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The Need for Specialized Long Term Residential Rehabilitation for Veterans



Introduction

Substance Use Disorders (SUD) are prevalent in the United States. Substance use among US Military veterans is a persistent problem. The US Department of Veterans Affairs currently operates over 60 residential treatment facilities specifically geared to veterans. Many of these facilities are subacute treatment facilities with programs lasting from 21 days to six months. This research establishes a need for specialized long-term treatment for veterans.
Overdose Deaths
The West Virginia Department of Health and Human Services (WVDHHR) tracks the numbers of overdose deaths that occur in WV each year. Those findings include statistics of veterans overdoses. According to WVDHHR, roughly 7.5% of the overdose deaths each year are veterans. Peltzman reports that the Veteran’s Health Administration (VHA) is making a concerted effort to curb the numbers of veterans who succumb to overdoses each year. Peltzman goes on to report that 2/3 of US veterans do not utilize VHA services however. These statistics emphasize the need for specialized long-term residential rehabilitation (RR) centers for veterans outside of VHA jurisdictions.
Effectiveness of Existing Services

There is very little literature about the effectiveness of non-VA facilities treating veteran addicts. The literature that exists focuses primarily on the efficacy of VA facilities. This literature shows that relapse rates among veterans are extremely high. According to Chang, >50% of veterans who are treated for SUD relapse within their first year of recovery. Chang finds in a study that ~50% of the subjects studied were readmitted to hospitalization for a SUD related diagnosis within one year of residential rehabilitation. Chang says the stability of both substance use and mental health outcomes in “relationship to services received” is an important variable on outcome. Clients must have all their psychosocial needs addressed or they will relapse. The failure of the current system to address the psychosocial needs of addicts is apparent. Veterans have even more specific needs that go unaddressed by current treatment modalities.
Lin reports that heroin and other narcotics overdoses increased among VHA populations despite substantial efforts made by the VHA to curb those rates. This supports the hypothesis that veterans suffer from addiction recidivism due to inadequately addressed psychosocial needs which will be elaborated on later. Li agrees that veterans relapse rates are extrem ely high and says that in a four-year study 14.7% of the subjects studied who had completed a RR programs relapsed into active addiction and 23.5% were suspected of having relapsed into active addiction. This emphasizes that current modalities do not address veteran specific issues. One of the issues often left unaddressed by RR centers is readjustment issues.
Readjustment Issues
Dererfinko quotes from a finding of the Pew Research Center in saying that 44% of the veterans studied reported having difficulties in readjusting to civilian life. A veteran of 28 years of service told this author of his separation issues. He reported that he had been an employee of a supermarket prior to enlistment and used his veteran’s preference to obtain reemployment by that supermarket. He said he experienced incredible angst upon receiving his first paycheck because he realized he had essentially been working to earn enough to pay for his transportation to work and his meals while working. Transportation and such things are provided by the military. The veteran reported that like many newly discharged veterans he experienced incredible culture shock after leaving a total institution that provided nearly everything and encountering an environment which provided nothing. This angst is reported by many veterans this author has encountered. Derefinko reports that these problems “lead to poor coping” among newly discharged veterans and often result in “severe and chronic’ substance use disorders that may have originated while on active duty.
Derefinko uses data from the 2011 Department of Defense Health Related Behavior Survey that says that 84.5% of active-duty personnel report regular use of alcohol, and 25% of active-duty personnel report “moderate to heavy use.”
VHA Reports: Suicide, Mental Health

It stands to reason that coping mechanisms learned in active duty, i.e., consumption of alcohol and drugs transition to civilian life. Data from the Department of Veterans Affairs reports that the rates of veterans reporting with SUD or mental health problems in 2016 were substantially higher than rates among veterans in 2001. Edwards finds that between 25-37% of veterans presenting at VA Medical Centers receive or have received psychiatric care. Edwards also draws attention to veteran’s suicide rates, veteran’s incarceration, and veteran’s homelessness. Edwards goes on to say that veterans are 150% more likely to die from suicide, over 50% more likely to experience homelessness, and 6.5% more likely to be incarcerated than
the general population. Each of these situations is exacerbated by SUD.

