2. 8/19/2015Exploratory Committee2 VETERANS HEALTH ALLIANCE OF LONG ISLAND John A. Javis Director of Special Projects (MHA Nassau County) PHONE: (516) 489-1120 ext. 1101 E-MAIL: jjavis@mhanc.org

3. INTRODUCTION OF THE ALLIANCE The Veterans Health Alliance is a collaborative effort of over 80 mental health and substance abuse providers, county and state mental health and substance abuse oversight bodies, the VA, VET Centers, county Veterans Service Agencies, veterans organizations, elected officials and other stakeholders.

4. MISSION OF THE ALLIANCE: “ To promote the health and well- being of Veterans and their Families through advocacy, and a broad array of services”

5. VISION OF THE ALLIANCE: “LONG ISLAND: A VETERAN FRIENDLY COMMUNITY”

6. LI STATISTICS LI is home to over 152,000 veterans, and is second only to San Diego in the percentage of veterans among its citizens. Over 4000+ Long Islanders have served in Iraq / Afghanistan. (Referred to as OEF “Operation Enduring Freedom – Afghanistan, and OIF “Operation Iraqi Freedom”) 8/19/2015Exploratory Committee6

7. LONG ISLAND No Active Duty Military bases on Long Island (Therefore no access to “on base” services / No strong military “culture”) Area saw a 35% increase in military enlistment following 9/11. High level of Guard / Reserve members Guard / Reserve Units have played a major role in OEF / OIF. (at certain points in time, Reserves total 40% of forces) Guard / Reserves have sustained 50% of casualties in OIF. 8/19/2015Exploratory Committee7

8. BASIC PRINCIPLES: “It is normal for one to have ‘trouble’ after the experience of combat. It would be abnormal not to have trouble.” Colonel George Patrin (SAMHSA Conference August 2008)

9. NYS OEF / OEF RESEARCH 2011 Study by the Rand Corporation for the NYS Health Foundation indicated that for NYS Veterans from Iraq / Afghanistan….. 8/19/2015Exploratory Committee9

10. RAND STUDY 22% had a probable diagnosis of PTSD of Major Depression 34% had some other concern Only 1/3 sought help Stigma, impact on current / future career, and not having a “buddy” to help navigate a confusing array of benefits and services cited. Only 50% received “minimally adequate” help. 8/19/2015Exploratory Committee10

11. National VA OEF / OIF Statistics Of OEF / OIF Veterans seeking help from the VA: * 38% were diagnosed with a mental health condition * 17% had substance abuse issues * 11% had a Traumatic Brain Injury

12. Long Island Crisis Since August 2012 there have been 8 either intentional (i.e. Gunshot) or accidental (drug / alcohol overdose) of deaths of OEF / OIF Veterans on Long Island. Some connections (served in same unit or were inpatient psych. together) 8/19/2015Exploratory Committee12

13. Reluctance to admit Problems POST DEPLOYMENT SURVEYS “Check the box honestly, and you could stand on another line or ten…and be held over for a few weeks…while your buddies went home to have sex with their wives, play with their kids, or drink beer on the beach”. (p. 253) Paul Rieckhoff, Chasing Ghosts 8/19/2015Exploratory Committee13

14. Is this war different from others for PTSD? CIVIL WAR: “Soldiers Heart” WORLD WAR I: “Shell Shock” WORLD WAR II: “Battle Fatigue” VIETNAM: “Combat Stress” / PTSD becomes diagnosis in 1980 Can’t compare Vietnam PTSD (some untreated 20+ years) with OEF / OIF PTSD (who may be treated within days.) 8/19/2015Exploratory Committee14

15. SUBSTANCES AND THE MILITARY CULTURE WORLD WAR II (Crash of Ruin, Peter Schrijvers) In Europe water shortages formed the perfect excuse for GI’s to justify drinking alcohol A soldier in Germany in 1945 wrote home to tell his parents he couldn’t access good drinking water, so he says he, “Wet my whistle with wine and champagne”. (p. 166)

16. WORLD WAR II (Continued) Cartoonist Bill Mauldin remarked, “Drinking was a big thing in a dogfaces life”. (p. 166) Surgeons of the 326 Airborne Medical Company during the invasion of Normandy carried with them 92 quarts of whiskey. (p. 166) During the siege of Bastogne, General McAuliffe said to give the wounded, “Booze for comfort”. (p.166)

