Drugs

Soldiers Are Coming Home Injured and Addicted -- Will We Pay Our Debt to Our Vets?

Soldiers come home from the two wars with a staggering rate of brain injuries and the addictions paired with them, but to treat them could cost $1 trillion.

Photo Credit: Expertinfantry via Flickr

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Robert LeHeup will be the first to admit that he's an alcoholic. “I drink so that I don't go to shit,” says LeHeup, a 30-year-old bartender living in Columbus, South Carolina. “I drink because I have to.”

LeHeup is a former Marine sergeant, who served two grueling tours in Afghanistan during the US invasion and early occupation. He drinks to dull memories of the everyday chaos and carnage. He drinks to tolerate his disgust at the raucous bar-goers who have no idea how easy life is in America, compared to the casual violence and grinding poverty of Afghanistan. He drinks because, in the Marines, that is just what everybody does.

“There was this drive to prove to each other that we can handle our liquor,” recalls LeHeup, who increasingly channels much of his distress more productively into his burgeoning writing career. “In the Marines, when I was stateside, I drank a fifth before I went out drinking, you know what I mean?” 

LeHeup, in his ongoing struggle with alcoholism, is anything but an outlier among this generation of military service-members. In fact, more than a decade after the start of the wars in Afghanistan and Iraq, an unprecedented number of men and women in the US military are currently in the throes of addiction.

In addition to the incalculable personal tragedies, the long-term socioeconomic costs range from healthcare to lost productivity, and could eventually rival even the estimated total costs of waging the two decadelong wars: $3 to $4 trillion dollars. (As sold to the American people by the Bush administration, the price tag of each war was said to be under $100 billion.) Recent estimates are lacking, but a 1997 report from the Office of the Inspector General warned that in a single year, the single problem of alcohol abuse among soldiers and veterans cost the country nearly $1 billion dollars, widely viewed as a conservative count.

There is no shortage of studies and statistics on the extent of the problem. Consider these: Between 24% and 38% of service-members between the ages of 18 and 25 (depending on their branch) qualified as “heavy drinkers” in a 2006 study, compared to 15% of the civilian population. 

total of 11,200 active-duty soldiers were busted for using illicit drugs in 2011, up from 9,400 in 2010.

And 17% of active-duty personnel admitted to “misusing” prescription drugs—primarily opiate painkillers—in a 2008 survey by the Department of Defense. By comparison, a 2010 survey of civilians found that 6% reported “nonmedical use” of prescription meds.

Of course, the consumption of alcohol or illicit drugs by soldiers is hardly a new phenomenon. Indeed, warriors have been imbibing for thousands of years. In the words of retired Army Brigadier General Stephen Xenakis, they drink “to celebrate, to forget and to fortify themselves for the next day's battle.”

The phenomenon continues to this day. According to a 2004 study, young recruits report that they drink because alcohol is viewed as “a necessary ingredient of successful group socializing,” because it is inexpensive and ubiquitous, and because it is “the only thing there is to do during off hours.” 

Where official military policy is concerned, alcohol use is strictly prohibited during deployment. On installation, imbibing—regardless of one's age—was once a mainstay of military culture. More recently, leaders have frowned upon such consumption. “Alcohol use is greater than anything else,” Major General Anthony Cucolo said in 2009. “We are most concerned about alcohol use and abuse [among soldiers].”

If addiction isn't new for the military, it’s much more complicated than media reports tend to convey. For example, there’s a widespread notion that many Vietnam Vets are the walking wounded, addicted to heroin and homeless.

But while thousands of soldiers experimented with the plentiful heroin in Vietnam during combat, the vast majority actually cleaned up and reintegrated into society successfully in the first few years after they came home. Rates of addiction among those veterans are in fact lower than rates among nonveterans from the same generation.

Yet one group of Vietnam Vets didn’t share in this relatively positive outcome: those who also suffered from a mental health ailment incurred by combat. Among veterans who’ve sought treatment for post-traumatic stress disorder (PTSD) in the years following their military service, between 50% and 80% also suffer from addiction. For decades, veterans groups have charged that these and other veterans' health needs have been inadequately met.

