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Issue Brief:November 4, 2009
Drug Policy Alliance70 West 36
th
Street16
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FloorNew York, NY10018212.613.8020www.drugpolicy.org
Healing aBroken System:Veterans BattlingAddiction andIncarceration
2 Healing a Broken System Drug Policy Alliance
Thousands of veterans of the wars in Iraq andAfghanistan are returning with Post-TraumaticStress Disorder (PTSD),
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Traumatic Brain Injury(TBI),
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and other illnesses and injuries
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thatoften contribute to substance abuse andaddiction,
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fatal overdose,
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homelessness,
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andsuicide.
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The current generation of veterans joins the large population of Vietnam-eraveterans who have struggled with the sameproblems for decades.
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Left untreated, these underlying medicalconditions also contribute to violations of thelaw, especially nonviolent drug offenses.
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Indeed, in 2004 roughly 140,000 veterans were inU.S. state and federal prisons,
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with tens ofthousands more in county jails.
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Research showsthat the single greatest predictive factor for theincarceration of veterans is substance abuse.
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As more veterans return from longer andrepeated deployments to Iraq and Afghanistan,the number of incarcerated veterans is likely toincrease significantly.
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Incarcerated veterans with PTSD report moreserious legal problems, higher lifetime use ofalcohol and other drugs, and poorer overallhealth than those without PTSD.
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Existing literature strongly indicates that“incarcerated veterans may face a level of suiciderisk that exceeds that attributable to eitherveteran status or incarceration alone.”
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Moreover, incarcerated veterans are highlyvulnerable to death by overdose after release ifthey do not receive effective treatment.
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Veterans who are convicted of criminal offenses,particularly drug felonies, or those who havedrug use histories, and their families, face a widerange of punitive policies that limit their access tosocial services necessary for their reentry tocivilian life.
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This policy brief by the Drug Policy Alliancehighlights some of the less-discussed but deeplytroubling issues affecting veterans and proposesproven, commonsense, and cost-effective ways toimprove the health, reduce the likelihood ofaccidental death, and preserve the freedom of thosewho have served in our armed forces.
Substance Abuse and Mental Illnessamong U.S. Veterans
Approximately 30 percent of Iraq and AfghanistanWar veterans report symptoms of PTSD, TBI,depression, or other mental illness or cognitivedisability.
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19 percent of current conflict veterans who havereceived VA care have been diagnosed withsubstance abuse or dependence.
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75 percent of Vietnam combat veterans with PTSDmet criteria for substance abuse or dependence ina national study.
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Veterans do not qualify for substance abusedisability benefits unless they also have PTSD.
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Summary of Recommendations
The United States Department of Veterans Affairs(VA) and Department of Defense (DoD) must adoptoverdose prevention programs and policiestargeting veterans and service members whomisuse alcohol and other drugs, or who takeprescription medications, especially opioidanalgesics.Veteran treatment programs must greatly expandaccess to medication-assisted therapies likemethadone and buprenorphine, which are the mosteffective means of treating opioid dependence.State and federal governments must modifysentencing statutes and improve court-ordereddrug diversion programs to better treat —ratherthan criminalize and incarcerate—veterans whocommit nonviolent drug-related crimes.
3 Healing a Broken System Drug Policy Alliance
Veterans of Every Major War HaveBattled PTSD, Addiction, andIncarceration
PTSD was added to the third edition of theDiagnostic and Statistical Manual of MentalDisorders (DSM-III) after the Vietnam War, butthe disorder has existed for as long as soldiershave gone to war.
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What was called “soldier’sheart” during the Civil War, “shell shock” duringWorld War I, and “combat exhaustion” or“combat fatigue” during World War II and theKorean War has evolved into what is now calledPTSD.
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Symptoms of PTSD include “strong memoriesand nightmares, feeling numb or detached, anddifficulty sleeping,”
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as well as hyper-arousaland hyper-vigilance, and a clinically recognizedtendency to self-medicate with alcohol and otherdrugs.
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Criminal justice involvement as a result ofcombat trauma is predictable after a major war.For example, 34 percent of new admissions to 11U.S. prisons between 1946 and 1949 were WWIIcombat veterans.
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Combat veterans from Vietnam onwards face aneven greater risk of arrest and incarceration thanprevious generations of veterans because the U.S.now criminalizes behaviors—especially druguse—that were not covered under federal andstate criminal codes until the 1970s.Consequently, in 1985, 21 percent of all men instate prison and 23 percent of all men in federalprison were veterans—a direct legacy ofVietnam.
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The largest study of Vietnamveterans, the National Vietnam VeteransReadjustment Study (NVVRS), found in 1988 thatnearly half of male Vietnam combat veteransafflicted with PTSD had been arrested orincarcerated in jail one or more times, and 11percent had been convicted of a felony.
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PTSD and other psychological wounds of warmay also emerge several years after returningfrom combat.
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Experts predict a tragic recurrence of these trendsas current conflict veterans return home, unlessurgent, evidence-based responses to supportveterans battling addiction and incarceration areimplemented at the local, state, and nationallevels.
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Veterans in Prison, as of 2004*
140,000 veterans were incarcerated in state andfederal prisons.46 percent of veterans in federal prison wereincarcerated for drug law violations.
15 percent of veterans in state prison wereincarcerated for drug law violations, including5.6 percent for simple possession.More than 25 percent of veterans in prison wereintoxicated at the time of their arrest.61 percent of incarcerated veterans met theDSM-IV criteria for substance dependence orabuse.More than half of veterans in federal (64percent) and state prisons (54 percent) servedduring wartime.26 percent of veterans in federal prison and 20percent in state prison served in combat.38 percent of veterans in state prison receivedless than an honorable discharge, which maydisqualify them for VA benefits.
* Source: United States Department of Justice, Bureau of Justice Statistics, “Veterans in State and Federal Prison,2004” 1,4,5,6,11 (May 2007).
Veterans Face Heightened Risk forDrug Overdose and HazardousDrinking
Veterans who struggle with substance abuseand mental illness are much more likely to dieprematurely than their peers who are notafflicted with these conditions.
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In particular,Vietnam veterans with PTSD from combat face aheightened risk of dying from a fatal drugoverdose.
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Media and anecdotal reports suggest thatoverdose is claiming many veterans of thecurrent conflicts.
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Their risk of fatal overdoseis especially high given the widespread use of
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