GENERAL DEAN REMARKS AMERICA WELCOMES HOME OUR VETERANS-- SAMHSA AND TCA CONFERENCE --MARCH 17, 2006

GOOD MORNING EVERYONE. IT IS A PLEASURE TO BE ABLE TO ADDRES YOU TODAY. I APPLAUD SAMHSA AND THERAPUTIC COMMUNITIES OF AMERICA FOR HOLDING THIS CONFERENCE. WE ARE ALL WORKING TO BETTER SUPPORT OUR TROOPS, ESPECIALLY AS IT PERTAINS TO MENTAL HEALTH AND SUBSTANCE USE DISORDERS.

OUR YOUNG MEN AND WOMEN IN UNIFORM, OVER A MILLION AND A HALF OF THEM, COME FROM ALL WALKS OF LIFE. THEY ARE ALL VOLUNTEERS; EVERY SINGLE ONE OF THEM RAISED THEIR HANDS AND

SAID THEY WANTED TO SERVE OUR COUNTRY. AND COLLECTIVELY, THEY REPRESENT ALL OF US ACROSS THE GLOBE. THEY ARE BRAVE MEN AND WOMEN WHO ARE RISKING THEIR LIVES EVERY DAY TO PROTECT OUR FREEDOMS. REGARDLESS OF ANY INDIVUDUAL VIEWS ABOUT THE WAR IN IRAQ, EVERYONE IN THIS ROOM IS HERE BECAUSE WE WANT TO GO THE EXTRA MILE TO SUPPORT OUR TROOPS. HAVING SPENT 35? YEARS OF MY LIFE IN MILITARY SERVICE, I UNDERSTAND THE CRITICAL NATURE OF COMBAT AND THE HORRORS OF WAR. I UNDERSTAND THE STRAIN PLACED ON A SOLDIER AND HIS FAMILY WAITING BACK HOME FOR HIM. I HAVE ALSO SEEN HOW INCREDIBLY SUPPORTIVE A FAMILY UNIT THE UNITED STATES MILITARY CAN BE.

OUR MILITARY, THE GREATEST IN THE WORLD, HAS MADE IMPORTANT STRIDES OVER THE YEARS TO PROVIDE SOLDIERS WITH THE BEST TECHNOLOGY IN THE FIELD AND THE BEST POSSIBLE SAFETY NET FOR ITS PEOPLE UPON THEIR RETURN FROM WAR.

WITHOUT A DOUBT, THE UNITED STATES VETERANS AFFAIRS DEPARTMENT HAS COME A LONG WAY FROM THE 1970’S, WHEN I WAS A (RANK) RETURNING FROM VIETNAM. THE VA HOSPITAL SYSTEM HAS VASTLY IMPROVED SERVICES, AND CONTINUES TO WORK TO FIND WAYS TO HELP OUR SERVICE MEN AND WOMEN HEAL THEIR WOUNDS –BOTH PSYCHOLOGICALLY AND PHYSICALLY. TODAY, THE DEPARTMENT OF VETERANS AFFAIRS HAS A NETWORK OF SPECIALIZED PTSD AND SUBSTANCE

USE TREATMENT PROGRAMS. THAT WAS SIMPLY NOT THE CASE 30 YEARS AGO.

HOWEVER, THERE IS ALWAYS ROOM FOR INCREMENTAL IMPROVEMENT. I WOULD SUGGEST TO THIS AUDIENCE THAT THE SYSTEMS IN PLACE CAN STILL BE IMPROVED UPON AND I BELIEVE THEY WILL.

IT HAS BEEN SAID “THOSE WHO CANNOT REMEMBER THE PAST ARE CONDEMNED TO REPEAT IT.” (A QUOTE BY A SPANISH PHILOSOPHER NAMED GEORGE SANTAYANA) IN 1983, A REPORT CALLED THE NATIONAL VIETNAM VETERANS' READJUSTMENT STUDY (NVVRS) WAS RELEASED. FROM THIS REPORT,

WE FOUND OUT THE FOLLOWING STATISTICS ABOUT HOW OUR VIETNAM VETERANS WERE DOING:

FORTY PERCENT OF VIETNAM THEATER VETERAN MEN HAVE BEEN DIVORCED AT LEAST ONCE (10% HAD TWO OR MORE DIVORCES), 14.1% REPORT HIGH LEVELS OF MARITAL PROBLEMS, AND 23.1% HAVE HIGH LEVELS OF PARENTING PROBLEMS.

