VETERANS HEALTH ALLIANCE OF LONG ISLAND John A. Javis Director of Special Projects

2. VETERANS HEALTH ALLIANCE OF LONG ISLAND John A. Javis Director of Special Projects (MHA Nassau County) PHONE: (516) 489-1120 ext. 1101 E-MAIL: jjavis@mhanc.org Exploratory Committee

3. WELCOME HOME! THANK YOU FOR YOUR SERVICE!

4. PERSONAL BACKGROUND

5. Exploratory Committee

6. PURPOSE OF PRESENTATION • (1) To provide an overview of the military culture in regards to substances (a) Public perception of substance abuse / mental health issues (b) Accurate / Inaccurate media portrayals of alcohol use and the military • (2) To discuss readjustment issues • (3) To discuss addictions and resources

7. WHAT’S THE FIRST THOUGHT OR IMAGE THAT COMES INTO YOUR MIND WHEN YOU THINK ABOUT MENTAL HEALTH OR SUBSTANCE ABUSE ISSUES? (IN GENERAL)

8. If this briefing does not apply to you at the present time – You may be able to use this information to help a buddy, or a soldier you are responsible for.

9. COMMUNTY RESPONSE TO RETURNING VETERANS • First reports of unusually high levels of PTSD began hitting the media in mid-late 2006. • Media publicity surrounding the Walter Reed and VA scandals in the Winter of 2007 resulted in a flood of reporting and studies.

10. INTRODUCTION OF THE ALLIANCE • The Veterans Health Alliance is a collaborative effort of over 70 mental health and substance abuse providers, county and state mental health and substance abuse oversight bodies, the VA, VET Centers, county Veterans Service Agencies, veterans organizations, elected officials and other stakeholders.

11. MISSION OF THE ALLIANCE: • “To promote the health and well-being of Veterans and their Families through advocacy, and a broad array of services”

12. VISION OF THE ALLIANCE: • “YOU SERVED YOUR COUNTRY, NOW LET YOUR COMMUNITY SUPPORT YOU”

13. New York is home to over 1,000,000 veterans and has the 4th largest number of veterans in the U.S. • The Long Island area is 2nd only to San Diego in the percentage of veterans among its citizens. (Suffolk is #1 in terms of numbers of veterans.) • Over 18,000 New Yorkers have returned home from service on OEF / OIF

14. HAVE YOU SEEN YOUR COUNTY VETERANS SERVICE AGENCY? • HAVE YOU REGISTERED WITH THE VA? • NEW YORK STATE DIVISION OF VETERANS AFFAIRS (http://veterans.state.ny.us)

15. BASIC PRINCIPLES: • “It is normal for one to have ‘trouble’ after the experience of combat. It would be abnormal not to have trouble.” Colonel George Patrin (SAMHSA Conference August 2008)

16. But Not Everyone Will Require Services • Of OEF / OIF Veterans seeking help from the VA: * 38% were diagnosed with a mental health condition * 17% had substance abuse issues * 11% had a Traumatic Brain Injury

17. RECOVERY FROM COMBAT RELATED TRAUMA AND SUBSTANCE ABUSE ISSUES IS POSSIBLE.

18. SUBSTANCES AND THE MILITARY CULTURE • WORLD WAR II (Crash of Ruin, Peter Schrijvers) • In Europe water shortages formed the perfect excuse for GI’s to justify drinking alcohol • A soldier in Germany in 1945 wrote home to tell his parents he couldn’t access good drinking water, so he says he, “Wet my whistle with wine and champagne”. (p. 166)

19. WORLD WAR II (Continued) • Cartoonist Bill Mauldin remarked, “Drinking was a big thing in a dogfaces life”. (p. 166) • Surgeons of the 326 Airborne Medical Company during the invasion of Normandy carried with them 92 quarts of whiskey. (p. 166) • During the siege of Bastogne, General McAuliffe said to give the wounded, “Booze for comfort”. (p.166)

20. WORLD WAR II (Continued) • At that time, Europe was more liberal with alcohol consumption than the U.S. • “It was indeed quite a sensation for GI’s who were attached to British Troops in North Africa to line up for the rum rations in the morning”. (p.167)

21. Character of CPT. Lewis Nixon Pending divorce at home + Guilt for not having fired his weapon in combat drove his alcohol habit.

