GPSolo Magazine - October/November 2006
On March 21, 2006, the United States marked the third anniversary of our involvement in Iraq, the largest ground war since Vietnam. The number of American troops deployed there fluctuates, but it is estimated to be more than 133,000. Forces deployed include active-duty military as well as troops called up from the U.S. Army Reserve and Army National Guard. In addition, defense contractors engaged in troop support and rebuilding efforts employ more than 75,000 civilians, who frequently encounter the same dangers as the enlisted servicemembers. One might assume that every lawyer in the military is serving as a lawyer in the Judge Advocate General’s (JAG) office; the reality of the current conflict is more complex. Some lawyers return home as combat veterans, and many in noncombat positions are not insulated from the violence.
As those who bravely serve return home, the issues surrounding their reintegration demand attention. Nationally, one-third of veterans from Iraq and Afghanistan have sought mental health care—including care for issues of post-traumatic stress disorder (PTSD), drug abuse, depression, and alcohol abuse—within a year of returning home.
According to Col. Charles W. Hoge, chief of psychiatry and behavioral sciences at Walter Reed Army Institute of Research, about 12 percent of veterans are at risk of developing PTSD. Known to veterans of earlier wars as “combat fatigue,” the emotional and physical “fight or flight” response to excessive stress, violence, or trauma can linger. If untreated, symptoms such as anxiety, sleeplessness, and nightmares intensify, leading to preoccupation, isolation, anger, and depression, with a risk of suicide. (For more information, see the sidebar “What Is PTSD” above.)
Dr. Robert Ireland, program director of mental health policies for the Department of Defense, says that three levels of prevention are used to reduce the risk of lingering trauma for today’s troops, including initial screening during medical assessment and minimizing traumatic exposures as much as possible. Primary prevention also includes tough, realistic training to provide “stress inoculation” that builds resilience in soldiers to the noise and chaos of combat.
Secondary prevention includes training on what to do after exposure to traumatic stress, including getting to safety as soon as possible, on-the-spot techniques for coping in combat situations, and relaxation techniques after the immediate crisis has passed.
Help offered after symptoms develop is described as tertiary prevention. Identifying individuals who may not be adjusting appropriately is important, particularly as people vary in their reactions or what triggers them. One veterans’ center counselor notes that driving may present issues for veterans returning from Iraq because so many dangerous events there occur on the road. Other veterans find that the sound of Fourth of July firecrackers triggers panic or anxiety. The success of tertiary prevention depends upon the affected individual receiving treatment.
Many military personnel avoid seeking help for emotional issues because of a perceived stigma in acknowledging a problem. In April 2004, Lt. Gen. James B. Peake, Army Surgeon General/MEDCOM Commander, stressed the need to make emotional health a priority. Discussing the 24-hour live hotline “Army OneSource,” which provides referrals to free counseling sessions with civilian psychologists and psychiatrists for veterans, as well as care managers specializing in post-deployment issues at primary care clinics, he encouraged veterans “to seek assistance early and without any concern of stigma that is sometimes associated with access to mental health assets.” Continuing, he noted that “I want you all to know that I believe it is important to make such assistance accessible and acceptable, and that it is important to understand that being affected by these kinds of deployment stressors is an absolutely normal set of reactions that can be made easier with assistance.”
Whether because of the availability of added help, the encouragement to access it, or more intense stress experienced by reservists or National Guard troops who were not anticipating an extended overseas tour of duty, Iraq veterans are more likely to seek help. To facilitate that process, the military has provided confidential channels for help, such as OneSource. There are also online resources such as www.militarymentalhealth.org or www.hooah4health.com that provide anonymous self-assessment tools.
In addition to traumatic stress reactions—and frequently as a means of self-medication to cope with these reactions—veterans may struggle with alcohol and drug abuse or dependence. The military is a zero-tolerance drug-free workplace for both enlisted troops and civilian employees. Regulations state that “drug abuse will not be tolerated and there are serious consequences for such misbehavior.” The Army Substance Abuse Program (ASAP), created by AR600-85, engages in prevention, enforcement (random drug testing is standard), and treatment. Soldiers identified as drug abusers are referred for clinical screening but are also subject to administrative separation, non-judicial punishment, or courts-martial. Those involved in alcohol-related misconduct are referred to ASAP for clinical screening and may be referred to alcohol and drug abuse prevention training, sent to another agency (clergy or marriage counselors), or sent to ASAP rehabilitation treatment, with a possibility of disciplinary action.
At the same time, servicemembers are encouraged to self-report their substance abuse issues. They can receive treatment, and the negative actions that can be taken against them are limited. Attorneys may draw comparisons between the dual enforcement/treatment structures of ASAP and state bar associations that maintain bar discipline (enforcement) programs as well as voluntary, confidential lawyer assistance programs.
Whether self-reporting or mandated to treatment, it’s important to note that 12-Step meetings (such as Alcoholics Anonymous) are available on military bases and among deployed servicemembers, carrying on a tradition of recovery that began in 1935 and was road-tested in World War II.
