New York State and the country at large face formidable challenges in meeting the behavioral health needs of veterans returning from active duty in Iraq, Afghanistan, and other countries. The New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) and its treatment provider partners are taking a leadership role in meeting these challenges by overseeing and supporting state-of-the-art residential services for female and male veterans, specializing in veteran-tailored treatment, and making veteran-aware referrals available through NYS OASAS’ confidential toll-free HOPEline.
Understanding Veterans Behavioral Health Needs
Since the beginnings of Operation Enduring Freedom in 2001, Operation Iraqi Freedom in 2003, and Operation New Dawn in 2010, more than 2 million U.S. military active duty service men and women and reservists have been deployed overseas. More than half of them have been redeployed multiple times according to the United States Department of Defense. The New York State Division of Military and Naval Affairs estimates that 80,000 of these troops have already returned or are in the process of returning home to New York. In this time of ongoing overseas conflict, NYS OASAS recognizes that the demands of military service and trauma from combat exposure can make the return to civilian life a difficult one.
With each deployment and redeployment, service members can encounter increasing strains on their physical and mental health, which can result in increased rates of physical and behavioral health problems, most notably post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). The stress of deployment, combat exposure, and exposure to other types of trauma can also lead to increased use of alcohol and/or prescription or illicit drugs by many veterans. These stresses also contribute to increasing rates of veteran suicides and homelessness.
Like our returning veterans, their family members struggle with the ramifications of extended and/or repeated deployments which can result in serious emotional and psychological tolls on the family unit.
NYS OASAS commends the service of the state’s 1.1 million veterans from all generations who have sacrificed both at home and overseas to serve their country. The agency continues to work to provide best practices in behavioral health services, including specialized veterans services for returning soldiers and their families.
Alcohol and Substance Use Disorder Treatment Services for NYS Veterans
Residential & Outpatient Service Models: To address the issues often encountered by returning veterans or the veterans who returned some time ago, and to provide a welcoming, supportive environment, in 2008, NYS OASAS began the process of establishing three 25-bed residential programs exclusively for housing and helping veterans with alcohol addiction and/or substance use disorders. NYS OASAS has provided $26 million in funding that contributed to the building of three new, state-of-the art residential facilities:
- Freedom Village Veterans Treatment Center, operated by Horizon Health, Inc. in Sanborn, N.Y., in Niagara County;
- the Women Veterans Program, operated by Samaritan Village in Ellenville, N.Y., in Ulster County;
- and the recently-opened Colonel C. David Merkel, M.D., Veterans Residence, operated by St. Joseph’s Addiction Treatment and Recovery Center, Inc., in Saranac Lake, N.Y., in Essex County.
The Women Veterans Program in Ellenville is one of only a few programs nationwide that is devoted solely to serving the needs of female veterans.
The Samaritan, Horizon Health and St. Joseph’s programs are “best practice” models that have been replicated by other NYS OASAS-certified-providers across the state. Several NYS OASAS-certified providers have established veteran-specific treatment programs which provide patient-centered care in supportive, trauma-informed environments, much like the care offered at these programs. These programs pride themselves in recognizing the values, core beliefs and unique culture of military service.
Today, including these three programs, there are 386 veterans treatment beds, operated by eight certified providers, throughout the state. In addition, three providers are also supporting veterans-only outpatient programs. These residential and outpatient programs for veterans support a clinical culture grounded in concepts of trauma-informed care. They also take military pride and values into account when offering a patient-centered approach to care.
Many treatment providers across the state offer outpatient services geared toward veterans with substance use disorders. The Realization Center in Manhattan, for example, began a comprehensive outpatient treatment program for male and female veterans with alcohol or substance use disorders in November 2014.
Veteran Specific Treatment: Because of the spirit of teamwork and camaraderie upon which the culture and traditions of the military are based, veterans often perform best when approaching challenges or tasks together even within a treatment setting. Veterans feel most comfortable, understood, and safe when they are with their “battle buddies” or “brothers in arms.” Many veterans say that no one quite understands the term “got your back” better than a fellow soldier, sailor, marine or airman who’s been through combat. Perhaps that is why NYS OASAS data indicates that veterans complete treatment at a higher rate than their civilian counterparts. For many of them, treatment is seen as a mission and completion of one’s mission is a familiar objective for military members. When possible, provider program staff members are veterans themselves, which helps build empathy and rapport.