22. KOREAN WAR • Korean War, Paul Edwards • Cigarettes were provided in C Rations. • Army Manuals urged leaders to encourage the soldiers to smoke. • “When unavailable, it lead to whole platoons of men going through withdrawal”. (p.155)

23. Continued • “Beer was provided rather routinely for the enlisted men, along with candy and cigarettes”. (p.155) • Issue with drinking was not so much drinking to excess on a regular basis, but binge drinking during periods of “R+R”. (Rest and Relaxation)

24. M*A*S*H

25. CARL STINER (Shadow Warriors, with Tom Clancy) • When reporting to his Special Forces assignment • “The last thing you need to know is we get together every Friday afternoon at four o’clock for happy hour. You’re expected to bring your wife, and your expected to have a 3rd Special Forces Group mug – which I just happen to sell for three dollars”…”This little ritual of happy hours and mugs might jar people in these politically correct times, but that was the way the Army was back then”. (p. 130) Exploratory Committee

26. “The social culture in the Army as a whole was far less structured than it is now…Socializing tended to focus on gatherings where everyone drank; Friday afternoon ‘happy hours’ were the norm”. (p. 130) • “Remember that we’re talking about only a few years after the end of the Korean War. Or example, in those days commanders were not nearly as involved in the training of soldiers or in the taking care of families. That culture did not really begin evolving until the draft was done away with and we became a volunteer force”. (p.131) Exploratory Committee

27. “Instead Commanders tend to host dinner parties at home for the officers and their spouses. It’s relatively relaxed and informal, and drinking is limited. There are pluses and minuses in all this. We probably don’t have as much spontaneity in today’s Army as we did back then, and that’s a loss; but fewer people make fools of themselves, and that’s a gain”. Exploratory Committee

28. VIETNAM WAR • GENERAL NORMAN SCHWARZKOPF (Vietnam) • Upon Taking Command of His Battalion: • The outgoing battalion commander…sought me out…”Come back to my hooch”, he said. “I need to talk to you a little”. On the table sat a bottle of Johnnie Walker Black label scotch. “This is for you”, he said. “You’re gonna need it”. (It Doesn’t Take a Hero, p. 175)

29. “I was expecting a two – or three hour discussion of the battalion, its officers, its NCO’s, its mission – but he only said, ‘Well I hope you do better than I did…this is a lousy battalion. It’s got lousy morale. It’s got a lousy mission. Good luck to you’. With that he shook my hand and walked out”. (It Doesn’t Take a Hero, p. 175)

30. AFTER THE BATTLE OF IA DRANG VALLEY • Pleiku: The Dawn of Helicopter Warfare in Vietnam (J.D. Coleman) “When they walked up to the bar the bartender told them he couldn’t serve them because Moore was too dirty…Moore patiently explained that they had just come out of the field and would really appreciate a drink”. The bartender refused to serve them and told them to leave. Exploratory Committee

31. “So Moore unslung his M-16 and laid it on the bar. Mills and Crandall solemnly following suit with their .38’s. Moore than said, ‘You’ve got exactly thirty seconds to get some drinks on the bar or I’m going to clear house’. The bartender got smart and served the drinks. By this time the club officer had arrived. He had heard all about the fight in the valley…so did most of the customers in the club. From then on the trio couldn’t buy a drink”. Exploratory Committee

32. ALCOHOL / DRUG USE IN VIETNAM • From American Psychiatry After World War II, Menninger and Case • Of 610 soldiers treated by 1 psychiatrist in country, 113 had an alcohol problem. • In 1970 an anonymous questionnaire indicated that 29% admitted to using marijuana in country. (p.23)

