Josh Bode, LCSWSocial WorkerSubstance Use Disorder ProgramBoise Veterans Administration Medical CenterCreated by: Nikole Gaskell, MSW Student

"The "The military history of the United military history of the United StatesStates spans a period of over two spans a period of over two centuries. During the course of those centuries. During the course of those years, the United States has evolved from years, the United States has evolved from a new nation fighting the British Empire for a new nation fighting the British Empire for independence (without a professional independence (without a professional military 1775–1783), through a military 1775–1783), through a monumental American Civil War (1861–65) monumental American Civil War (1861–65) to the world's sole remaining superpower to the world's sole remaining superpower of the late 20of the late 20thth and early 21st and early 21st centuries" Wikipedia (Dec 2010)

Since Sept 11, 2001Since Sept 11, 2001:: More than 1.5 million troops have deployed More than 1.5 million troops have deployed

in support of OEF/OIF. in support of OEF/OIF.

Fiscal year 2010Fiscal year 2010: : There were about 2.2 million active duty and There were about 2.2 million active duty and

reserve component military personnel.reserve component military personnel. Reservists and National Guard members Reservists and National Guard members

represented roughly 59% of the total military represented roughly 59% of the total military force. force. Dulaney, M., Illingsworth, M. & Savitsky, L. , (2009)Dulaney, M., Illingsworth, M. & Savitsky, L. , (2009)

Sections 401 & 411 of 2010 Defense Authorization ActSections 401 & 411 of 2010 Defense Authorization Act

50% are between 17-24y/o50% are between 17-24y/o

16% are women16% are women

25% are minorities25% are minorities

DuLaney et.al (2009)DuLaney et.al (2009)

TravelTravel Housing assistanceHousing assistance Occupational trainingOccupational training Health clubsHealth clubs Education benefitsEducation benefits Competitive pay for someCompetitive pay for some Medical/Dental careMedical/Dental care Food reimbursementFood reimbursement

"Military life is characterized by mobility "Military life is characterized by mobility and an emphasis on mission readiness.“and an emphasis on mission readiness.“

(DuLaney et.al, 2009)(DuLaney et.al, 2009)

For Service members:For Service members:

Must be available 24/7, 365 days a yearMust be available 24/7, 365 days a year Basic needs are met/supported by the militaryBasic needs are met/supported by the military Culture of high alcohol useCulture of high alcohol use Strict training and discipline regimensStrict training and discipline regimens Physical fitnessPhysical fitness

For Service members:For Service members:

Superiors are involved in personal life issuesSuperiors are involved in personal life issues Multiple deploymentsMultiple deployments High training tempo, even for those who don’t High training tempo, even for those who don’t

deploydeploy Source of pride for manySource of pride for many It is what you make itIt is what you make it Enjoyable for manyEnjoyable for many

For military families:For military families: IsolationIsolation Single parenting during times of separationSingle parenting during times of separation Re-integration challengesRe-integration challenges Coping with soldiers’ injuriesCoping with soldiers’ injuries Financial strain for younger/lower enlistedFinancial strain for younger/lower enlisted Repeated personal readjustmentRepeated personal readjustment FearFear

Challenges can lead to : domestic violence, substance Challenges can lead to : domestic violence, substance abuse, child abuse/neglect.abuse, child abuse/neglect.

In a 2005 study of military veterans, PTSD was associated In a 2005 study of military veterans, PTSD was associated with partner violence for one-third of the study with partner violence for one-third of the study participants. participants.

““For those still on active duty, the process of ‘self-For those still on active duty, the process of ‘self-medicating’ [with drugs/alcohol] and resulting instances medicating’ [with drugs/alcohol] and resulting instances of misconduct… can have disastrous effects.”of misconduct… can have disastrous effects.”

Child abuse/neglect may be perpetrated by either or both Child abuse/neglect may be perpetrated by either or both parents due to these stressors.parents due to these stressors.

(DuLaney et al, (DuLaney et al, 2009)2009)

““Deployment describes a service member’s Deployment describes a service member’s time spent away from his or her home time spent away from his or her home

base in support of a military operation and base in support of a military operation and involves three phases each with its own involves three phases each with its own unique set of stressors for the service unique set of stressors for the service

member and his/her family.”member and his/her family.”

(DuLaney et al., (DuLaney et al., 2009)2009)

Pre-deployment-Pre-deployment- Preparation and training away Preparation and training away from homefrom home

Deployment-Deployment- Both family and service members Both family and service members worry about the stress of the combat zone as worry about the stress of the combat zone as well as the overall well-being of their families.well as the overall well-being of their families.

Post-deploymentPost-deployment- Stressful time of readjustment - Stressful time of readjustment for all family members.for all family members.

