The War on Addiction Comes Home

Every war has its “signature” wound. In the Civil War, it was gangrene; in World War I, it was lungs shredded by mustard gas attacks; in World War II, shrapnel. In Iraq and Afghanistan, it's Traumatic Brain Injury, or TBI. With armored Humvees and new body protection, soldiers are surviving massive IED blasts that send huge shock waves through their bodies. The concussive force of five artillery shells exploding beneath a vehicle damages a soldier's brain in ways researchers are just starting to understand.

The symptoms of TBI are similar to those of post-traumatic stress disorder (PTSD); one of the main commonalities is, of course, increased alcohol and drug use. Take First Sergeant Hector Matascastillo, a warrior’s warrior. He finished top of his class in Ranger training, and had boots on the ground in 57 countries with a whopping 13 combat deployments in an 18-year career in the military.

“Multiple tours and violent conflict generate PTSD. Add to that the worst economy since the Great Depression, traumatic brain injury, and suicide and divorce rates that are off the charts—there is going to be a tsunami of addiction, alcoholism and homelessness.”

Seven years ago he was on a “house cleaning” operation in Iraq, sweeping room to room, a pistol in each hand, ferreting out enemy combatants. “My training had taught me that when faced with an armed enemy to kill him,” he says.

This house was clear, but as Matascastillo stepped outside, an enemy stood directly in front of him with his gun raised. Matascastillo’s weapons were at his sides. He was wondering why the man hadn't instantly fired when, inexplicably, the enemy began backing away with his gun raised. Then he tripped on a curb. Matascastillo raised his sidearm and just as he was about to open fire, he heard his wife screaming behind him.

Suddenly, he realized he was standing in front of his modest home in Lakeville, Minnesota. Police lights were flashing all around him. He emerged from a nightmare to a life marked by increased drinking, to nights when he had to "Nyquilize" himself to sleep. This time, a late-night fight with his wife had led to this moment, an extreme manifestation of the damage of Post Traumatic Stress Disorder.

Matascastillo is one of thousands of vets who've dealt with the harrowing transition from combat to civilian life and the complications of substance abuse. Unlike Hector, though, most remain silent, and countless go untreated. The consequences are grave: A recent study reported that a veteran commits suicide every 80 minutes; another determined that in 2009, 1,868 veterans from the wars in Iraq and Afghanistan tried to kill themselves. Clearly, not enough is being done to help.

Defense attorney Brock Hunter has made a study of the relationship between soldiering and booze. “PTSD and alcohol have gone together for as long as there has been war,” he says. “There are clear images of combat soldiers using alcohol going back to Homer and The Iliad.” Alcohol works well for soldiers trying to manage the flashbacks, insomnia, anger and anxiety of PTSD and TBI, Hunter says. “Some veterans have told me that their prescriptions for PTSD are not as effective as alcohol at managing nerves and anxiety. Alcohol is by far the most popular and widely abused [drug in the military]—and the most likely to get them in trouble with the police.”

Hunter specializes in representing veterans who get into legal scrapes, mostly due to PTSD and related alcohol and drug use. And he has seen a dramatic spike in caseload in the last six months. “It's scary,” he says. “I am getting three or four calls a day.”

Lisa Jaycox, project co-leader of a 2008 Rand report on veterans, said, "If PTSD and depression go untreated or are under-treated, there's a cascading set of consequences: Drug use, suicide, marital problems and unemployment."

Veteran’s advocates like Hunter expect the percentage of veterans suffering from PTSD to be far higher than during previous wars. “The United States has the smallest military in our history,” says Hunter, “and we are fighting the two longest wars. Two or three combat tours is commonplace, with some serving as many as eight deployments. And the combat is brutal: face-to-face, hand-to-hand in the street in an urban civilian environment.”

Soldiers returning from the Vietnam War with PTSD led to a wholesale reform of how vets are treated. Veteran’s advocates like Hunter and Shad Meshad, founder of National Veterans Foundation, made sure vets kept benefits if they sought help for mental illness, worked to get services like alcohol treatment programs at VA hospitals, and devised ways to fill holes in VA services—resources like the Vets Clinic, or Military OneSource, a VA facility that protects confidentiality of its patients.

