Thursday, March 8, 2007

Army Substance Abuse Treatment Program officials see successes in servicemembers



As Soldiers return home from the Global War on Terrorism, the Army here continues to fight a seemingly intractable enemy for America—addiction to drugs and alcohol.

Walter Reed officials pointed this week to a string of successes in treating Soldiers for substance abuse, however, noting that independently-licensed clinical social workers collaborate closely with commanders to preserve manpower while safeguarding the health of the individual.

As an example of success, Harris pointed to Staff Sgt. Jeffrey Lewis, who returned last year from a tour of duty in Iraq after the military transferred his brigade there from South Korea.

After completing an outpatient treatment regimen from July to December last year, Lewis began leading a weekly peer-level meeting for medics and others interested in discussing their issues with substance use.

‘‘If you let the program work, it will work,” Lewis told the Stripe last Friday.

In the war theater, the Army supports Soldiers with combat stress teams, though many Soldiers only experience problems later when they return home and face medical problems and a tough transition to stateside life, he said.

‘‘My coping mechanisms weren’t that great when I came back,” Lewis said. ‘‘Unfortunately for me, and others like me, I turned to alcohol as an answer.”

A temperate drinker before his experience in Iraq, Lewis said he soon began drinking several nights per week, later being diagnosed as a problem drinker but not an alcoholic. As others turn to street drugs and prescription narcotics such as Percocet and OxyContin, Lewis said he turned to alcohol, a drug which is readily available and, ‘‘unfortunately, part of our culture.”

Lewis said he recognized his problem and exceeded treatment expectations by not only attending program meeting thrice-weekly but checking out AA meetings, where he met a broader cross-section of American society who suffer similar problems with substance use as Soldiers returning from war.

‘‘It’s like anything else,” Lewis said. ‘‘You have to put forth the effort.”

The Program

The Army Substance Abuse Program saw 90 or so patients last month, receiving referrals from Soldiers or their commanders daily, in an effort to treat issues ranging from problem drinking to the abuse of hardcore street drugs and prescription narcotics. Though many patients relapse and require six to 12 months of therapy, the overall failure rate for treatment remains relatively low with few Soldiers forced to separate from the Army.

‘‘The numbers of people undergoing treatment at Walter Reed for alcoholism and substance abuse are confounded by the fact that we have so many medical boards and that we’re in a war,” Barbara Marin, PhD, director of the Army Substance Abuse Program told the Stripe on Tuesday. ‘‘People are here for significant treatment and we understand that many of these Soldiers increase their substance use after getting home from a war.”

Yet, a number of Soldiers arriving at Walter Reed suffer not from addiction but from untreated maladies, self-medicating until they begin to receive treatment for medical problems, Marin said.

Controlling liquor sales on post

For Soldiers living on post away from friends and family, the temptation to drink may be answered by a quick three-minute walk to the liquor store on Georgia Avenue outside the front gates or by stopping at the bar in the Mologne House on post.

Thelma Harris, one of the program’s four independently-licensed clinical social workers with a master’s-level certification in addiction, said that while they cannot control liquor sales off-post, they have lobbied the command to further restrict alcohol sales here — a controversial issue given that most Soldiers drink legally and responsibly.

‘‘At our last meeting with the command, they agreed to pull the alcohol from the [commissary] — that just happened recently,” Harris said. ‘‘But we have been advocating to have the bar in the Mologne House closed.”

Aside from alcohol, Soldiers enter the program for abuse of drugs such as marijuana and cocaine and, to a much lesser extent, ecstasy, heroin and chemicals abused by ‘‘huffing.”

To treat the gradient nature of addiction, the program offers four levels of care augmented by referrals to civilian programs and the Health Care Provider Support Group, a peer-level group meeting for medics, as well as weekly meetings of two Alcoholics Anonymous groups.

As patients enter the program, the program’s staff meets to assess the case and, possibly, assign the patient to a care level that may include hospitalization, partial-hospitalization, ‘‘intensive outpatient” care with nine required hours per week or outpatient treatment with weekly meetings and substance testing.

Though adhering to the criteria of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders IV to make diagnoses, program staff tailor the treatment to the individual, making recommendations for care and meeting weekly or more with patients for therapy and substance-use tests.

As addiction varies by the individual, therapists work to identify the route causes of patient symptoms, Harris said.

‘‘Substance abuse is always a symptom of an underlying problem,” she said. ‘‘Someone may be drinking because they’re having trouble managing their [Post Traumatic Stress Disorder] or having unresolved issues from childhood ... or because they are still grieving the loss of a loved one or comrade.”

Therapists remain mindful, she said, that every patient recovers from addiction at their own pace, often getting worse before they get better.

‘‘If I see a guy who is really struggling, I may decide to take it to the next step, which may be a higher level of care such as partial-hospitalization at Malcolm Grove [Medical Center at St. Andrews Air Force Base] or in a residential treatment program at the Naval Station in Norfolk, Va.

Regardless of the care level, Marin said, Soldiers receive support from their commanders, who classify any treatment for substance use as medical appointments taking precedence over other work-related obligations. Working closely with the command at Walter Reed, mental health professionals encounter the same ‘‘dual loyalty” conflict familiar to physicians and other military medical providers, given that they serve two clients: the patient and the command.

To that end, the Army strikes a balance by safeguarding the privacy of individual details but requiring therapists to report major events affecting treatment status such as failed substance-use tests, which, when conducted by the program rather than the unit, do not involve Uniformed Code of Military Justice penalties.

‘‘We are here with a dual responsibility,” Marin said. ‘‘We are therapists to provide clinical care to Soldiers and patients but we are also the commander’s clients and our goal is manpower conservation.”

‘We’re the good guys’

Treatment for substance use in the Army poses no per se penalties against the Soldier, aside from possible military penalties for failed unit-conducted drug tests and any legal problems in the civilian world, Harris said.

‘‘We’re the good guys,” she said. ‘‘A lot of people come to ASAP with misperceptions, thinking that once you’re in [the program] it’s like the Hotel California — you can check in any time but you can never leave.”

Rather, she said, ‘‘we’re here to try to improve the lives of Soldiers not because we want to preach to them or make their lives miserable” butto help them.

Soldiers interested in speaking with a counselor may visit the program office on the second floor of Bldg. 6 at WRAMC.