Healing Combat Trauma

Reservists, Guard Personnel at Risk for Alcohol-Related Problems

Higher Risk of Alcohol-Related Problems for Reserve, National Guard Personnel

Younger service members and Reserve and National Guard combat personnel returning from the wars in Iraq and Afghanistan are at increased risk of new-onset heavy drinking, binge drinking, and other alcohol-related problems, according to a recent study in The Journal of the American Medical Association.

Isabel G. Jacobson, MPH, of the Naval Health Research Center in San Diego, and colleagues examined whether military deployment to the wars in Iraq and Afghanistan is associated with new-onset or changes in alcohol consumption, binge drinking behavior, and other alcohol-related problems. Data were derived from questionnaires completed by participants at the beginning of the and follow-up. After the researchers applied exclusion criteria, the analyses included 48,481 participants (active duty, n = 26,613; Reserve or National Guard, n = 21,868). Of these, 5,510 deployed with combat exposures, 5,661 deployed without combat exposures, and 37,310 did not deploy.

The researchers found that among Reserve or National Guard personnel who deployed with combat exposures the rate of new-onset heavy weekly drinking was 8.8%; the rate for new-onset binge drinking was 25.6%; and for new-onset alcohol-related problems, 7.1%. Among active-duty personnel, new-onset rates were 6.0%, 26.6%, and 4.8%, respectively. Among Reserve/Guard personnel, deployment with combat exposures was associated with increased odds of new onset of all three drinking outcomes compared with nondeployed personnel, with heavy weekly drinking (63%) and alcohol-related problems (63%) showing the strongest association.

Among active-duty personnel, those deployed with combat exposures were at increased odds (31%) of new-onset binge drinking at follow-up. Those born after 1980 were at 6.7 times increased odds of new-onset binge drinking and 4.7 times increased odds of new-onset alcohol-related problems. Those with PTSD and depression were at increased odds of new-onset and continued alcohol-related problems at follow-up.

“These results are the first to prospectively quantify changes in alcohol use in relation to recent combat deployments. Interventions should focus on at-risk groups, including Reserve/Guard personnel, younger individuals, and those with previous or existing mental health disorders,” the authors concluded.

— Source: American Medical Association 

PTSD: (That's Some) Pretty Terrible Sh*t (to Have to) Deal (With), Don't You Think?

Editor's Note: We commemorate the otherwise momentous, historic signing of the GI bill into law today with this little snippet of what life was like for someone who served recently.  For everyone who doesn't "get" what sacrifice is, and that those who've served have earned their accolades and rewards, here's a grunt's-eye view of the experience of combat trauma, and how that relates to PTSD and various other topics in the news.  It's doubtful that any one of us would like to have changed places with him, at such a young age.  Herewith, his story, emphasis mine:

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I'm no Vietnam vet, but a vet of Operation Iraqi Freedom. I turned 18 while in boot camp because I graduated high school at 17. I was discharged early for having "personality disorder" after I went to Iraq.

I was in the Marines, and my MOS was a ground communications electronics technician. A couple months after graduating my training for the job and going to my first unit, I was "volunteered" to join and train with another unit that was leaving soon. The new task I was given was "Mortuary Affairs".

This group was put together with a couple dozen other Marines from other sections. Our job was to go to locations where troops had been killed and not able to be retrieved by the group they were out with due to the fact they were under too much danger or whatever the case. I had no clue the effects this would have on me. It was a horrible experience.

It was not like going and picking up a corpse and that's it. For one, you were in a hot zone, where people were just killed, not just by gunfire.

Here are some brief descriptions of the missions I was a part of...
 

The first one wasn't too bad; the body was actually brought to us at the camp we were at.

 

It was a young male Marine. He was supposedly in a Hummer going somewhere and might not have been wearing his helmet. He had a silver dollar sized hole in the side of his head.

When we get the bodies back the camp we have to take off all materials on the body, and go through and bag each individual body part. It was more of a surreal experience really, I did not know how I was supposed to feel.

Once our troops invaded Fallujah was when things started to get worse. On another of the missions, a truck carrying fuel was crossing a bridge and was shot with an RPG. The truck went off the bridge and fell, the fire burning most of everything.

 

When we went out it was usually just a dozen of us with maybe 2 Hummers of security if we were lucky. For anyone who doesn't know, most the Hummers used were old and poorly maintained/equipped... almost no armor. So we get there and head down to the bottom where the truck fell and we had to pull out burnt bodies from inside of the cabin.

