has revealed areas in
which improvement is needed.

Some VA clinics, she said, do not provide mental health or substance
abuse care, or if they do, "waiting lists render that care virtually
inaccessible."

"The VA needs more capacity so that vets can get treatment and don't
have to wait," Sullivan said.

If they are able to see a VA doctor, hundreds of veterans with severe
symptoms of post-traumatic stress disorder are being denied
disability benefits because their condition is obscured by drug or
alcohol abuse, which is labeled "willful misconduct," said Elinor
Roberts, legal director for Swords to Plowshares, a San Francisco-
based veterans organization.

The military maintains a zero tolerance policy for drug use on all
but prescription medications.

Some service members have lost their military benefits, regardless of
their combat citations, after they have been found to have used
banned substances.

But many commanders offer leeway in such cases, choosing nonjudicial
punishments such as demotions to keep soldiers on duty, said Army
Col. Bill Buckner, a public affairs officer at Fort Bragg, N.C.

The VA is allowed to give benefits to veterans dealing with alcohol
abuse but not illicit drugs, and only if a clinician finds that the
veteran also has post-traumatic stress disorder. VA officials say
many vets with the condition have trouble making appointments to get
that diagnosis in the first place.

Amy Fairweather, who has counseled about 50 Iraq vets for Swords to
Plowshares, said the impact of repeated deployments "is enormous."

"It contributes to all the elements for substance abuse, mental
illness and family dissolution," she said. "There's only so many
times you can be uprooted from family and work. Not to mention that
they're over there in hell."




Generated on: Monday 27th of November 2006 11:55:41 AM Site Created
by Plank