ALMOST HALF OF ALL MALE VIETNAM THEATER VETERANS CURRENTLY SUFFERING FROM PTSD HAD BEEN ARRESTED OR IN JAIL AT LEAST ONCE -34.2% MORE THAN ONCE- AND 11.5% HAD BEEN CONVICTED OF A FELONY.

THE ESTIMATED LIFETIME PREVALENCE OF ALCOHOL ABUSE OR DEPENDENCE AMONG MALE THEATER VETERANS IS 39.2%, AND THE ESTIMATE FOR CURRENT ALCOHOL ABUSE OR DEPENDENCE IS 11.2%. THE ESTIMATED LIFETIME PREVALENCE OF DRUG ABUSE OR DEPENDENCE AMONG MALE THEATER VETERANS IS 5.7%, AND THE ESTIMATE FOR CURRENT DRUG ABUSE OR DEPENDENCE IS 1.8%.

AS EVERYONE IN THIS ROOM IS AWARE, PTSD DOES NOT AUTOMATICALLY CAUSE PROBLEMS WITH ALCOHOL USE; THERE ARE MANY PEOPLE WITH PTSD WHO DO NOT HAVE PROBLEMS WITH ALCOHOL. HOWEVER, PTSD AND ALCOHOL TOGETHER CAN BE SERIOUS TROUBLE FOR THE TRAUMA SURVIVOR AND HIS OR HER FAMILY.

PEOPLE WITH PTSD ARE MORE LIKELY THAN OTHERS WITH SIMILAR BACKGROUNDS TO HAVE ALCOHOL USE DISORDERS BOTH BEFORE AND AFTER BEING DIAGNOSED WITH PTSD, AND PEOPLE WITH ALCOHOL USE DISORDERS OFTEN ALSO HAVE PTSD.

ALONG THOSE LINES, IF I MAY JUST TELL YOU A PERSONAL STORY. I GREW UP IN RURAL NORTH CAROLINA AND ALL OF MY BROTHERS SERVED IN VIETNAM. THANK GOD, ALL MY BROTHERS ALL CAME BACK COME FROM THAT WAR. BUT NO PERSON RETURNING FROM A WAR COMES HOME UNCHANGED. THE EXPERIENCE LEAVES AN INDELIBLE MARK. MY YOUNGEST BROTHER CAME BACK AND HARD THE HARDEST TIME OF ALL OF US

ADJUSTING. HIS PERSONAL STRUGGLES UPON RETURNING HOME, INCLUDED SUBSTANCE ABUSE AND BRUSHES WITH THE LAW. FOR OVER TWO YEARS, WE WORRIED AS A FAMILY THAT WE MIGHT LOSE HIM FOREVER. TODAY, HE IS A SUCCESSFUL

BUSINESSMAN WITH A VERY FULL LIFE. HE WAS HEALED, OVER TIME, BY A COMBINATION OF FAMILY, CHURCH, AND COMMUNITY HEALTH SERVICES. IT WAS TRULY A COALITION OF PEOPLE, WATCHING OUT FOR HIM, NOT GIVING UP ON HIM, THAT SAW HIM THROUGH WHAT WAS MOST CERTAINLY A SERIOUS CASE OF POST TRAUMATIC STRESS DISORDER. AS YOU KNOW, SINCE LEAVING THE ARMY IN 1997, I HAVE DEDICATED MY TIME AND EFFORT TO LEADING CADCA--COMMUNITY ANTIDRUG COALITIONS OF AMERICA.