Hunter wants to build on that. In response to the cases he has in Minnesota, he has helped establish a “Veteran's Court” in Hennepin County, Minnesota. He and Meshad are writing a book for other attorneys to help them represent veterans better in the legal system. Says Meshad, “These men and women deserve therapy first; the violence is a result of their PTSD, and they are trained killers.”

Meshad has worked with veterans for over 40 years, helping soldiers from World War I on. He has appeared on Dateline and been quoted in the New York Times, and he was also once held hostage by a disgruntled vet for hours (he later made the veteran a partner in one of his organizations; they're close friends today). He has slept on the streets with homeless vets and testified before Congress. Meshad is not easily rattled, but this time around, with these wars, he's afraid.

“Multiple tours and violent conflict generate PTSD," he says. "Add to that the worst economy since the Great Depression, high incidence of traumatic brain injury, and suicide, violence and divorce rates that are off the charts—there is going to be a tsunami of addiction, alcoholism and homelessness.” According to Meshad, “Los Angeles has the largest homeless population in the country and a third are veterans. It took 15 years for the Vietnam vets to start showing up under the 405 bridge. The Iraq and Afghanistan kids are up there now.”

A Pew Research report published on October 5th, 2011 supports Meshad's point. While over 90% of veterans are proud of their service, 44% report they have had difficulties readjusting to civilian life, 37% say they have suffered PTSD (whether or not formally diagnosed), 48% felt strains in family relationships, and 47% frequently feel irritable or angry.

The report states, “Among all post-9/11 veterans who report having had traumatic experiences during their time in the military, 72% say they have had flashbacks, repeated distressing memories or recurring dreams of those incidents. Among post-9/11 combat veterans, the share is slightly higher—75% of those who say they had traumatic experiences while they were in the service also say they've had flashbacks or nightmares related to those incidents.”

“The military is issuing prescription meds like anti-anxiety and pain medications to troops in combat to keep them from breaking down.”

In 2008, the New York Times reported that Iraq and Afghanistan veterans had committed 121 homicides, but most of the crimes were related to drugs and alcohol; one in four veterans between the ages of 18 and 25 met the criteria for a substance abuse disorder, and 18 veterans a day commit suicide in the United States—a casualty rate that will continue long after the wars end. The Rand study estimated that returning veterans with PTSD and depression will cost the nation as much as $6.2 billion in the two years following deployment.

But the addiction and alcohol issues are not only due to PTSD. Says Hunter, “The military is issuing prescription meds like anti-anxiety and pain medications to troops in combat to keep them from breaking down—and to keep them functioning.” Psychologists are unsure of the impact, but some suggest that by using drugs to keep soldiers functioning who have already been exposed to multiple traumatic events they continue to be exposed when they would otherwise have broken down.

“We've got medicated soldiers fighting because that's all the military has got,” says Meshad. “They have to recycle the soldiers back to the battlefield.” Soldiers with battle wounds are given Oxycontin and fentynal. “Pain medications are a big deal,” Hunter reports. “Vets get addicted and then their prescription ends and they have go out and get it illegally.”

The VA, to its credit, has far better services for soldiers suffering from PTSD than it did for Vietnam era veterans. Yet despite the improvements, the VA is a vast bureaucracy facing a flood of mental health issues. Funding for veterans services requires annual appropriations from Congress, making the survival of vets' programs a constant political football. The biggest problem is that soldiers with PTSD don't go into the VA and ask for help.

First Sergeant Hector Matascastillo lost his family and went to jail after having his flashback. Still, he resisted the idea that he was suffering from a mental health disease.

“The stigma is still very much out there,” he says about seeking help. “As I was realizing that I was not well, I thought if I can't handle this, my superior won't move me forward.” He pauses. “The quick, easy way to deal with flashbacks was to numb it by drinking or even 'Nyquilize' myself so I could sleep.”

One Afghanistan combat veteran interviewed for this article laughs when asked about the idea of a soldier asking for help. “Right, a guy admit he's weak,” he says. “They'd be on him like jackals.”