PTSD has likely been around for as long as war itself. Called “soldier’s heart” during the Civil War, “shellshock” in World War I, and “combat fatigue” in World War II, PTSD was made an official diagnosis only with its inclusion in the DSM in 1980, due to the high incidence of psychological distress in Vietnam Vets. 

This link between addiction and mental health is precisely what makes the situation of today’s soldiers so dire. More men and women who have seen combat in the wars in Afghanistan and Iraq are suffering from brain-based damage—primarily, PTSD and traumatic brain injury (TBI)—that frequently precipitates addiction. And, crucially, these soldiers have received grossly inadequate care from the military’s medical system.

As the two wars wind down, the price paid in veterans’ mental and physical illnesses will become only more glaring. Two factors stand out as fateful: First, that our military, unlike in generations past, is entirely comprised of volunteer fighters; second, that these two wars were two of the longest in our history. As a result, soldiers have been redeployed to an unprecedented extent. Three, four, even five tours of duty are now par for the course.

They’re also suffering from devastating rates of PTSD, often described as “the invisible wound” of this generation’s wars. The condition, estimated to afflict at least 25% of returning service-members who saw combat, is characterized by a bevy of symptoms, including rage, insomnia and anxiety—that can often be soothed with alcohol or drugs.

Myriad studies have long found a distinct connection between PTSD and substance abuse. A comprehensive 2006 analysis by Veterans Affairs sums them up: An estimated 52% of those afflicted with PTSD will be diagnosed with alcohol abuse or dependence, and 34.5% with dependence on drugs. According to the report, PTSD doubles one's odds of an alcohol-use disorder, and a drug-use disorder triples the risk.

Thanks to technological breakthroughs in better body armor and battlefield medicine, more soldiers are also coming home alive: With injury survival rates that exceed 90%, more members of our military than ever before are living with brain damage, physical disability or chronic discomfort caused by injuries that, in previous wars, would have killed them.

In particular, exposure to insurgents’ use of improvised explosive devices (IEDs), such as roadside bombs, has been a routine experience for US soldiers. A veteran of 26 such blasts told The New York Times, “It feels like you’re whacked in the head with a shovel. When you come to, you don’t know whether you’re dead or alive.”

Not surprisingly, IEDs cause both PTSD and traumatic brain injury. A 2008 report provided the first estimates of the rates of such casualties among soldiers in Iraq and Afghanistan: 19% suffered a TBI, 18% PTSD and 5% a combination. The consequences of the extraordinarily high rate of IED exposures and casualties not only for soldiers but for almost every aspect of the military services are frankly unprecedented.

Growing anecdotal evidence suggests that soldiers afflicted with both post-traumatic stress disorder and traumatic brain injury face especially grave risks to their psychological well-being. TBI-induced damage to the frontal lobe, which controls executive functions, can short-circuit the brain’s capacity to choose between right and wrong, recognize future consequences of actions and generally keep impulsivity in check.

 Unfortunately, drug abuse also targets this same brain area, impairing inhibition and decision-making, and facilitating addiction by fueling compulsive drug seeking and craving-induced relapses. Together, the injuries caused by PTSD and TBI, and reinforced by addiction, can catalyze a chain reaction that increases the risk of violence and suicide. The sudden, powerful emotions sparked by a PTSD flashback may meet no inhibitory check from the frontal cortex.

Robert Bales, the 38-year-old Army staff sergeant accused of the Kandahar massacre of March 11, in which he killed 17 defenseless civilians, has a medical history all too typical of a redeployed soldier in these wars. Bales reportedly suffered a traumatic brain injury when his humvee detonated a roadside bomb in Iraq. He lost part of his foot in a separate incident. The day before his alleged Afghanistan murder spree, he was standing next to a fellow soldier when that man’s leg was blown off. Reports of Bales' alcohol abuse have also surfaced.

The massacre provoked moral outrage and inevitable comparisons to the infamous My Lai massacre in Vietnam. However, unlike Second Lieutenant William Calley, who was found guilty of premeditated murder at My Lai and sentenced to life in prison (later converted), Bales may never go to trial on charges that include 17 counts of murder—and for which he faces the death penalty. Some experts suggest that his lawyer is considering an insanity defense based on the effects of PTSD and TBI.