I LEARNED QUITE A BIT ABOUT DRUG AND ALCOHOL ABUSE FROM MY OWN PERSON FAMILY ISSUE, AND I ALSO HELPED OTHERS WITH THE PROBLEM WHILE WORKING IN HUMAN RESOURCES AND MANAGEMENT FOR THE ARMY. HOWEVER, ONCE I JOINED CADCA, I BECAME A STUDENT OF SUBSTANCE USE DISORDERS AND THEIR RELATED ISSUES. I LEARNED FROM PEOPLE LIKE ALAN LESHNER, THE FORMER DIRECTOR OF NIDA AD ENOCH GORDIS WHEN HE WAS LEADING NIAAA. I TALKED WITH LEADERS AT SAMHSA, AND OF COURSE I HAVE BEEN LEARNING FROM EXPERTS LIKE CSAT DIRECTOR, DR. CLARK, FOR QUITE SOME TIME. YOU KNOW I REACHED OUT TO OTHER NATIONAL ORGANIZATIONS, AND I ALSO TALKED WITH MY

PEERS, LIKE JOE CALIFANO AT CASA. MOST OF ALL, I LISTENED TO THE THOUSANDS OF COMMUNITY LEADERS I WAS TASKED TO LEAD.

LET’S TALK A LITTLE BIT ABOUT THE COALITION PHENOMENON. IN THE US WE HAVE A TRADITION OF COMMUNITY PROBLEM SOLVING. COALITIONS ARE LOCAL GROUPS OF CITIZENS, INSTITUTIONS AND GOVERNMENT ENTITLES THAT WORK TOGETHER TO REDUCE SUBSTANCE ABUSE RATES.

THIS IS BASED ON THE BELIEF THAT, AMERICA DOESN’T HAVE A DRUG PROBLEM; AMERICA’S COMMUNITIES HAVE A DRUG PROBLEM.

CADCA DEFINES A COALITION AS: “A FORMAL ARRANGEMENT FOR COOPERATION AND COLLABORATION BETWEEN GROUPS OR SECTORS OF THE COMMUNITY, IN WHICH EACH GROUP RETAINS ITS IDENTITY BUT ALL AGREE TO WORK TOGETHER TOWARD A COMMON GOAL OF BUILDING A SAFE, HEALTHY AND DRUG-FREE COMMUNITY.”

COALITION BUILDING IS A SMART STRATEGY THAT PROMOTES COORDINATION AND COLLABORATION AND MAKES EFFICIENT USE OF LIMITED COMMUNITY RESOURCES.

COALITIONS CREATE SYNERGY AND LEVERAGE RESOURCES AMONG VARIOUS COMMUNITY SECTORS – BUSINESS, LAW, EDUCATION, GRASSROOTS,

SERVICE PROVIDERS, ETC. – TO REDUCE THE DEMAND FOR DRUGS AND ALCOHOL.

IN FIGHTING THE ABUSE OF ALCOHOL, TOBACCO AND OTHER DRUGS, LOCAL COALITIONS MUST HAVE EVERY TOOL AVAILABLE TO SUCCEED IN THEIR MISSION. CADCA STRENGTHENS THE CAPACITY OF THESE COALITIONS TO BUILD SAFE, HEALTHY AND DRUG-FREE COMMUNITIES.

SO, I’D LIKE FOR THIS AUDIENCE TO THINK ABOUT COALITIONS FOR A MOMENT TODAY AS “AGENTS OF SYSTEMS CHANGE.” COALITION LEADERS ARE THE PEOPLE ON THE GROUND LEVEL—THE GROUND TROOPS SO TO SPEAK—WORKING EVERY DAY TO IMPROVE THE COMMUNITY CLIMATE AND MAKE

THEIR HOMETOWN MORE CONDUCIVE TO RECOVERY. THE TREATMENT AND PREVENTION COMMUNITY MUST WORK TOGETHER IF WE ARE TO ACHIEVE LASTING REDUCTIONS IN ALCOHOL AND OTHER DRUG USE. WE ARE ALL WORKING TO REDUCE RATES OF ABUSE. SMART COALITIONS SEE THIS BIGGER PICTURE—AND ARE WELL-CONNECTED WITH THEIR LOCAL TREATMENT SERVICES.