So the soldiers won't talk to caseworkers, psychologists, or even writers for The Fix. But PTSD, alcoholism and addiction are family diseases, and the wives do talk—but only off the record, and even then only through the relative anonymity of the Internet. Sites like FamilyOfaVet.com, a non-profit organization dedicated to helping heroes and their families survive and thrive after combat, are avenues of hope for isolated wives and family. When I posted on one site for this story, emails trickled into my inbox. The wives want to talk, but they're guarded, suspicious and maintain anonymity. After all, living with a husband suffering from PTSD is a form of combat in itself, and the disease is contagious.

One woman wrote, “I am glad to contribute as long as none of my personal info is used… I am rarely away from my husband and he doesn't want me talking to anyone about him. My husband was diagnosed with PTSD during his first tour…TBI during his 2nd tour. After he…came home…he was very stand off-ish, going out to our garage…alone…in the middle of the night and just sit in the dark. He started sleepwalking…crazy mood changes…an explosive temper…he is…an almost daily drinker…his mind going 24/7. He wants something to block that even if just for a short time.”

She continued, “We cope the only way we can, we laugh as much as possible…at his crazy memory loss, we laugh when his brain can't form the right words. We talk, seriously, on those days when he is doing 'good' so he understands what I am feeling and going through. I give him his space on the days when he is doing 'bad.' I try to treasure all the good days.”

“I am seeing these guys drinking or shooting heroin so they don't have the anxiety attacks or flashbacks,” wrote one wife, who's a nurse at a VA psych ward. “One of the main things we do is detox a lot of really young guys.” Two of her patients have overdosed on heroin.

Another woman called and said, “Addiction is a huge problem.” Her voice was even and quiet, the struggle and turmoil beneath her words like a great weight. “I left my husband at the end of March,” she said. “PTSD turns you into a beast…he was self-medicating…drinking all the time. I am pregnant with his child and he doesn't know and with him using I am not sure what to do.”

One woman takes care of her husband and also works as a nurse on a VA psych ward. “What I am seeing is these guys are drinking or shooting heroin so they don't have the anxiety attacks or flashbacks,” she wrote. “One of the main things we do is detox. We are detoxing a lot of really young guys.” Two of her patients have overdosed on heroin in the last few years.

None of the wives would allow their names to be used. Only a hero like Hector Matascastillo, brave in both battle and civilian life, has stepped forward to speak on the record. The wives understand anonymity. Says one, “I have secondary trauma issues, and it is hard to talk about. Surrounding the military is the stigma that you can't admit to being mentally weak [which] is preventing people from seeking help. The military has trouble recognizing PTSD and they don't communicate that you can seek help without repercussions.”

I pressed the wives, asking them why it was impossible to find a veteran beyond Matascastillo that was willing to talk about his PTSD and struggles adjusting to life after war.

One woman had a startling view. “PTSD changes your brain,” she says. “It makes them angry and kinda jerks; they lose their sympathetic response [where they would normally be] willing to help out with something like this."

Milan Christianson is a veteran who works as a psychologist, human relations and family life specialist and teaches at North Dakota State. He sees a need for groups like FamilyOfaVet. Christianson wrote the book for the Air Force that helps Chaplains help families deal with a major deployment and the return of their soldier. “The VA needs to be more connected with the civilian portion, that piece beyond diagnosis and prescribing medication,” said Christianson. “The military needs to train soldiers and their families to deal with family issues right at boot camp. They (families and soldiers) have not been trained, and they do not know what they are up against.”

The “militaristic culture” of this war, says Christianson, is so much less than in previous wars. During World War II, for instance, with over half of all military aged males serving, the military culture was very much a part of mainstream culture. Not so for Iraq and Afghanistan, with only about 1% of military aged males serving. In addition, World War II Veterans returned to a booming economy and free education in the form of the GI Bill.

Said Christianson, “The number one thing we could do for these veterans is to give them a job or education.”

Congressman Tim Walz, a retired National Guard Command Sergeant Major, elected in Minnesota’s First Congressional District in 2006, agrees. Congressman Walz has become a national leader on veterans issues, serving on the House Veterans Affairs Committee and working to make reintegration easier for veterans and their families. Says Walz, “You need to have a comprehensive approach. From being able to get a good paying job to support your family when you return home, to getting the physical and mental health care you need and have earned, to getting the support your family needs as you reintegrate to civilian life—none of these things happen in a bubble. They are all interconnected and it’s important we approach our work that way.”