The scope and severity of combat-related invisible brain injuries may well surpass current expectations, according to controversial new research by Boston University’s Center for the Study of Traumatic Encephalopathy. The center’s studies show that many cases of TBI rapidly develop into a condition called chronic traumatic encephalopathy (CTE), a degenerative and incurable neurological disease linked to symptoms of dementia, including memory loss, personality changes, impaired judgment, depression and dementia.

Since 2001, the military has confirmed traumatic brain injury—the precursor to CTE—in more than 220,000 of the 2.3 million troops who have served in Iraq and Afghanistan, although many experts say that the actual number is much higher.

With adequate preventative measures, those factors—repeat deployments, grueling physical and mental health problems—might never have resulted in what is looking more and more like an epidemic of PTSD and TBI, as well as a substance abuse crisis, among veterans of the Afghanistan and Iraq wars.

But the military and Veterans Affairs are both overwhelmed, short-staffed and cash-strapped, after so many years combat. As a result, soldiers are falling through the cracks of a healthcare system stretched far too thin.

In fact, it took a major scandal—the Washington Post's 2007 expose of Walter Reed Army Hospital—to catalyze the military and VA’s focus on troops with brain injuries. Congress responded by allocating some $300 million for research into TBI and PTSD. That money, however, gives no evidence of having curbing the rates of substance abuse or violent incidents among soldiers and veterans, nor has it mitigated the stark prospects for their health in both the short and long terms.

“I think the military is taking the problem of addiction seriously, now,” Patrick Bellon, executive director of Veterans for Common Sense, says. “But it's been more than 10 years. So the response to mental health, to addiction, has simply been too slow for soldiers.”

Whether the military will take the problem seriously when the wars are over—and for the decades that follow—remains to be seen. At present, no one knows how many invisible brain injuries have gone undiagnosed. As a result, estimates of the extent of the health complications issuing from these traumas, including addiction, are hard to make. One thing is certain: these complex and severe problems are only going to increase over time—along with the cost of treatment.

America claims to be committed to taking care of ailing veterans for their entire lives if need be. For the generation of veterans of the war in Vietnam, which ended in 1975, the peak in healthcare costs and disability payments has not yet been reached. For the new generation of veterans of the wars in Iraq and Afghanistan, the peak is not due for another 40 or 50 years. By one estimate, the total price tag for this care will be $1 trillion. Yet budget hawks in Congress, especially among the Republicans, have already proposed cutting funds for veteran affairs.

Harry, a 35-year-old former Army corporal from New York, is but one example of a system that has too often failed this generation of soldiers.

After six years of service, Harry—who asked that his last name not be used—came home with the kinds of anxiety and nightmares that characterize PTSD. He was also suffering from a devastating injury wrought by an improvised explosive device: Harry is blind in his right eye, underwent the insertion of two metal plates into his skull and now relies on a leg brace to stay mobile.

Largely because of his injuries, reintegrating into civilian life proved tougher than Harry had anticipated. He was depressed but shied away from asking for help—a common problem in a military culture that, at least until recently, lauded tightened bootstraps over talk therapy. And, according to Harry, military doctors didn't exactly offer it. “Nobody was there to help me,” he says. “I was like damaged goods.”

Instead, Harry relied on alcohol and cocaine to relieve the physical and psychological anguish. Arrested last year for drug possession, he’s now sober. Thanks, rather tellingly, to a court-ordered stint at a civilian—not military—rehab clinic.

“I fulfilled my contract [with the military], and that's what got me into trouble,” he says. “When I came home, I would have at least expected them to fulfill theirs.”

This is the first in a three-part series investigating the causes, diagnosis, prevention and treatment of addiction in soldiers and veterans of the wars in Afghanistan and Iraq.

Katie Drummond is a reporter for Danger Room at Wired.com, a contributing editor at The Daily, and a freelance writer for outlets including New York magazine and Prevention.