Treating Addiction For Veterans 'Takes A Village'
High numbers of fatal drug overdoses continue to serve as a tragic reminder of the opioid epidemic plaguing many communities. From Memorial Day weekend to the middle of last week at least 43 people died from fatal drug overdoses in Cuyahoga County alone.
Some of those suffering from addiction and many other complex conditions…are veterans.
I recently spoke about this with Dr. Ali Mchaourab, the head of Pain Medicine Service at the Louis Stokes VA Medical Center in Cleveland. I began by playing a clip from a formerly homeless veteran in Lorain, Norman Swinehart, and then having Dr. Mchaourab respond:
Swinehart: “When I went into the military I wasn’t an alcoholic. I wasn’t a drug addict. But after I got in there, my whole life twisted around on me. I overdosed three times in Germany on heroin, trying to kill myself, because of what happened to me…lately I’ve had six years of sobriety…and I’ve found…you’ve got to let the past go.”
Ganzer: “So Norm there says he wasn’t an addict before he joined the military, and ‘something happened to me.’ And later in the interview he talks about seeing some of his friends die next to him. Can you talk, maybe, about what leads to addiction issues, especially with veterans?”
Dr. Mchaourab: “Well, I’m not an expert in PTSD, Post-Traumatic Stress Disorder. You know, physicians at the VA are well-aware that certain exposures to trauma during combat, or sometimes during training, can lead to a high stress level. And at times, some patients are more pre-disposed than others to be affected by that trauma and not be able to cope with it well. So this is actually how it starts, and it becomes a self-medication for mental illness, or Post-Traumatic Stress Disorder, or to shut down these nightmares, these thoughts, they self-medicate with these medications that alter their mood, or improves their level of sadness and makes them happier.”
Ganzer: “Something a lot of the veterans told me—who I interviewed from Lorain—they said that ultimately they had to admit there was a higher power, that they couldn’t solve their issues on their own, and they had to go through treatment and kind of surrender that control to a treatment program of some sort. Like you said, it’s not just the substance abuse per se, but it’s also psychological issues, it could be chronic health issues that they’re also dealing with…”
Dr. Mchaourab: “Well they say ‘it takes a village,’ right? In these cases like the gentleman that we heard from, the same thing. We have established over the last several years a team approach to patients who have, let’s say, chronic pain and addiction; mental illness and chronic pain; or the three. And we’ve been very successful as long as the patient is compliant. I can speak about the VA, the resources are there, the resources are available for us. The problem, Tony, is that these patients also have so much social difficulties: their families sometimes are nowhere to be found, they’ve been abandoned by their kids, so the support system might not be there, so their motivation sometimes suddenly wanes when they leave the hospital, and then you can’t find them. But I can only say the success stories are much more than the failures.”
Ganzer: “Broadly society is also dealing with this addiction epidemic that it seems we’re all mobilizing against now.”
Dr. Mchaourab: “It is, and it affects certain communities more than others…as a physician in pain management, I would say today that we don’t have enough, we don’t do enough, there’s not enough time. A lot of places can’t afford psychologists, which is an integral part when you’re treating chronic illness such as chronic pain or addiction. So the patient ends up seeing a physician who does not have that much in his or her armamentarium. So there’s definitely a shortage in my opinion in the resources that healthcare can provide for complex and challenging patients such as these.”
Ganzer: “Is there anything else you want to say about the epidemic we’re seeing, or the work you’re doing at the VA?”
Dr. Mchaourab: “We need to understand the roots of this epidemic. We know that three-quarters, or two-thirds of heroin addicts have started with prescription drugs, and we know that prescription drugs don’t just find their way to households. They come from physicians like myself, and dentists, and this liberal practice needs to stop. It needs to be brought to the center.”