There are challenges for ALL service There are challenges for ALL service members when transitioning back to members when transitioning back to civilian life whether they served in a civilian life whether they served in a

combat zone or not.combat zone or not. Perception of being able to get out of the Perception of being able to get out of the

military and get career “credit“ for being military and get career “credit“ for being inin

Coping with woundsCoping with wounds Psychological problemsPsychological problems Family changesFamily changes

Lifestyle changesLifestyle changes Sense of loss (comrades, mission)Sense of loss (comrades, mission) Military- put aside personal life to be Military- put aside personal life to be

available 24/7available 24/7 Connecting to a new communityConnecting to a new community Things were scheduled and strictly Things were scheduled and strictly

regulated, not so in civilian life regulated, not so in civilian life Physical changes- no longer required to Physical changes- no longer required to

do PTdo PT

Competitive nature of civilian sector vs. Competitive nature of civilian sector vs. teamwork in the military teamwork in the military

RelocationRelocation Family/interpersonal problems are “in their Family/interpersonal problems are “in their

face” on a daily basisface” on a daily basis May be resentments if bad military experienceMay be resentments if bad military experience Substance abuse Substance abuse Divorce- Enlisted soldiers and Marines divorced Divorce- Enlisted soldiers and Marines divorced

their spouses at a higher their spouses at a higher raterate in fiscal 2008 in fiscal 2008 than at any other time in at least 16 years. than at any other time in at least 16 years.

Homelessness- vets are 12.6% of the U.S. Homelessness- vets are 12.6% of the U.S. population, but 18.7% of homeless population, but 18.7% of homeless population. Many suffer from substance population. Many suffer from substance abuse, mental illness and 33% of homeless abuse, mental illness and 33% of homeless vets have served in a war zone. vets have served in a war zone. (DuLaney et. Al, (DuLaney et. Al, 2009)2009)

Unemployment rate is higher in newly Unemployment rate is higher in newly returning OEF/OIF era veteran population returning OEF/OIF era veteran population than that of non-vets for the same period. than that of non-vets for the same period. This increases the financial stress that This increases the financial stress that veterans experience.veterans experience.

Battlemind skills helped them survive in combat, but may Battlemind skills helped them survive in combat, but may cause problems if not adapted when they get home.cause problems if not adapted when they get home.

Buddies (cohesion) Buddies (cohesion) vs. Withdrawalvs. Withdrawal

AccountabilityAccountability vs. Controlling vs. Controlling

Targeted Aggression Targeted Aggression vs. Inappropriate Aggressionvs. Inappropriate Aggression

Tactical Awareness Tactical Awareness vs. Hypervigilancevs. Hypervigilance

Lethally Armed Lethally Armed vs. “Locked and Loaded” at Homevs. “Locked and Loaded” at Home

Emotional Control Emotional Control vs. Anger/Detachmentvs. Anger/Detachment

Mission Operational Security (OPSEC) Mission Operational Security (OPSEC) vs. Secretivenessvs. Secretiveness

Individual Responsibility Individual Responsibility vs. Guiltvs. Guilt

Non-Defensive (combat) Driving Non-Defensive (combat) Driving vs. Aggressive Drivingvs. Aggressive Driving

Discipline and Ordering Discipline and Ordering vs. Conflictvs. Conflict

ALCOHOL TRANSITIONALCOHOL TRANSITION- Alcohol may be - Alcohol may be limited, but back home it is plentiful. Many limited, but back home it is plentiful. Many service members use it as a way to cope and service members use it as a way to cope and relax which can lead to further problems.relax which can lead to further problems.

Battlemind skills come along with Battlemind skills come along with trainingtraining. . This mentality also affects those who have not This mentality also affects those who have not

been in battle. been in battle. This is an Army concept. Other services have This is an Army concept. Other services have

similar models.similar models.

As of 2007, including injuries in combat and non-As of 2007, including injuries in combat and non-hostile activities, nearly 53,000 service members hostile activities, nearly 53,000 service members have been injured since the onset of Operation have been injured since the onset of Operation Enduring Freedom (Afghanistan) and Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom (Iraq). Iraqi Freedom (Iraq). (DuLaney et. al, 2009) (DuLaney et. al, 2009)

In the past many injuries were fatal, but medical In the past many injuries were fatal, but medical advances have made survival rates much higher.advances have made survival rates much higher.

HOWEVER:HOWEVER: Grave physical injuries due to advances; damaged Grave physical injuries due to advances; damaged

brains (traumatic brain injury), spinal cords, vision, brains (traumatic brain injury), spinal cords, vision, hearing loss, amputated limbs, disfigured faces and hearing loss, amputated limbs, disfigured faces and invisible injuries including psychological problems.invisible injuries including psychological problems.

