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
3/21/2016
Exploratory Committee
2


INTRODUCTION OF THE ALLIANCE
The Veterans Health Alliance is a collaborative
effort of over 80 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.
MISSION OF THE ALLIANCE:

“To
promote the health and wellbeing of Veterans and their
Families through advocacy, and
a broad array of services”
VISION OF THE ALLIANCE:

“LONG ISLAND: A
VETERAN FRIENDLY
COMMUNITY”
LI STATISTICS


LI is home to over 152,000 veterans, and is
second only to San Diego in the percentage of
veterans among its citizens.
Over 4000+ Long Islanders have served in Iraq
/ Afghanistan. (Referred to as OEF “Operation
Enduring Freedom – Afghanistan, and OIF
“Operation Iraqi Freedom”)
3/21/2016
Exploratory Committee
6
LONG ISLAND





No Active Duty Military bases on Long Island
(Therefore no access to “on base” services / No strong
military “culture”)
Area saw a 35% increase in military enlistment
following 9/11.
High level of Guard / Reserve members
Guard / Reserve Units have played a major role in OEF
/ OIF. (at certain points in time, Reserves total 40% of
forces)
Guard / Reserves have sustained 50% of casualties in
OIF.
3/21/2016
Exploratory Committee
7
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)
NYS OEF / OEF RESEARCH

2011 Study by the Rand
Corporation for the NYS
Health Foundation indicated
that for NYS Veterans from
Iraq / Afghanistan…..
3/21/2016
Exploratory Committee
9
RAND STUDY





22% had a probable diagnosis of PTSD of Major
Depression
34% had some other concern
Only 1/3 sought help
Stigma, impact on current / future career, and
not having a “buddy” to help navigate a
confusing array of benefits and services cited.
Only 50% received “minimally adequate” help.
3/21/2016
Exploratory Committee
10
National VA OEF / OIF Statistics

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
Long Island Crisis


Since August 2012 there have been 8 either
intentional (i.e. Gunshot) or accidental (drug /
alcohol overdose) of deaths of OEF / OIF
Veterans on Long Island.
Some connections (served in same unit or were
inpatient psych. together)
3/21/2016
Exploratory Committee
12
Reluctance to admit Problems


POST DEPLOYMENT SURVEYS
“Check the box honestly, and you could stand
on another line or ten…and be held over for a
few weeks…while your buddies went home to
have sex with their wives, play with their kids,
or drink beer on the beach”. (p. 253) Paul
Rieckhoff, Chasing Ghosts
3/21/2016
Exploratory Committee
13
Is this war different from others for
PTSD?





CIVIL WAR: “Soldiers Heart”
WORLD WAR I: “Shell Shock”
WORLD WAR II: “Battle Fatigue”
VIETNAM: “Combat Stress” / PTSD becomes
diagnosis in 1980
Can’t compare Vietnam PTSD (some untreated
20+ years) with OEF / OIF PTSD (who may be
treated within days.)
3/21/2016
Exploratory Committee
14
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)
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)
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)
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)
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)
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
20


“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)
3/21/2016
Exploratory Committee
21

“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”.
3/21/2016
Exploratory Committee
22
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)

“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)
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)
(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)
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’”.
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
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
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”.
Mental Health in Today’s Combat
Zone




13 - 17% of soldiers deployed to Iraq / Afghanistan are
taking some form of medication for stress, anxiety,
depression or sleeplessness.
This would not have been done in earlier wars.
2004 New England Journal of Medicine reported that
11% of recruits had a psychiatric history before
entering the military.
Increase in “waivers” from 5% in 2004 to 11% (leading
up to the surge) for issues like marijuana possession,
DUI, misdemeanors and felonies.
3/21/2016
Exploratory Committee
31
Substance Use in OEF / OIF







Iraq / Afghanistan are “dry” countries
US Policy prohibits alcohol consumption there
Alcohol being mailed overseas from the U.S.
Alcohol available from other allies
Steroids being mailed
“Huffing” compressed air / Computer Cleaner
Morphine being mis-used
3/21/2016
Exploratory Committee
32
SGT. BALES INCIDENT

Army alleges that SGT.
Bales was using alcohol
and steroids on the
night of the incident.
3/21/2016
Exploratory Committee
33
Opiates in Afghanistan

In 2010 – 2011 Army
investigated 56 soldiers for
possessing opiates – 8 of
whom died of overdoses.
3/21/2016
Exploratory Committee
34
Drug use among the insurgents

Particularly during battles in
Fallujah – US Forces found
that dead Insurgents had
injected themselves with
shots of adrenaline.
3/21/2016
Exploratory Committee
35
FORT DRUM, NY


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 offlimits in Iraq, at least openly, they were that
much more likely to binge, that much less
able to tolerate it”.
(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”.
(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”.
(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.
(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.
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”.
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
BOREDOM






Deployment / Combat is an adrenaline “high”.
Reintegration:
Less Excitement
“Normal Responsibilities” – (i.e. “Take out the
trash!”)
“Boring” Job
May seek out “thrills” – Driving fast / Spending
$ recklessly / Risky Sex / Use substances
HOMECOMING





HOLIDAYS
FAMILY FUNCTIONS
SEE OLD FRIENDS
GO OUT
INCREASE ACCESS TO ALCOHOL / DRUGS
CAPELLA STUDY: What Helps


77% of service members seeking mental
health services said the assistance was
helpful – with community mental health
providers receiving higher rankings than
military providers.
87% felt that setting a goal (Degree, new
career) was helpful.
3/21/2016
Exploratory Committee
46
LI Response
Veteran Peer Support Groups
in Suffolk County – Funded
by efforts of Sen. Lee Zeldin
 Suffolk County Veterans
Crisis Task Force

3/21/2016
Exploratory Committee
47