200,000 US veterans are in prison or jail, many of them there because
of substance abuse or mental health issues, according to a new report
released Wednesday. The report outlines the problem and suggests
reforms that could ease the plight of American soldiers returning from
the war zone and trying to make the transition back to civilian society.
VA Medical Center, Columbia, MO
According to the report, 140,000 vets were in prison in 2004, with tens
of thousands more serving time in jails. Nearly half (46%) of vets
doing time in federal prison were incarcerated for drug offenses, while
15% of those in state prison were, including 5.6% doing time for simple
possession. Three out five (61%) of incarcerated vets met the criteria
for substance dependence or abuse.
The report, Healing a Broken System: Veterans Battling Addiction and Incarceration,
comes at a critical time. With hundreds of thousands of soldiers
currently deployed in Iraq and Afghanistan, the US faces a mounting
challenge in caring for returning vets.
Many are returning home damaged by their experiences. According to
the report, 30% of Iraq and Afghanistan veterans report symptoms of
Post-Traumatic Stress Disorder (PTSD), traumatic brain injury,
depression, mental illness, or other cognitive disability. These
medical conditions, if left untreated, can contribute to problematic
drug use, addiction, and fatal overdoses, as well as homelessness,
suicide, and criminality, particular violations of the drug laws.
While the study mentions 200,000 vets behind bars, the number is
most likely much higher. That's because owing to problems in data
collection -- a problem in itself -- the last year for which hard
numbers on vets behind bars is available was 2004. Since then, more
than a million more vets have returned from their deployments and
The report had its genesis about a year and a half ago, when the Drug Policy Alliance
(DPA) teamed up with a classroom of law students at Northeastern
University in Boston to investigate the obstacles veterans were facing
in obtaining adequate access to mental health and substance abuse
services. In addition to a series of surprising and dramatic findings,
the report also includes a list of specific recommendations about how
to improve services for vets suffering mental health and substance
"We learned that far too many returning vets are falling victim to
the war on drugs because of barriers to effective treatment," said
DPA's Dan Abrahamson at a Wednesday press conference. "There are nearly
a quarter million vets behind bars right now for crimes motivated in
part by mental health or drug addiction problems. One third of
returning vets report symptoms of Post-Traumatic Stress Disorder
(PTSD). Also, vets suffer from traumatic brain injury, depression, and
mental illness at higher rates than normal. All of those are
contributory factors to substance abuse and drug addiction, as well as
overdose, homelessness, suicide, and being arrested for a non-violent
In the battle theater, soldiers are supposed to function despite
high stress, and the military is more than willing to prescribe them
whatever it takes to keep them fighting. But it's a different story
when the vets come home.
"Service-related drug dependency is being talked about quite a bit
in the veterans community, but is not well understood outside the
military," said Tom Tarantino, an Iraq war veteran and now legislative
associate for Iraq and Afghanistan Veterans of America.
"The ease of obtaining prescriptions in theater is staggering," he
explained. "I know crack dealers who are more discriminating about
issuing drugs than some of the medics I saw in Iraq. It's alarming how
many people were just given anti-depressants instead of asking whether
they were really fit for duty," said the veterans' lobbyist.
"Sometimes, it's just a matter of expediency and life in a combat
zone, but then you have vets coming back from an environment where meds
are very loosely prescribed and they are confronted with a medical
system much more stringent about issuing drugs," Tarantino explained.
"And that can cause problems."
"Let's be smarter than the problem," said veterans' advocate Guy
Gambill. "We can't afford not to be. We arrest too many people and
incarcerate them for too long. Then the mark of a criminal record keeps
them from getting jobs, housing, and other services, and then the
recidivism rate goes up."
There are things that can be done, Gambill said. States can change
their incarceration policies. Localities can be more proactive.
"Chicago police and the LAPD are doing front-end interventions,"
Gambill noted. "In LA, trained peer specialists are doing ride-alongs
with the LAPD so the officers will recognize Iraq and Afghanistan war
vets. In Chicago, police are doing crisis intervention training, and
the first hundred of them are all Iraq and Afghanistan vets. They'll
try to grab these guys at first contact and get them into treatment
instead of jail. These sorts of peer-led interventions work very well.