 

It sounds bad, but burnt bodies are almost like burnt food... so perhaps it wasn't as bad as the rest. It did not help our appetite when we had to eat in the same building we processed the bodies in. Our shop was just a medium-sized bunker, no walls or anything so yes we basically ate next to the bodies. It is obvious why some of us didn't eat the meat.

 

The worst mission I went on was when an army tank was traveling down a road and was blown up from a roadside explosive. The bomb was so powerful: you could not identify ANY part of the tank except for the tracks. It had been tossed a couple hundred feet in different directions.

 

It took us I think, about 15 hours to do this mission. There was gunfire when we first arrived but nothing more. I think we picked up a couple thousand pieces of flesh that day. Going through each one individually. They would range from small penny-sized pieces to legs, torsos, heads, feet, testicles, arms, etc.

 

There were a few more missions but we get the idea by now I'm sure. I guess it started to become noticeable that I wasn't doing well. I was taking whole boxes of NyQuil tablets and drinking bottles of medicine to get anything I could out of it at night. I smoked probably a pack of cigarettes a day, which is a lot for me because I have never really smoked more than a couple cigs a day if at all.

 

My officer had me go speak to the chaplain and from there a navy doctor who was a great person to have over there. He pulled strings and had me med-evac'd out of there a few weeks later.

 

In the meantime I had been moved out of my job until I was able to leave. I was harassed for leaving: superiors thought I was just faking to get out.

 

I had become highly depressed and my roommates noticed me screaming sometimes in my sleep.

 

From Iraq I spent a few days at an army hospital in Germany, talking to various doctors and such... going through the process.

 

I was being given pills for depression and for insomnia. Then I made it back to the US and once at my base I was seen by a psychologist. They actually gave me the option to get of the military, so I did.

 

I had been told the process takes several months to year until you finally leave. In the meantime I started drinking daily, and stopped taking the pills they gave me because they seemed to numb my mind and I could not stand it because I have always had such a wonderful and creative mind. It made me feel like a zombie, I could not even create artwork which was my biggest hobby.

 

A month down the road I started having nightmares, very detailed and morbid. A few times I would wake up with tears. I began having suicidal thoughts and crying at least a few times a day. Thank God my best friend was stationed not so far, he saved my life I think.

 

It was hard for me to wake up because of the medicine I had been taking, that’s another reason I stopped it, I was always drained. The first week I was back I never even reported back to my old unit, I didn't know what I was doing.

 

A week later they send somebody to come get me. There, I was harassed and treated like a piece of s%#t some more by my master sergeant. They had me sit in inventory room all day while I struggled to stay awake. I luckily had a very kind staff sergeant in charge of me at the time. He would let me sleep and go home early.

 

I admit I was very lucky in getting out, because it only took me about 2 months until I was officially a civilian again. I was going back home. I stayed with my older sister and her boyfriend at first, because I was not too fond of going back to my parents. My depression got worse and I started to drift further from sanity and comfort; people noticed I was a different person.

 

At this point I started smoking marijuana occasionally. Which was really the only time I felt anything, happy, able to think, speak, talk to people, feel normal.

 

Eventually I moved back with my parents and that's when things got worse for me. I had some additional problems I know was facing, I needed a job, and had people on my back constantly. I had no access to marijuana during this time.

 

My insomnia got to its peak to where I could not sleep AT ALL at night. I also began having more suicidal thoughts, nightmares got worse and I had them ANY time I could sleep which was usually from 7:00 AM to 12:00 PM, began having auditory and visual hallucinations everyday, and constant anxiety.

 

I knew I had PTSD and that the military used "personality disorder" so that they would not take the rap for it.

 

I finally couldn't take the insomnia anymore and was prescribed Ambien, which actually works extremely well and helped get my body back on schedule, only thing is I had to take it for 3 months and then no more because they said it was addictive.

 

So it became difficult without it. I did a long process of seeing doctors and filling out paperwork for the VA and was finally officially a disabled vet due to chronic Post Traumatic Stress Disorder, normally referred to as PTSD.

 

I started to be able to get a hold of marijuana again and when I had it things were more stable. My temper was not out of hand and I could sleep comfortably having less nightmares. At this point I had gone a year or more straight of having nightmares every night.

 

It has been three years now and I am much better. Time has healed me a little and I smoke marijuana as often as I can. I don't have hallucinations anymore, or rarely any nightmares. I do however still have bad anxiety, temper, and depression problems when I'm not high.

