America claims to revere its veterans and has demonstrated an admirable commitment to those returning from our wars with visible wounds. Public and private organizations, as well as countless individuals, have extended their generosity and compassion to those heroic men and women who have served our country. But sadly, we seem to turn a blind eye toward the very real and often debilitating effects of extended combat exposure and the invisible wounds it causes. Marked less by physical scars and missing limbs, many soldiers returning from war face serious diseases of addiction and mental illness as they struggle to readjust to civilian life.
Unsurprisingly, the effects of recent war for many of our hundreds of thousands of service men and women have not been dissimilar to those of past wars, including high rates of alcohol, illicit and prescription drugs use, addiction, depression, post-traumatic stress, brain injuries and other mental health problems. Untreated, these conditions too often result in high rates of suicide, unstable lifestyles and criminal activity that can lead to incarceration.One recent step toward addressing these problems was the introduction of the Justice and Mental Health Collaboration Act by Sen. Al Franken (D-Minn.) and Rep. Richard Nugent (R-Fla.). If passed, this bipartisan initiative will help improve treatment for veterans and the mentally ill in our criminal justice systems. The bill extends for five years the authorization for mental health courts and crisis intervention teams and expands veterans’ treatment courts, all important and proven tools to divert non-violent offenders from unnecessary incarceration. While these steps are an important part of the solution to the myriad addiction and mental health related issues affecting veterans, by themselves they will not solve the larger problem of keeping our military personnel from landing in the criminal justice system in the first place.
The correlation of substance use and mental illness with incarceration is well established. CASAColumbia researchers have found that substance use is implicated in the crimes and incarceration of 85 percent of inmates in the U.S. Almost two-thirds of all inmates meet medical criteria for addiction involving alcohol and other drugs and one third have a mental health disorder. Furthermore, a quarter of all inmates suffer from both addiction and mental illness. Left untreated, these inmates are more likely to engage in repeat offenses. But, many of them would never have entered the criminal justice system if their substance use, addiction and mental health problems had been prevented or treated effectively. To neglect these health problems until they result in complications with the law is tragic, costly and largely avoidable.
We must focus on both preventing the addiction and mental health ills that plague so many of our military personnel and on intervening early to keep these conditions from worsening. To do this, we must put in place coordinated outreach to engage those who require assistance and connect them with needed care. This process should begin during active duty and continue after retirement, and it should include the National Guard and Reserves. We must incorporate comprehensive screening and early intervention for both addiction and mental illness into routine medical care for all military personnel. We need to ensure that our service men and women receive effective, evidence-based treatment and disease management services as they do for other medical conditions. We must stop simply referring people to support groups or requiring they “get over” their addiction before other services will be provided. There is plenty of evidence available on how to effectively treat addiction and mental illness. Failure to do so is not only inhumane, it borders on medical malpractice.
Creating an accountable, effective outreach, prevention and treatment infrastructure will allow us to mobilize the quality care we owe our military personnel and their families, including both the younger cohort of military in Iraq and Afghanistan and the aging Vietnam era population.
So while we endorse a quick passage of the Franken-Nugent bill, we advocate also for a more comprehensive system of addiction and mental illness prevention and treatment, one that will help our military personnel long before they run afoul of the criminal justice system – or worse.
Foster is vice president and director of policy research at the National Center on Addiction and Substance Abuse at Columbia University (CASAColumbia)
McDonough, a retired colonel, is the author of the Vietnam memoir, Platoon Leader, a leader in drug control policy nationally and in Florida, and former secretary of the Florida Department of Corrections.
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