After discharge, returning veterans can receive treatment for substance abuse from the Veterans Administration (VA). It’s helpful to note that these benefits are not limited to newly returning vets. When alcohol or drug abuse has depleted an individual’s financial resources, determining eligibility for veterans’ health benefits can be a lifesaver when the cost of long-term residential treatment would otherwise be prohibitive.
Domestic and Professional Challenges
Where some veterans are challenged by the memories and trauma of war, others face readjustment issues on a very basic level: employment, housing, and family. Lawyers in solo practice or small firms may have to rebuild their client base, while others may have difficulty fitting into a daily routine and workload after a long absence. Some may return and face the reality of needing to find a new job. Career counseling is available through the VA and some state lawyer assistance programs.
Many veterans find that their family dynamics have shifted, making it difficult for them to return to the life they led before deployment: Children and spouses have become used to acting on their own, or they may be overly needy. Adjusting to a changing family environment after months or years of military routine may be jarring for all involved. Family and individual counseling—as well as an acceptance of the fact that things have changed—will be helpful in negotiating this aspect of the transition.
Female veterans frequently have additional needs. They may have experienced sexual harassment or assault, and they also have a difficult time shifting roles: from tough military servicemember to nurturing wife or mother. Upon their reintegration, the combination of career and family demands may make it more difficult for them to find the time to seek outside help.
The ABA and local state bar associations have stepped forward to provide legal services to military servicemembers and their families who may face legal issues. Through the ABA Standing Committee on Legal Assistance for Military Personnel, Operation Enduring LAMP provides legal assistance on civil matters to an estimated 9 million military personnel and their dependents (www.abanet.org/legalservices/helpreservists). Many state bars provide similar programs, such as the Oregon State Bar Military Assistance Panel. The panel provides opportunities for Oregon attorneys to receive specialized training in legal issues pertinent to military families, such as the Servicemembers Civil Relief Act (SCRA), and to offer pro bono services to active-duty servicemembers and their families.
Finally, although this article has focused on helping returning vets, it is important to mention that many members of the bar have spouses and, more frequently, children serving in the military. They frequently access lawyer assistance with concerns about their family members and anxiety and grief. By serving their needs, we also can serve those who serve our country.
What Is PTSD?
Post-traumatic stress disorder, or PTSD, is a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, abuse (sexual, physical, emotional, ritual), and violent personal assaults such as rape. People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person’s daily life.
PTSD is marked by clear biological changes as well as psychological symptoms. There are four main types of PTSD symptoms. A diagnosis of PTSD requires the presence of all categories of symptomatic response.
• Re-experiencing the trauma: Flashbacks, nightmares, intrusive memories, and exaggerated emotional and physical reactions to triggers that remind the person of the trauma.
• Emotional numbing: Feeling detached, lack of emotions (particularly positive ones), loss of interest in activities.
• Avoidance: Avoiding activities, people, or places that remind the individual of the trauma.
• Increased arousal: Difficulty sleeping or concentrating, irritability, hypervigilance (constantly being on guard), and exaggerated startle response.
Resources for Veterans
U.S. Department of Health and Human Services (HHS)
Substance Abuse and Mental Health Services Administration (SAMHSA)
SAMHSA’s publications on veterans include several short reports from the Agency’s Office of Applied Studies (OAS). Recent reports include Substance Use, Dependence, and Treatment Among Veterans and Alcohol Use and Alcohol-Related Risk Behaviors Among Veterans (see SAMHSA News , January/February 2006). Visit SAMHSA’s website at www.oas.samhsa.gov/topics.cfm for a complete list under the topic “veterans.” Other SAMHSA resources include:
SAMHSA’s National Mental Health Information Center
SAMHSA’s National Clearinghouse for Alcohol and Drug Information
800/487-4889 (TDD) (toll-free)
800/767-8432 (Spanish) (toll-free)
SAMHSA’s National Helpline
800/662-HELP (4357) (toll-free)
(English and Spanish)
800/487-4889 (TDD) (toll-free)
Other Federal Agencies
U.S. Department of Defense (DoD)
Main Office: 703/681-0064
Office of Assistant Secretary of Defense for Public Affairs
Army Substance Abuse Program (ASAP)
U.S. Marine Corps
Marine Corps Community Services (MCCS)
Navy Alcohol and Drug Abuse Prevention Program (NADAP)
U.S. Department of Veterans Affairs (VA)
VA Benefits: 800/827-1000 (toll-free)
Military ONESource 24-Hour Live Hotline
from the United States: 800/464-8107
from outside the United States: dial the appropriate access code to reach a U.S. number and then 800/464-81077 (all 11 digits must be dialed)
hearing-impaired callers: 800/364-9188
Disabled American Veterans (DAV)
National Alliance on Mental Illness (NAMI)
800/950-NAMI (6264) (toll-free)
National Coalition for Homeless Veterans (NCHV)
800/VET-HELP (838-4357) (toll-free)
National Mental Health Association (NMHA)
800/969-NMHA (6642) (toll-free)
National Veterans Foundation (NVF)
Meloney Crawford Chadwick, JD, CADC III, NADC II, is an attorney counselor with the Oregon Attorney Assistance Program. She can be reached at firstname.lastname@example.org.