Why Are We Locking Up Traumatized Veterans for Their Addictions Instead of Offering Them Treatment?
A new report by the Drug Policy Alliance exposes practices and policies that for decades have unjustly resulted in large numbers of psychically injured and addicted veterans landing in U.S. prisons and jails.
The report reflects a year's worth of outreach to veterans and veterans' advocates across the country and a distillation of their most creative, innovative and optimistic responses to the problem.
Gen. Steven Xenakis, M.D., special adviser to the Joint Chiefs of Staff for warrior and family support, brought a message of official support to a teleconference announcing the release of the report:
"250,000 soldiers is a large number of soldiers, Marines, sailors and airmen who have been affected," he said. "It is so important that people are made aware of the issues and that we follow up with the best action plans we can find. … We in this country have a responsibility to assist and support them."
The report recommends changes in state and federal statutes that now prioritize punishment over treatment for veterans who commit nonviolent drug-related offenses as a result of their addictions and other mental health issues.
"Courts, as a way of dealing with large numbers of people with substance-abuse problems, are a very slow and expensive way to go," Dan Abrahamson, the Drug Policy Alliance's director of legal affairs, explained. "You need a courtroom and a judge and all the players, from prosecutors to defense attorneys. Providing treatment straight up requires far fewer resources and far less investment for far greater returns."
The report also calls for the adoption of overdose-prevention programs and the expansion of veterans' access to medication-assisted therapies to treat opioid dependence.
Overdose is an ongoing problem among veterans, as are other self-destructive behaviors that inflate the official and unofficial tally of suicides among active-duty troops and veterans. (Veterans, often compromised by alcohol or drugs, are an astonishing 148 percent more likely to die in a motorcycle crash than civilians of comparable age, race and sex.)
Guy Gambill, a longtime veterans advocate who was instrumental in shaping the report, reminded the teleconference participants that "one of the hallmark symptoms of PTSD is the tendency to self-medicate."
"In the aftermath of Vietnam, self-medication and its collateral behaviors landed tens of thousands of veterans in prison," Gambill said. "This time, let's be smarter than the problem."
Gambill is a veteran of nuclear duty forces in Europe and of President Ronald Reagan's South American military ventures. He makes no secret of the fact that he has done time in jail and under bridges, kicked a serious drug habit and managed to live with the mental-health issues that are a result of his service.
For the last decade, his firsthand experiences have fed his efforts to promote the diversion of veterans from incarceration into treatment, and he is convinced that finding ways to deal with addictions is a key part of that effort.
"We are not going to let murderers off the hook, or sex offenders. We're not going to let people who have 16 aggravated DUIs and killed somebody, off the hook. Those guys aren't getting out of jail any time soon.
"So who do we have room to help? People with drug-offense charges.In cases where a veteran has combat-related psychological trauma and nonviolent drug offenses, there is a lot of political will to give these guys a break."
A great litmus test for that political will would be the immediate repeal of the 2002 Veterans Administration directive barring treatment for incarcerated veterans. This almost incomprehensibly myopic policy is, as the report states, "a missed opportunity for the VA to provide critical services and support for veterans to recover from the psychological wounds that caused their criminal activity in the first place."
Currently, the most successful mechanism for diverting veterans from incarceration and into treatment was conceived by Judge Robert Russell. His veterans' court in Buffalo, N.Y., is a hybrid version of the drug and mental health courts that since the 1980s have had a dramatic impact on the conversation about who and under what circumstances should be sent to prison.
Russell's court was the first in the country to cater specifically to the needs of veterans with addiction disorders and/or mental illness who are charged with nonviolent criminal offenses. After almost two years, Russell's court boasts an astonishing recidivism rate of zero, compared to the 60 to 70 percent national average.
Such courts are now springing up across the country, but they are seriously limited by their abilities to attract and process large numbers of cases. Last year, Russell's court processed under a hundred cases.
"And they're not getting any current-conflict vets," Gambill told me in a phone interview. "It's a lot of Vietnam vets, and it's great that they are getting help, but the intent of all this is not to have another generation go through the same bullshit. It doesn't mean anything if we don't get some significant numbers of veterans to participate in the program."
One serious problem, he explains, is that the specialty courts -- drug, mental health and veterans -- are voluntary. "Consider a 23-year-old who gets arrested for drunk-and-disorderly conduct on a Friday night. The cops throw him in jail, but before he is arraigned on Monday morning, the public defender offers him the choice of a $600 fine -- $500 suspended, pay $100 down, 90 days -- 87 days suspended, time served three days, and you walk out today.