17. WORLD WAR II (Continued) At that time, Europe was more liberal with alcohol consumption than the U.S. “It was indeed quite a sensation for GI’s who were attached to British Troops in North Africa to line up for the rum rations in the morning”. (p.167)

18. KOREAN WAR Korean War, Paul Edwards Cigarettes were provided in C Rations. Army Manuals urged leaders to encourage the soldiers to smoke. “When unavailable, it lead to whole platoons of men going through withdrawal”. (p.155)

19. Continued “Beer was provided rather routinely for the enlisted men, along with candy and cigarettes”. (p.155) Issue with drinking was not so much drinking to excess on a regular basis, but binge drinking during periods of “R+R”. (Rest and Relaxation)

20. CARL STINER (Shadow Warriors, with Tom Clancy) When reporting to his Special Forces assignment “The last thing you need to know is we get together every Friday afternoon at four o’clock for happy hour. You’re expected to bring your wife, and your expected to have a 3 rd Special Forces Group mug – which I just happen to sell for three dollars”…”This little ritual of happy hours and mugs might jar people in these politically correct times, but that was the way the Army was back then”. (p. 130) Exploratory Committee20

21. “The social culture in the Army as a whole was far less structured than it is now…Socializing tended to focus on gatherings where everyone drank; Friday afternoon ‘happy hours’ were the norm”. (p. 130) “Remember that we’re talking about only a few years after the end of the Korean War. Or example, in those days commanders were not nearly as involved in the training of soldiers or in the taking care of families. That culture did not really begin evolving until the draft was done away with and we became a volunteer force”. (p.131) 8/19/2015Exploratory Committee21

22. “Instead Commanders tend to host dinner parties at home for the officers and their spouses. It’s relatively relaxed and informal, and drinking is limited. There are pluses and minuses in all this. We probably don’t have as much spontaneity in today’s Army as we did back then, and that’s a loss; but fewer people make fools of themselves, and that’s a gain”. 8/19/2015Exploratory Committee22

23. VIETNAM WAR GENERAL NORMAN SCHWARZKOPF (Vietnam) Upon Taking Command of His Battalion: The outgoing battalion commander…sought me out…”Come back to my hooch”, he said. “I need to talk to you a little”. On the table sat a bottle of Johnnie Walker Black label scotch. “This is for you”, he said. “You’re gonna need it”. (It Doesn’t Take a Hero, p. 175)

24. “ I was expecting a two – or three hour discussion of the battalion, its officers, its NCO’s, its mission – but he only said, ‘Well I hope you do better than I did…this is a lousy battalion. It’s got lousy morale. It’s got a lousy mission. Good luck to you’. With that he shook my hand and walked out”. (It Doesn’t Take a Hero, p. 175)

25. ALCOHOL / DRUG USE IN VIETNAM From American Psychiatry After World War II, Menninger and Case Of 610 soldiers treated by 1 psychiatrist in country, 113 had an alcohol problem. In 1970 an anonymous questionnaire indicated that 29% admitted to using marijuana in country. (p.23)

26. (Continued) Between 1969 – 1971, 9 – 10% of lower enlisted soldiers reported daily marijuana use. By 1970, 90 – 96% pure heroin became readily available. By 1971, 44% of lower enlisted had used heroin. By 1971 there were more evacuations due to drugs than to combat wounds. (p. 24) There were 75 confirmed or suspected opiate deaths from Aug. 1 – Oct. 1970. (p. 23)

27. New York Times Article (March 13, 2007) For US Troops at War, Liquor is Spur to Crime “Commanders have not always regarded drinking as a problem. The Army ‘was a culture in the 1970s that encouraged drinking’, said a retired Army colonel. ‘You’d go out drinking together and you’d find your buddy hugging the toilet at the officer’s club and think nothing of it’”.

28. CONSEQUENCES  In 2007 NYS OASAS (Office of Alcoholism and Substance Abuse Services) served nearly 14,000 veterans  14% under age 35, 19% over 55 years of age. 59% seen for alcohol 17% Crack / Cocaine 17% Heroin / Opiates 5% Marijuana / Hash

29. CONSEQUENCES (Continued) 22% Were Employed 30% Unemployed 48% Report “Not in Labor Force” 31% had Criminal Justice involvement 24% Homeless 40% had also been treated at some point for a mental health issue

30. NY Times Article (Continued) “Command tolerance for such behavior began changing in the 1980’s and by the 1990’s. ‘If you had more than a couple of drinks at the club, people started looking at you strange,’ the retired colonel said”.

