A civilian hand for veterans: insights into the military system can prepare counselors for effective treatment planning.

According to the U.S. Department of Defense Manpower Data Center, more than 1 million Americans have served overseas in operations supporting the Global War on Terrorism. Adding that number to the number of veterans from prior wars, conflicts, and service, the Department of Veterans Affairs places the total number of living veterans at about 25 million. Research has demonstrated that military service takes a toll on veterans and their family members, with issues of alcohol and drug abuse among those that have a dramatic impact.

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According to the National Center for Posttraumatic Stress Disorder, 75% of veterans with lifetime PTSD have a substance abuse disorder. A 2005 report from the Substance Abuse and Mental Health Services Administration, based on 2003 data from the National Survey on Drug Use and Health, states that an estimated 200,000 veterans received specialty treatment for substance abuse in 2003. Given today's level of military involvement and well-publicized concerns over the adequacy of health services for veterans, it is reasonable to expect that the civilian counseling community will be overwhelmed with veteran clients.

The addiction professional attempting to serve the client who is a veteran must use all available resources in conducting a clinical evaluation. The counselor's effectiveness depends on adhering to all dimensions of addiction counseling, with the clinical evaluation being the first. The clinical evaluation provides extensive information on the client's history. Every military veteran, regardless of the branch in which service is performed, receives a DD Form 214 (Report of Separation). The DD Form 214 (www.archives.gov/veterans/military-service-records/dd-214.html) provides important information about a veteran's military service--information that an addiction professional can use to construct the veteran's military history and then to develop an effective treatment plan.

Information about a veteran's military service on the DD Form 214 includes:

* Date and place of entry into active duty;

* Home address at time of entry;

* Date and place of release from active duty;

* Last duty assignment;

* Military job specialty;

* Military education;

* Decorations, medals, badges, citations, and campaign awards;

* Total creditable service;

* Foreign service (overseas and combat tours); and

* Separation information (honorable, dishonorable, etc.).

The addiction professional who uses the information provided by the DD Form 214 gains a valuable edge in unlocking a significant amount of historical information at the center of many issues surrounding a veteran client. The addiction professional conducting the clinical evaluation will be able to establish rapport and trust from a veteran client--not a small accomplishment considering the vast differences between the military and civilian cultures.

One veteran's progress

The actual case-study example of "Jim" offers evidence of how data can inform treatment. Jim was a Vietnam-era and Gulf War veteran who was medically discharged from the U.S. Army. He was on probation after serving a five-year prison sentence for possession of crack cocaine with intent to distribute. He was enrolled in an inpatient substance abuse treatment program as part of a court-ordered sanction imposed for his testing positive on a drug screen. On his intake assessment, he answered "no" to the question on military service (this is a common occurrence often resulting from guilt/shame). The client presented as an angry, defensive, and subdued individual.

Jim had been in the inpatient substance abuse program for about three weeks when I met him. During an initial discussion, Jim noticed a military badge lapel pin on my jacket. This turned the discussion to military topics. Jim talked about how he had a successful military career until his return from the Gulf War. As a result of a postdeployment training accident, he was medically discharged from the Army and his life began to spiral out of control. I asked Jim if he had his DD Form 214 or had accessed VA services or programs. He stated that after he had begun heavy alcohol and crack use, he became disconnected from his support system and lost most of his possessions, including his DD Form 214 and other personal memorabilia. It was suggested that if Jim filled out a request form, he would be able to obtain a replacement DD Form 214 and could reconstruct his personal military history. Jim became very interested in reconnecting with his past, grateful that someone was interested in helping him reconstruct his service record.

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I discussed what had taken place with Jim's primary counselor from the inpatient program. The counselor was very surprised about the disclosure involving military service. I explained that like many veterans of the Vietnam generation, Jim was guarded about discussing his military service, and also was embarrassed by his illegal activity and substance abuse after being discharged. The next day, Jim filled out a form (SF 180, Request Pertaining to Military Records; www.archives.gov/research/orderlstandard-form-180.pdf) requesting a replacement DD Form 214. During the next few weeks, Jim became more vocal and started participating in group and working seriously on treatment plan goals. Several parts of the treatment plan were changed because of new information related to trauma, wartime service, and other military experiences.

A significant development in Jim's treatment occurred when his DD Form 214 arrived in the mail. Jim now wanted to share his military record and to talk about how the document helped him reconnect with past memories and experiences. He wanted more information on how to obtain replacement medals, certificates, and other records associated with his military service. Jim's primary counselor was impressed that a very simple document could unlock an otherwise difficult client.

Jim progressed with the remaining phases of his treatment program. He graduated from the inpatient program and successfully completed his probation requirement. He was able to connect with a veterans recovery group for support. Also, he was able to access VA services and resources to assist him in remaining drug- and alcohol-free. This was possible since he had a copy of his DD Form 214.

Many counselors are unaware that a veteran needs a significant number of documents in order to access VA services. The application process starts with the DD Form 214 and a photo ID. The downside is that with the large number of veterans in need of VA services, the paperwork process can be long and frustrating. This can result in problems worsening before services can be obtained.

Conclusion

The case study outlined above demonstrates what can occur when the veteran connection is reestablished and trust is engendered in a veteran client. By incorporating military service questions into the clinical evaluation process, using the expertise of military veteran counselors when applicable, and being aware of the important forms that veterans have and need, the addiction professional can maximize chances of developing an effective treatment plan.

Information provided by the DD Form 214 can help professionals more closely examine issues such as the circumstances that led to military service and how military service might have affected later experiences and problems. Finally, professionals always should make it a point to acknowledge a veteran's service to the country by saying, "Thank you for your service."

Michael R. Hurst, MS, CSAC, CEAP, is a retired U.S. Army Special Forces Captain (Green Beret) and a veteran of Southwest Asia and Somalia. He is the Founder and President of The Hurst Group, LLC, and specializes in military counseling consulting. Hurst is a member of NAADAC, The Association for Addiction Professionals. His e-mail address is [e-mail].

BY MICHAEL R. HURST, MS, CSAC, CEAP