Matascastillo is proof that there is life after PTSD. He was finally able to get treatment, and he dove into individual therapy the way he did everything: balls-to-the-wall. “I did intensive therapy for a year, and pilot programs at the VA like spiritual healing, which was awesome.”

During therapy, Matascastillo was able to identify the thing that haunted him, the event from his 13 combat missions that put him on edge: he was in Kosovo in the late 1990s, on a hilltop to witness events and report back to command and ordered to take no action. He watched through his riflescope as the genocide unfolded, as soldiers rounded up and shot the all the men in a village and then raped the women. One woman had her baby torn from her arms and Matascastillo was forced to watch as they shot her child in front of her and then raped the mother. His eye was to the scope of a weapon that could end her misery, protect her child, and bring justice. But his orders were to do nothing and so, impotent, he watched. The horror never left him.

During his trial, many of the officers who Matascastillo had served under came forward. He was able to avoid jail time. He may have lost his wife and home, but not his career. In fact, after his therapist suggested a remarkable way for him to heal himself—by going back into the breach—he was able, with the help of supportive officers and his sterling record, to convince the army to send him back to Iraq in command of a full company of men as their Staff Sergeant.

He knew what these men faced and was relentless in training. “My men hated me,” he says. “I needed to train them hard so that they all came back and could hate me for the rest of their lives.”

They were sent to Al Anbar during the surge and saw heavy action. Matascastillo barely slept during that time—his energy was intense, his mind racing a million miles an hour. “It was a crucible,” he says. “But I brought them all home. Some purple hearts and shattered minds but all alive. Back home we went on parade and read the roster. I turned them all back to the commander and said, 'They are all here.'”

And then he collapsed. He wept. He allowed his racing mind to quiet and the demons to depart. Just two years shy of his pension, he retired and left the military. He got his degree as a psychotherapist and clinical social worker. Now he spends his life trying to help other vets navigate their battle related PTSD, TBI, drinking and drugging. “We do a lot of reality therapy to overcome that stigma,” he says. “We try to re-frame that stigma by being realistic.” His record is such that the jackals don't dare bite, so, like Audie Murphy, the most decorated warrior in American history who broke the code of silence during the Vietnam War, Matascastillo is carrying the message. “It is easier,” he says, “to live the rest of my life without worrying about what the military thinks.”

There is hope, and it is at the VA, warts and all. “The VA is a very frustrating system,” says Matascastillo. “But there you will find the warriors that have gone before you. The Vietnam era broke down a lot of barriers and guys need to be persistent and ask for help.” One of the women's husbands saw a speech therapist that gave him an iPod to help him break free of flashbacks. Apps reminds him of appointments and to-do lists, Cozi.com sends him reminders from his wife for his family calendar, and a special watch given to him by the VA vibrates against his wrist every 10 minutes, reminding him to come back to the “now” if he is slipping into flashback.

According to one of the wives, “Veterans need to register. All benefits depend on registry. The VA doesn't advertise. Soldiers can get five years of health care, and there's the post 9/11 caregiver program— you can apply for it if your husband was severely wounded post 9/11 and you get support and a stipend every month.” The second thing vets should do, she says, is to make an appointment with the transition clinic. If they don't feel like they can come to the VA, there are other resources. She urges the men and their wives to speak out, if only anonymously. “The more exposure we give to PTSD, the less stigma there will be,” she says. “The less stigma, the less self medicating. The less self medicating, the less dependence and addiction and broken families and legal problems.”

One of the wives perhaps best sums up the situation we find ourselves in when she says, “This war has come home to all of us. Now it is being fought in homes across the country. We are in the fight of our lives.”

The Huffington Post Impact has compiled a list of organizations that seek to help veterans like the ones mentioned here. You can read more about those groups, and ways you can help, here.

Jeff Forester is a writer in Minnesota. His book, Forest for the Trees: How Humans Shaped the North Woods, an ecological history of his state's famed Boundary Waters, came out in paperback in 2009. He has also written about sober high schools and relapsing addiction counselors, among many other topics, for The Fix.