 

Another thing I forgot to mention is that PTSD has basically ruined my memory. Since I first showed symptoms until now, my memory does not work nearly as well as it should.

 

I still have major problems concentrating and working sometimes too. It makes interviews and other social activities near impossible for me, as I cannot speak or express myself as I used to. I get very nervous and my mind blanks out sometimes. I cannot say if marijuana will help all my problems, but I can say marijuana helps me feel alive.

 

Being high is the only time I feel good and happy, deep down. I can be around loved ones or any social crowd without tweaking out from anxiety, I can think and operate much more smoothly, I don't have a short temper, and it makes me want to live.

 

The past couple months have been rough on me and I have been going to the VA hospital here to try and get help. The first 4 times I went, they did the same exact thing which was to ask a series of questions, ask me if I want pills and send me home. I kept telling them I did not want pills because I have seen what they have done to people I know and what they have done to me.

 

All I wanted was someone to talk to.

 

After the fourth time of going in there feeling like I wanted to die, they finally got someone for me to talk to. We have just met once so far, but I think it will be good for me.

 

In the meantime I have not been able to smoke recently because I am trying to find another job, which is not going too well and I only have a couple weeks before my current job ends.

 

I have had a few interviews but blow them miserably because it’s getting harder and harder for me to go through the whole thing without my nerves choking me to death. It’s only been a week or two since I smoked last and my temper and depression are already busting through the door. I worry too easily and stress out to the extreme.

 

Take what you will from this story, but I know for a fact marijuana has saved my life numerous times.

 

-- One young former Marine's story, in his own words. Used with permission.

Editor's note: "Mortuary Affairs" was also the detail highly-decorated Marine ("Marine of the Year") Daniel Cotnoir worked in Iraq, before a combination of circumstances, including PTSD, triggered an event in his hometown of Lawrence, Massachusetts -- which got him arrested, and barely escaped conviction.  We have blogged about Daniel Cotnoir's case many times on this blog, going back several years, when it was current.  It's safe to opine, that even within the trauma of war, some things are harder to endure than others.  Our guess would be, mortuary affairs really qualifies for extreme hardship and exposure to things that make PTSD an occupational hazard.

The Blunt Truth: Combat Veterans, PTSD and Medical Marijuana

There's a great article on the Web from the Salem (Oregon) News-Record of June 11, 2007, called "Marine Combat Vet Discusses Iraq, PTSD and Medical Marijuana," linked here.  The former Marine in question is Nicholas Burgin, and the subhead to the article is, "The courage of an Iraq War veteran continues in his honesty about PTSD."

In the tradition of Tony Neff's story, "All I Want is What I Deserve," about getting his veterans benefts for a service-connected disability, linked here, Nicholas Burgin's story is another great, first person narrative account of his experience, and what actually happened to him.  (We're in the process of seeing if we can get Burgin's permission to reprint his story in full, here, because it would help so many readers.)

In the meantime, read his story, while it's still up on the Web, or save yourself a copy of it, for future reference.  It's powerful.  And don't neglect reading the comments section, either, that follows the article.  A whole lot of people checked in and said they knew what he was talking about, and they agreed, from Vietnam vets through other OIF/OEF combat vets.

Burgin is a young Marine who, like a highly decorated Marine with PTSD we've blogged about here, Daniel Cotnoir, worked in mortuary affairs for the Marines in Iraq - a more gruesome job hardly exists -- and saw enough stuff to last a thousand lifetimes.  Later on, of course, Burgin had trouble with the memories, and despite trying everything recommended to him, found one and one thing only that helped him ease the pain.  He details his struggles, and his victories, in the excellent, first person narrative, and closes with the line, "Take what you will from this story, but I know for a fact marijuana has saved my life numerous times."  Good for him.

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In the 60s, draft dodgers and anti-war types in the U.S. made their way to Canada to ride out the Vietnam war.  Many stayed for years.  Today, with an all-volunteer military, "escaping" to Canada isn't nearly so popular; but if anyone compares the drug laws in the U.S. and Canada re: marijuana use, and finds themselves overly hassled by the perspective in the U.S. that it's still a criminal offense, they might start to find Canada more attractive again.  Depending on whether the party in power is liberal or conservative, their drug policy waxes and wanes, but more than 51% of Canadians are in favor of decriminalizing marijuna use, says the BBC, and using is often treated differently there than selling (possession v. intent to distribute).