COALITIONS ARE WELL-POSITIONED TO STRATEGICALLY IMPACT THE SYSTEMS OF CARE IN THEIR COMMUNITY. COALITION LEADERS ARE USUALLY WELL-CONNECTED LOCAL EXPERTS WHO CAN HARNESS THE POLITICAL WILL TO CHANGE LOCAL POLICIES, PROGRAMS AND PRACTICES.

THERE IS A ROLE FOR THE PREVENTION COMMUNITY IN WELCOMING VETERANS HOME, AND GOES WELL BEYOND ORGANIZING A MEMORIAL DAY PARADE DOWN MAIN STREET. COALITIONS ALSO CAN CONNECT SERVICEMEN WITH TREATMENT OPTIONS. NOT ALL SERVICEMEN ARE ABLE TO ACCESS MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT SERVICES.

CADCA COALITIONS ARE PART OF THE SAFETY NET IN THE COMMUNITY, PROVIDING EDUCATION AND COMMUNITY INVOLVEMENT THAT DEMONSTRATES A REAL AND LASTING COMMITMENT TO OUR VETRANS.

AS YOU ARE AWARE, A STUDY OF THE MENTAL HEALTH OF TROOPS WHO FOUGHT IN IRAQ WAS

RECENTLY PUBLISHED IN THE JOURNAL OF AMERICAN MEDICAL ASSOCIATION. THE STUDY, PRODUCED BY THE WALER REED ARMY INSTITUTE OF RESEARCH, FOUND THAT ABOUT ONE IN THREE SOLDIER S AND MARINES WHO HAVE SERVED IN IRAQ LATER SOUGHT HELP FOR MENTAL HEALTH PROBLEMS.

EARLIER RESEARCH HAD FOUND THAT LESS THAN HALF OF THOSE WITH PROBLEMS SOUGHT HELP, MOSTLY OUT OF FEAR OF BEING STIGMATIZED OR HURTING THEIR CAREERS.

THE SURVEY OF ARMY AND MARINE COMBAT UNITS WAS CONDUCTED A FEW MONTHS AFTER THEIR RETURN FROM IRAQ OR AFGHANISTAN LAST YEAR.

MOST STUDIES OF PAST WARS’ AFFECTS ON MENTAL HEALTH, LIKE THE ONE I CITED EARLIER, WERE DONE YEARS AFTER THE CONFLICT, MAKING IT DIFFICULT TO COMPARE THE LATEST RESULTS WITH THOSE FROM THE VIETNAM OR PERSIAN GULF WARS.

SO IT REMAINS TO BE SEEN WHAT THE ONGTERM MENTAL HEALTH EFFECTS WILL BE FOR OUR IRAQ AND APHGAHANISTAN VETERANS, BUT WE DO KNOW THE NEEDS MAY BE MUCH GREATER FOR OUR IRAQ WAR VERTERANS BECAUSE UPWARDS OF 80 TO 85 PERCENT OF SOLDIERS IN IRAQ HAVE WITNESSED OR ENGAGED IN A TRAUMATIC EVENT.

THE ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS, DR. WILLIAM WINKENWERDER, JR.

(WINK-IN-WER-DER) HAS SAID “THE COMBAT EXPERIENCES OF OUR SERVICE MEMBERS CAN HELP OUR ENTIRE BENEFICIARY POPULATION SHED THE COMMON STEREOTYPE OR IMAGE THAT SEEKING SERVICES FOR MENTAL HEALTH CONCERNS IS SOMETHING TO AVOID.” I THINK THAT IS VERY TRUE.

SO WHAT CAN COMMUNITY COALITIONS AND OTHERR PREVENTION PROFESSIONALS DO? WELL, I WOULD SUGGEST THAT THERE ARE SOME BASIC ROLES FOR THE COMMUNITY.

1.) WE CAN ALL PARTICIPATE IN WELCOMING AND EMBRACING OUR TROOP AS THEY RETRUN HOME. JUST THIS ACT OF RESPECT AND RECOGNITION OF THEIR SERVICE IS CRITICAL.

WHEN YOU SEE A SOLIDER, THANK THEM FOR THEIR SERRVICE. IT IS THAT EASY.
2.)