"Or of matriculating into the veterans court for a year or so of court-supervised treatment, at the end of which time the charges against him will be thrown out.
"Which one do you think a 23-year-old guy on a roll is going to choose?
"That's what is happening all over the country," Gambill explains, "That's why the numbers are so low and why the specialty courts cannot be expected to solve the whole problem."
Furthermore, "the whole problem," Tom Tarantino, a legislative associate with Iraq and Afghanistan Veterans of America, pointed out, is of an entirely unknown magnitude.
"We don't really know how many veterans are in jail right now. The numbers cited in the DPA report are from a survey done in 2004. In 2004, there were over a million fewer veterans of Iraq and Afghanistan than there are today."
Tarantino offered a simple solution to the absence of that information: "The Department of Defense has lists of people who have been in the military, and the Department of Justice quarterly collects lists of people who have been arrested. We just need them to compare lists."
But even armed with that data, there are all told only about a dozen veterans courts in operation or in the planning stages in the entire country. Even if more troops and veterans can be persuaded to make use of them, there are hardly enough courts to handle the daunting wave of new veterans expected to run afoul of the law.
The DPA report is, however, more interested in interventions that can occur before veterans become entangled in the criminal justice system.
Presently, most prison-diversion programs, including many, if not all, of the emerging veterans treatment courts, require veterans to plead guilty to criminal charges before being directed to treatment.
The consequences of an arrest and conviction can be devastating, the report explains, including denial of employment, housing or public benefits. And an estimated 585,000 veterans are denied the right to vote because of felony convictions.
And even when all charges are finally dismissed, electronic information that has been released, cannot always be recovered. Data harvesting has become a big business, and any arrest, regardless of outcome, can resurface to compromise a veteran's future.
So the report emphasizes "front-end diversion practices," or ways keep veterans out of prison in the first place. Gambill describes some encouraging experimental programs in Chicago and Los Angeles that make use of veterans who are specifically trained to ride along with police when they get disturbance calls.
These "peer-intervention specialists" can recognize another vet by his bearing and behavior. Speaking a common language and referencing a common culture, these intervention specialists are far more likely to persuade a freaked-out vet to back down, and then talk him into accepting a treatment option.
Some of the suggestions made in this report will require the coordinated efforts and funds of multiple agencies. But some are so simple and obvious, even cheap, that it is sort of mind-boggling that they even warrant discussion.
For, example, Dr. Bob Newman, director of the Rothschild Chemical Dependency Institute at the Beth Israel Medical Center in New York, wants to know how TRICARE, the Defense Department's health insurance plan for active-duty service members, can justify its refusal to not pay for methadone and other medication therapies for addicted veterans.
"I want to stress," Newman said on the teleconference, "that we are not talking about some hypothetical new idea as to how to approach the problem of opiate addiction. It is endorsed by the World Health Organization, the National Institute of Drug Abuse, the World Health Organization and the Institute of Medicine.
"And our Department of Defense has an insurance plan that simply excludes maintenance treatment. No explanation. It just says, we don't pay for it. And I understand that could be changed with the stroke of a pen."
So simple, and yet like many of the recommendations in this report, so stubbornly resistant to change. One must wonder, why?
Untreated combat-related mental-health injuries are predictive of substance abuse, and untreated substance abuse is predictive of encounters with the criminal justice system. And the door predictably revolves.
Tarantino wants it made very clear that, for many service members the vicious cycle begins while they are still under military jurisdiction.
"It was really alarming how many combat soldiers were given prescription drugs with little or no supervision," he reported. "To be really blunt, I know crack dealers who are more discriminating with issuing drugs than some of the clinics that I saw in Iraq."
Many of those drugs have serious known side effects, including suicide. And many of them, drugs to help soldiers sleep and drugs to help them stay awake, are seriously addictive.
"The ease of obtaining prescription drugs in the combat zone," Tarantino explains, "is not mirrored back in garrison. When soldiers come home, their reliance on those same drugs can create severe problems."
This report highlights the gross injustice of holding service members and veterans entirely responsible for drug reliance that is facilitated, if not encouraged, when it serves military purposes. That injustice is aggravated when it is used as an excuse to kick people out of the military, thereby denying them benefits. It is further aggravated when treatment is withheld, both for their injuries and for their addictions, and aggravated further still when it is punished with incarceration.
One must wonder whose interests then are being served?
Xenakis promises that "our leadership heartily endorses" what this report is hoping to accomplish. It should. Its recommendations are an important step in the right direction.
But it should be held to that promise.