31. Mental Health in Today’s Combat Zone 13 - 17% of soldiers deployed to Iraq / Afghanistan are taking some form of medication for stress, anxiety, depression or sleeplessness. This would not have been done in earlier wars. 2004 New England Journal of Medicine reported that 11% of recruits had a psychiatric history before entering the military. Increase in “waivers” from 5% in 2004 to 11% (leading up to the surge) for issues like marijuana possession, DUI, misdemeanors and felonies. 8/19/2015Exploratory Committee31

32. Substance Use in OEF / OIF Iraq / Afghanistan are “dry” countries US Policy prohibits alcohol consumption there Alcohol being mailed overseas from the U.S. Alcohol available from other allies Steroids being mailed “Huffing” compressed air / Computer Cleaner Morphine being mis-used 8/19/2015Exploratory Committee32

33. SGT. BALES INCIDENT Army alleges that SGT. Bales was using alcohol and steroids on the night of the incident. 8/19/2015Exploratory Committee33

34. Opiates in Afghanistan In 2010 – 2011 Army investigated 56 soldiers for possessing opiates – 8 of whom died of overdoses. 8/19/2015Exploratory Committee34

35. Drug use among the insurgents Particularly during battles in Fallujah – US Forces found that dead Insurgents had injected themselves with shots of adrenaline. 8/19/2015Exploratory Committee35

36. FORT DRUM, NY In late 2007 soldiers from the 10 th Mountain Division returned after 15 months in Iraq. Some had served 3 and 4 tours. “Many also did what generations of homecoming soldiers have done: they salved their wounds in local bars. With drinking off- limits in Iraq, at least openly, they were that much more likely to binge, that much less able to tolerate it”.

37. (Continued) FORT DRUM, NY A 23 year old soldier at Ft. Drum, New York, interviewed by Reuters said, “The first month back, everybody got drunk, pretty much”….You’ve been gone 15 months and that’s what everybody wants to do”.

38. (Continued) FORT DRUM The base commander, MAJ. GEN. Michael Oates ordered post newspaper to publish names and photographs of all soldiers charged with drunken driving – 116 appeared “I’m not a teetotaler. I’m not against people drinking. I’m against misconduct”.

39. (Continued) HEAVY DRINKING 2005 Army Survey found that nearly 25% of soldiers described themselves as “heavy drinkers” (i.e. Having 5+ drinks at 1 sitting once a week) 18 – 25 year old Soldiers and Marines are 2X as likely to be “heavy drinkers” than their civilian counterparts.

40. (Continued) Lack of Substance Abuse Treatment New Jersey National Guard 37% had “problem drinking” 55% for those with PTSD Of those reporting both, 41% received mental health treatment – only 9% received help for substance abuse.

41. NY Times Article, After the Battle, Fighting the Bottle at Home (July 8, 2008) “In recent years the military has worked to transform a culture that once indulged heavy drinking as part of its warrior ethos into one that discourages it and encourages service members to seek help”.

43. WARRIOR PRIDE MESSAGES Maintain your Warrior Pride – Don’t Drink and Drive! Don’t leave a Soldier behind on the battlefield, in a bar or at a party. I am a Warrior - I am Drug Free. Warrior Pride 0-0-1: Warriors have ZERO DUIs, ZERO underage drinking incidents, and don’t drink more than ONE drink per hour

44. BOREDOM Deployment / Combat is an adrenaline “high”. Reintegration:  Less Excitement  “Normal Responsibilities” – (i.e. “Take out the trash!”)  “Boring” Job  May seek out “thrills” – Driving fast / Spending $ recklessly / Risky Sex / Use substances

45. HOMECOMING HOLIDAYS FAMILY FUNCTIONS SEE OLD FRIENDS GO OUT INCREASE ACCESS TO ALCOHOL / DRUGS

46. CAPELLA STUDY: What Helps 77% of service members seeking mental health services said the assistance was helpful – with community mental health providers receiving higher rankings than military providers. 87% felt that setting a goal (Degree, new career) was helpful. 8/19/2015Exploratory Committee46

47. LI Response Veteran Peer Support Groups in Suffolk County – Funded by efforts of Sen. Lee Zeldin Suffolk County Veterans Crisis Task Force 8/19/2015Exploratory Committee47