We need to catch this on the front end, so we don't have 200,000
homeless vets on the streets like we do now."
Another stumbling block is the Department of Veterans Affairs
current policy on drug treatment for vets. The VA is willing to offer
treatment, but not for vets behind bars.
"We need the Department of Veterans Affairs to lift their ban on
drug treatment of incarcerated vets," said Tarantino. "We're pleased
that the department now has a justice coordinator at every VA hospital,
but they're waiting outside the prison door, not inside, when the vets
need it most. This is a regulation they can change with the stroke of a
pen," he said.
Yet another problem for vets, especially those with substance abuse
issues, is the lack of access to proven treatments. And because the
insurance provided to soldiers by the armed forces also covers their
families, lack of access to treatment affects them as well.
"Vets don't qualify for substance abuse treatment unless they are
diagnosed with PTSD," said Abel Moreno, a former Army sergeant who saw
service in both theaters and who now works with veterans through his
organization Vets 4 Vets. "We are fighting two wars at once. It's
obvious PTSD exists, and it's clear there are going to be substance
abuse issues. We've created a subgenre among today's vets where there
is a pain pill-popping mitigation ideal. We need quantified data so we
can attack this situation head on," he said.
It's not only in failing to provide drug treatment absent a PTSD
diagnosis where the DOD falls down, said Dr. Bob Newman, MD, director
of the Rothschild Chemical Dependency Institute at Beth Israel Medical
Center in New York City. "Tricare, the Department of Defense insurance
plan refuses to pay for maintenance treatment of addiction with
methadone or buprenorphine," he noted. "Maintenance therapy is not a
new idea. It's endorsed by agencies such as NIDA, SAMHSA, the Institute
of Medicine, and the World Health Organization. The US government
supports this, yet DOD has an insurance plan that excludes maintenance
treatment without explanation. That's outrageous," he said.
Tricare insures not only military personnel, but also their
families. Tricare's refusal to pay for maintenance therapy nearly cost
Teresa Bridges her daughter. Teresa's daughter, Amanda, married a
soldier, Sgt. Shawn Dressler. Dressler was killed in combat shortly
after the couple were wed, and Amanda retreated into a haze of Lortab
and Tramitol. Tricare paid for her treatment, but after a year, her
doctor noted on her records that she was being subscribed maintenance
doses of Suboxone.
"Suddenly, Tricare dropped her like a hot potato," Bridges said.
"Tricare believes taking Suboxone is just substituting one addictive
drug for another -- at least that's what they told me. Amanda has done
well on Suboxone, and if she stops taking it, she will eventually
relapse. Fortunately, she is now in a temporary assistance program, but
that will end after a year."
There are potential reforms that could ease the plight of returning vets, the report said. Among them are:
- Changes in state and federal statutes to focus on treatment instead
of incarceration for veterans who commit nonviolent drug-related
- Adoption by government agencies of overdose prevention
programs and policies targeting veterans who misuse substances or take
- Significantly expanded access for veterans to
medication-assisted therapies such as methadone and buprenorphine to
treat opioid dependence.
"The care and feeding and support of vets is a national concern and
responsibility," said Gen. Stephen Xenakis, MD, Special Adviser to the
Chairman of the Joint Chiefs for Staff, Warrior & Family Support .
"We are looking to knit together all the various services and
institutions so that the soldier who has served and come home and ends
up having problems or maybe ended up incarcerated gets treatment from
all the sources available."
One of the big problems, said Tarantino, is lack of hard
information. He noted that the Justice Department numbers in the report
are from 2004. "In 2004, there were over one million fewer vets than
there are today," he said. "We don't know how many vets are behind bars
right now. We have no method for tracking vets unless they interact
with some social services. We need to have DOD and DOJ compare lists.
We need data," he said.
Lack of coordination among agencies dealing with vets is part of the
problem, said Xenakis. "We need to better configure what we're doing,"
he said. "Records are not shared. The Department of Justice doesn't
have access to Department of Defense records. We need to get organized
so we can track people over time."
That effort has the support of the Pentagon, Xenakis said. "Our
leadership heartily endorses this," he said. "It is really important
that this information that this information is out there now, and that
we follow it with the best action plans we can create. As a country, we
have a responsibility to support our vets."