33. (Continued) • Between 1969 – 1971, 9 – 10% of lower enlisted soldiers reported daily marijuana use. • By 1970, 90 – 96% pure heroin became readily available. By 1971, 44% of lower enlisted had used heroin. • By 1971 there were more evacuations due to drugs than to combat wounds. (p. 24) • There were 75 confirmed or suspected opiate deaths from Aug. 1 – Oct. 1970. (p. 23)

34. PLATOON

35. New York Times Article (March 13, 2007) For US Troops at War, Liquor is Spur to Crime • “Commanders have not always regarded drinking as a problem. The Army ‘was a culture in the 1970s that encouraged drinking’, said a retired Army colonel. ‘You’d go out drinking together and you’d find your buddy hugging the toilet at the officer’s club and think nothing of it’”.

36. CONSEQUENCES • In 2007 NYS OASAS (Office of Alcoholism and Substance Abuse Services) served nearly 14,000 veterans • 14% under age 35, 19% over 55 years of age. • 59% seen for alcohol • 17% Crack / Cocaine • 17% Heroin / Opiates • 5% Marijuana / Hash

37. CONSEQUENCES (Continued) • 22% Were Employed • 30% Unemployed • 48% Report “Not in Labor Force” • 31% had Criminal Justice involvement • 24% Homeless • 40% had also been treated at some point for a mental health issue

38. NY Times Article (Continued) • “Command tolerance for such behavior began changing in the 1980’s and by the 1990’s. ‘If you had more than a couple of drinks at the club, people started looking at you strange,’ the retired colonel said”.

40. NY Times Article, After the Battle, Fighting the Bottle at Home (July 8, 2008) • “In recent years the military has worked to transform a culture that once indulged heavy drinking as part of its warrior ethos into one that discourages it and encourages service members to seek help”.

44. WARRIOR PRIDE MESSAGES • Maintain your Warrior Pride – Don’t Drink and Drive! • Don’t leave a Soldier behind on the battlefield, in a bar or at a party. • I am a Warrior - I am Drug Free. • Warrior Pride 0-0-1: Warriors have ZERO DUIs, ZERO underage drinking incidents, and don’t drink more than ONE drink per hour

45. Continued (Fort Drum) • In late 2007 soldiers from the 10th Mountain Division returned after 15 months in Iraq. Some had served 3 and 4 tours. • “Many also did what generations of homecoming soldiers have done: they salved their wounds in local bars. With drinking off-limits in Iraq, at least openly, they were that much more likely to binge, that much less able to tolerate it”.

46. (Continued) FORT DRUM, NY • A 23 year old soldier at Ft. Drum, New York, interviewed by Reuters said, “The first month back, everybody got drunk, pretty much”….You’ve been gone 15 months and that’s what everybody wants to do”.

47. (Continued) FORT DRUM • The base commander, MAJ. GEN. Michael Oates ordered post newspaper to publish names and photographs of all soldiers charged with drunken driving – 116 appeared • “I’m not a teetotaler. I’m not against people drinking. I’m against misconduct”.

48. (Continued) HEAVY DRINKING • 2005 Army Survey found that nearly 25% of soldiers described themselves as “heavy drinkers” (i.e. Having 5+ drinks at 1 sitting once a week) • 18 – 25 year old Soldiers and Marines are 2X as likely to be “heavy drinkers” than their civilian counterparts.

49. (Continued) Lack of Substance Abuse Treatment • New Jersey National Guard • 37% had “problem drinking” • 55% for those with PTSD • Of those reporting both, 41% received mental health treatment – only 9% received help for substance abuse.

50. HOMECOMING / TRANSITION (Dan Taslitz, One Freedom, SAMHSA August ’08) • In combat, life is “Either – Or” • Either “I’m Safe” OR “I’m in danger – kill” • Civilian world is not “Either – Or” (ex. Being insulted by someone is not a “life threatening experience” • Sleeping is dangerous in combat zone - how to sleep when home?