Readjustment / Military Separation Issues

Derefinko states that the evidence of increased rates of mental health issues and substance use disorders among military personnel returning to civilian life points to a “need to address” the mental health needs of these veterans. Derefinko adds that the shortage of studies regarding separation issues is “no small oversight.”
The Derefinko report goes on to state that 47% of the veterans studied reported readjustment issues upon returning to civilian life. These findings are consistent with the findings of this author in informal interviews with veterans. Readjustment issues identified by the veterans in the Derefinko report include issues such as being able to adequately express or describe experiences to non-military personnel. Veterans often express this same concern to this author with expressions such as “civilians have no clue.”
This angst in turn leads veterans to SUDs and mental health issues as veterans often quit trying to express these experiences to family and friends. Instead, the veterans start bottling up anger, stress, and anxiety. Teeters says that “environmental stressors” specific to veterans and military personnel have been linked to increased risk of developing SUDs, including combat exposure, deployment, and “post-deployment civilian / reintegration” issues. Teeters says that misuse of opioids is also on the increase among veterans. Teeters goes on to say that veterans use of illicit drugs is roughly equivalent to the civilian population with roughly 4% reporting the use of illicit drugs in the months reported. Hinrichs reports that a subacute residential rehabilitation center associated with the Veterans Health Administration has seen an increase of admissions of veterans with polysubstance SUDs in the three years prior to 2016. These increases are also reported by the VHA in general.
West Virginia / Appalachia

This is consistent with findings from the WV Department of Health and Human Resources which tracks the rates of overdose deaths in West Virginia. Veterans accounted for roughly 7.5% of all overdose deaths in WV between 2015 and 2019. The need for access to improved services for veterans is apparent. The VA currently offers over 60 residential rehabilitation treatment centers for veterans across the USA. One such facility is located at Woody Williams VA Medical Center in Huntington WV and one is located at the Louis A. Johnson VA Medical Center in Clarksburg WV. These are short-term facilities however, offering subacute residential rehabilitation. The need for long term residential rehabilitation centers that specifically address veteran’s issues is apparent. These facilities must be staffed with veterans or personnel intimately familiar with veteran’s issues with whom veterans can establish rapport. These facilities must address not only the SUDs and co-occurring mental diagnoses, but also address the readjustment issues so prevalent among veterans. Chang reports that recidivism among SUD patients in the year after treatment is about 50%. These statistics show that problems exist in current treatment modalities.
Conclusion
Post-separation and readjustment issues are an understudied and neglected segment of scholarly research. This paper set out to establish that a need exists for further research into the relationship between readjustment issues and SUD in veterans and to establish the need for long term treatment facilities that specialize in the treatment of veterans with SUDs. It began by exploring the literature in existence and establishes that few such studies have been conducted. The fact that most of the studies that have been conducted center around the VHA was then established. Little literature exists that studies the outcomes for non-VHA established veterans although many veterans choose not to use the VHA. The literature establishes that the occurrence of SUDs among veterans is on average with civilian populations and that veterans experience a recidivism rate of about 50% within the first year after residential rehabilitation and treatment. Overdose death rates in West Virginia are studied. These studies establish that approximately 7.5% of all overdose deaths in West Virginia are veterans. This then establishes the conclusion that a need for long term residential treatment specializing in the treatment of veterans, which address veteran’s readjustment issues in West Virginia is an imminent need. Veteran’s overdose death rates are surpassed only by suicide rates. The need for long term treatment of veterans with SUDs is pressing. The literature examined pertains to VHA affiliated veteran populations. There is little or no available research pertaining to veterans who do not access VHA services, yet conservative estimates are that 2/3 of honorably discharged veterans do not access VHA services. Shiner estimates that Operation Iraqi Freedom veterans access the VHA for Post Traumatic Stress Disorder at a rate of 58%. However, this leaves 42% of those veterans unaccounted for. Haibach says that there are about 21 million veterans living in the USA. Yet estimates from Ohl state that only 5.9 million veterans access VHA services. This leaves about 15 million veterans who do not access VHA services for whatever reason. The literature does not address these veterans. The veterans addressed in known literature access VHA services, which specializes in the treatment of veterans health disorders including SUD. The remaining 15 million veterans access civilian medical centers, many of which are unaware of the specialized needs of veterans. This makes the need for research into post-separation issues and the correlation between post-separation issues and SUD readily apparent. Veterans suffer from SUD at a rate equal to or greater than civilian populations due in part to these untreated post-separation issues. This urges the need for LTRR treatment centers specializing in veterans care that are not affiliated with the VHA.


Bibliography

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