Many service members and veterans don’t Many service members and veterans don’t seek treatment, particularly for invisible seek treatment, particularly for invisible injuries, because of:injuries, because of:

StigmaStigma Fear of career impact (even civilian)Fear of career impact (even civilian) Loss of peer confidenceLoss of peer confidence Military culture: “suck it up”Military culture: “suck it up”

This can lead to substance abuse, suicide, This can lead to substance abuse, suicide, violence and family problems.violence and family problems.

To connect a veteran to the various services available, please contact your local Veterans Justice Outreach Coordinator.

VJO’s for state of Idaho Southwest Region: Joshua Bode

(208) 422-1000 Ext 7154 Central Region: Rhonda Strother

(509) 525-5200 Ext 22056 Northern Region: Paul Nicolai

(509) 434-7285 Eastern Region: Amy Earle

(801) 582-1565 Ext 6327

Medical Centers Treating Idaho Boise VA Medical Center

Community Based Outpatient Clinic in Salmon, Caldwell, and Twin Falls

Walla Walla Medical Center Community Based Outpatient Clinic in Lewiston

Spokane VA Medical Center Community Based Outpatient Clinic in Coeur

d’Alene Salt Lake City VA Medical Center

Community Based Outpatient Clinic in Pocatello

White City Oregon Domiciliary Program Up to 6 month admission Mental Health and Substance Dependency Services. Wide array of services available

American Lakes Domiciliary Program Substance Dependency and Post Traumatic Stress

Disorder Treatment Program Boise Substance Abuse Residential

Rehabilitation Treatment Program Walla Walla Substance Abuse Residential

Rehabilitation Treatment Program

Boise Vet Center (208) 342-3612 Pocatello Vet Center (208) 232-0316

Services provided by Vet centers: Adjustment Counseling Military Sexual Trauma Mobile Vet Center

Boise VA Regional Office Veterans Benefit Administration Federal Benefits for Veterans Handbook

Veterans Service Organizations Idaho Division of Veteran Services

208-577-2310 Responsible for State Veterans Homes Assist in disability claims

Disabled American Veterans 208-429-2140

Numerous others available in local communities

Boise

Pocatello

Lewiston

Idaho Falls

Post Falls

Twin Falls

Caldwell

Hayden

Legend: Active Army Installation

Army National Guard Family Assistance Center

Army Reserve Family Programs Office

Joint Forces Headquarters

Survivor Outreach Services

ROTC

MEPPS

Recruitment Battalion

Moscow

www.gibill.gov www.gibill.gov Education and training (1-888-442-4551)Education and training (1-888-442-4551)

Military OneSource Military OneSource (1-800-342-9647)(1-800-342-9647)

Army OneSource Army OneSource Sheila Schumacher (208) 660-5607 Sheila Schumacher (208) 660-5607

Military Family Readiness CentersMilitary Family Readiness Centers Mountain Home AFB, IdahoMountain Home AFB, Idaho

(208) 828- 2458(208) 828- 2458

Gowen Field, IdahoGowen Field, Idaho (208)(208)

Fairchild AFB, WashingtonFairchild AFB, Washington (509) 247-2246

Hill AFB, UtahHill AFB, Utah (801) 777-4681

Mary Kelly, Transition Assistance Advisor (208) 272-4408 Mary.kelly3@id.ngb.army.mil

Tom Obstarczyk, National Guard Family Assistant (208) 272-4355       Thomas.obstarczyk@us.army.mil

Jase Theyer, IDARNG Resilience and Suicide Prevention Program Manager 208-995-4069 Jace.theyer@us.army.mil

Kim Cole-Washington National Guard Family Programs 509 844-1115

Mary Thomas, Readiness Program Manager, Fairchild Air Force Base 509-247-7009

National Center for Post Traumatic Stress Disorder

Veterans Crisis Line 1-800-273-8255 Suicide Prevention Coordinator Available at

every Medical Center Army OneSource

Contact Sheila Schumacher for questions and support

“Treating the Invisible Wounds of War” Training

Don't assume every veteran has deployed.Don't assume every veteran has deployed. Clarify if the veteran that deployed saw Clarify if the veteran that deployed saw

“hard time.”“hard time.” Don't assume every veteran has PTSD.Don't assume every veteran has PTSD. Remember that many veterans are female Remember that many veterans are female

with many of the same issues.with many of the same issues. Resiliency factors for people differ and Resiliency factors for people differ and

some veterans may be able to handle some veterans may be able to handle readjustment easier than others. readjustment easier than others.

Lifestyle in the military is very different from Lifestyle in the military is very different from that of civilians.that of civilians.

There are numerous challenges for veterans There are numerous challenges for veterans who are discharging from the military who are discharging from the military whether they have seen combat or not.whether they have seen combat or not.

A positive relationship between military, A positive relationship between military, veteran and civilian services is crucial. veteran and civilian services is crucial. Memorandums of Understanding (MOU’s) Memorandums of Understanding (MOU’s) are helpful.are helpful.