In addition to alcohol and substance use disorder treatment, many NYS OASAS-certified providers offer additional specialized services including individualized case management, 12-step theme lectures and onsite meetings, onsite medical services, HIV prevention lectures and HIV testing, family reunification counseling, individual and group therapy, individualized treatment planning, therapy facilitated by substance abuse specialists, vocational services, recreational therapy, and anger management training.
These programs typically use the “Sanctuary Therapeutic Model,” a comprehensive approach to developing a trauma-sensitive culture in which psychological and social trauma can be addressed and resolved, and the “Seeking Safety” model, a present-focused, coping skills therapy designed to help people feel safe from PTSD and other traumatic events that may have influenced their alcohol addiction or substance use disorder. These evidence-based practices have been shown to be effective in treating veterans.
In addition to these treatment modes, NYS OASAS established a screening, brief intervention, and referral to treatment (SBIRT) program in the vicinity of Fort Drum, the largest military facility in New York State located near Watertown, NY. SBIRT is an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs. This SBIRT program was begun in 2012 to serve the behavioral health needs of active member of the military, veterans and their families.
Best Practice Trainings for Clinical Staff that Provide Treatment for Veterans: Trauma, including the types of trauma typically suffered by those serving in the military, is often deeply rooted for those who are diagnosed with an alcohol addiction or substance use disorder. Trauma can function as both a cause and continuing trigger for addictive behavior. To make sure that clinical staff in NYS OASAS-certified programs better understand and can more effectively serve traumatized patients, NYS OASAS developed a two-day training titled, “Trauma-Informed Care: An Awareness Perspective.” This 12-hour program, delivered to providers throughout the state beginning in 2012, seeks to provide participants with an understanding of the significant role traumatic life experiences can play in addiction. Clinicians attending this training learn to ask their patients, “what happened?” as opposed to “what’s wrong?” This helps individuals focus on what events may have shaped their behavioral norms and views, how they are coping with the trauma/s they were exposed to, and how these events may be contributing to their addictive behaviors.
NYS OASAS’ goal is that repeated deliveries of this training will embed a heightened level of knowledge and understanding system-wide about the influence of trauma, and pave the way for more advanced training in trauma-informed care. In 2014, NYS OASAS conducted 15 trainings, which benefitted approximately 525 clinicians across the state. Through this type of system-wide-focused initiative, NYS OASAS looks to enhance quality of care state-wide and improve services for New Yorkers and others whom the agency serves, including veterans.
Accessing Services: 24 Hours-A-Day Through the State’s HOPEline
Though it is known that increasing numbers of veterans are returning with serious mental health and substance abuse issues, unfortunately, many service men and women in need do not seek help. According to the United States Army, only 40 percent of veterans who screen positive for serious emotional problems seek help from a mental health professional (Mental Health Advisory Team IV: Operation Iraqi Freedom, 2007). In addition, only 30 percent of veterans with PTSD or depression seek help from the Veterans Affairs Health System (Invisible Wounds of War, 2008).
The Army recognizes that stigma is a major barrier for veterans in need of mental health care (Mental Health Advisory Team IV, 2007). According to SAMHSA, service members frequently cite fear of personal embarrassment, disappointing comrades, losing the opportunity for career advancement, and dishonorable discharge as motivations to hide symptoms of mental illness, and alcohol or substance use or abuse, from family, friends and colleagues (2007).
To help reach veterans with behavioral health and addiction problems, masters-level clinicians who staff the NYS OASAS HOPEline, have been trained to determine if the caller is a veteran or a veteran’s friend or family member. Clinicians are trained to make referrals for treatment with providers who have veteran-specific programs in the state. The HOPEline is a confidential, toll-free, telephone service help line available at 1-877-846-7369 that people suffering from alcohol abuse problems or substance use disorders can call 24 hours a day, seven days a week to access help. Family members can also take advantage of this call-in line.
The Path Ahead: Caring for Veterans with Alcoholism and Substance Use Disorders
NYS OASAS remains committed to supporting and fostering the development of expanded services for veterans with addiction disorders, promoting the use of the effective treatment models and therapies within those services, and ensuring the ongoing clinical competence of its workforce in working with veterans.
Future plans call for the development of clinical guidelines for serving veterans and the delivery of training in advanced topics relating to caring for trauma-afflicted patients. NYS OASAS continues to look for ways to continue to maximize its effectiveness in serving those in New York state who have served in the military and are now battling addiction.
For more information, contact the NYS OASAS Veterans Program at firstname.lastname@example.org, call 518-457-5005 or view the Veterans and Military section on the NYS OASAS’s webpage: http://www.oasas.ny.gov/treatment/veteran/index.cfm.