One Marine Reflects on His Battle with PTSD

Back in January, The Marine Corps Gazette published the account of one Marine's own struggle with PTSD.  The Marine was 1st Staff Sergeant Travis N. Twiggs, and the article was called "PTSD: the War Within - A Marine Writes about His PTSD Experience."  Twiggs had four deployments with OIF/OEF: one to Afghanistan, and three to Iraq.  He writes fairly bluntly about what his experience with PTSD was like; how it crept up on him; what the process of admitting that he had it was like; and what he did to recover from it.  He also writes a postscript about what his like has been since then.  I've tried to contact Twiggs several times and the Marine Corps Gazette, to see about getting permission to reprint Twiggs' story on this blog; but haven't heard anything back.  That makes me concerned that perhaps the end of the story isn't as positive as it seemed it was going to be; but I hope that I'm wrong about that.  Twiggs' writing his story about his own fight with PTSD is a very powerful thing.  While many veterans obviously suffer from PTSD, not many have come forward to really talk about what it's like to have had it, and to have made progress in overcoming it.  That's why Twiggs' story is so valuable.  It also has the added benefit of being a story by a combat veteran to other veterans -- with all the shared camaraderie and empathy that implies. I hope things continue to go well for Twiggs -- his example and his openness can really be helpful to other veterans who are suffering from combat trauma.

Some items that stand out from his story:

• A triggering point: arriving back in the U.S. after his third deployment, and being greeted by the families of the two Marines who were killed in action on his tour at the homecoming for his battalion.  It seems to have pushed to the forefront of his mind the question, "Why them, why not me?" which is classic for people to ask.  "From then on my life began to spiral downward," he says.
• At another point he describes being back from the front: "When I arrived back in the States, it was as though I had never left. All of my symptoms were back, and now I was in the process of destroying my family. This was all taking place because I did not understand what was happening to me. My situation worsened, if you can believe that. I started neglecting my work, and my answer for everything was alcohol."
• In other point, he describes with great poignancy the real battle within himself: "The true horror of war is coming home without all of your Marines, because at some point you have to look at yourself in the mirror and wonder, “Did I give them my all?” “Did I train them to the best of my ability?” I could not answer yes to either question. I still can’t and wonder if I ever will." (That last point also makes me concerned about how fully he's been able to put this in the past; it's probably still far too difficult to - and there's definitely no shame in that.)

Another constructive part of the article is the recommendations he offers as a layman, about what he believes helped his PTSD, and what might help others.  Here are the majority of things he says he learned from the experience, that he can recommend to others:

• Medication alone will not calm PTSD symptoms. Therapy is a must, and it has to be done with others who have experienced the same war or conflict. In other words, veterans of Operation IRAQI FREEDOM should not be undergoing therapy with Vietnam or Operation DESERT STORM veterans. The symptoms are the same, but the time periods are different.
• Alcohol and pills don’t mix. The Marine/sailor should never be told that moderate alcohol consumption is acceptable.
• It is okay to mourn those you’ve lost, but remember, they don’t want you to be sad. They want you to celebrate their lives.
• PTSD is not a weakness. It is a normal reaction to a very violent situation.
• I firmly believe that a lot of my [subsequent] problems were caused by overmedication. The medication affected my judgment and my ability to cope with the true issues that haunted me. I also have since suffered from a seizure, which is believed to have occurred from the same cause. So, ensure that the Marines/sailors know that it is okay to question the amount of medications they are taking and why.
• Place more emphasis on the post-deployment health questionnaire all Marines/sailors have to fill out before leaving theater. I remember Marines being told that if they marked “yes” to anything, it would cause problems with their taking leave. They don’t know that PTSD is not even noticeable until they come home. Marines/ sailors should fill out these questionnaires honestly when they get back in garrison, and they need to know that it is okay if they are experiencing difficulties readjusting.
• Leaders should sit down with their Marines/sailors prior to releasing them for leave and cite different examples of PTSD so that they know what to expect and how to recognize the symptoms. When they return from leave, leaders should get them enrolled in as many schools as they can. Regardless of whether they can get them into the schools or not, leaders should set up a well-planned schedule for them.

Wherever you are, Travis Twiggs, best wishes for your continued health and healing.  Thanks for being strong enough to write this; thanks for sharing it with your fellow combat veterans. 

Editor's Note: A copy of the original article is linked here; a PDF copy of it on the Web is also linked here.

Alcohol No Cure for Painful Memories, Study Finds