AS I STATED EARLIER, COALITIONS ARE VERY ADEPT AT THE WORK OF SYSTEMS CHANGE. SO I WOULD ENCOURAGE COALITIONS TO FIRST DEVELOP STRONG TIES WITH THE LOCAL VETERANS SUPPORT SYSTEMS IN PLACE, AND THEN WITH A GOAL OF A HEALTHIER OVERALL COMMUNITY, WORK WITH THEM TO TAKE STOCK OF THEIR SYSTEM. IDENTIFY WHAT IS WORKING AND ADDRESS THOSE PLACES WHERE THERE ARE GAPS.

3.)

A PARTICULAR CONCERN IS THAT TROOPS WITH PROBLEMS ARE NOT SEEKING CARE. SERVICE MEN AND WOMEN STRUGGLING WITH MENTAL HEALTH PROBLEMS ARE A DNAGER

TO THEMSELVES, THEIR FAMILY AND THEIR COMMUNITY. SOME PEOPLE CHOOSE TO SEEK HELP OUTSIDE THE MILITARY SYSTEM, FOR NUMBEROUS REASONS. COALITIONS CAN HELP CONNECT PEOPLE TO COMMUNITY SERVICES.
4.)

DON’T FORGET THE FAMILIES AND CHILDREN OF SERVICEMEN AND WOMEN. TEEN AGERS OFTEN ACT OUT TO EXPRESS THEIR STRESS, AND HAVING A PARENT IN COMBAT IS VERY STRESSFUL FOR CHILDREN. THE NATIONAL INSTITUTE OF MENTAL HEALTH REPORTS THAT PARENTS' RESPONSES TO TRAUMA STRONGLY INFLUENCE THEIR CHILDREN'S ABILITY TO RECOVER. THIS IS PARTICULARLY TRUE FOR MOTHERS OF YOUNG CHILDREN. IF THE MOTHER IS DEPRESSED OR HIGHLY ANXIOUS,

SHE MAY NEED TO GET EMOTIONAL SUPPORT OR COUNSELING IN ORDER TO BE ABLE TO HELP HER CHILD. COALITIONS CAN MAKE TREMENDOUS INROADS WITH THE CITIZENS IN THEIR COMMUNITY WHO HAVE A DEPLOYED FAMILY MEMBER. COALITIONS CAN GO DIRECTLY TO THEIR LOCAL NATIONAL GUARD, OR IF THEY LIVE IN A TOWN WITH A MILITARY BASE, MAKE AN APPOINTMENT WITH THE MENTAL HEALTH PROFESSIONALS THERE. JUST ASK…”HOW CAN WE HELP?” 5.) CADCA ALREADY HAS A STRONG PARTNERSHIP WITH THE NATIONAL GUARD. COALITIONS RELY UPON GUARD DRUG DEMAND REDUCTION COORDINATORS TO HELP THEM CARYY OUT THEIR COMPREHENSIVE

STRATEGIES LOCALLY. I WOULD SUGGEST TO ALL COALITIONS THAT THEY REACH OUT TO THE NATIONAL GUARD IN THEIR COMMUNITY AND STATE. FIND CREATIVE WAYS TO SAY THANK YOU, CONNECT THOSE IN NEED OF SERVICES. WHEN POSSIBLE, CONNECT FAMILIES WITH EVIDENCE-BASED PARENTING AND SUPPORT PROGRAMS. PROVIDE REFERRAL INFORMATION FOR TREATMENT, HOST A HEALTH FAIR FOR VETERANS IN PARTNERHSIP WITH YOUR LOCAL VA, CONNECT PEOPLE TO 12-STEP PROGRAMS, ETC. COALITIONS, THE COMMUNITY CONNECTORS, CAN MAKE A DIFFERNCE FOR OUR RETURNING VETERANS.

AS WE WELCOME HOME OUR IRAQ AND APHGANISTAN VERTERANS, WE WILL CONTINUE TO LEARN MORE ABOUT PTSD AND ITS CONNECTION WITH SUBSTANCE ABUSE. THE DEPARTMENT OF VETERANS AFFAIRS ALREADY SPENDS $3.2 BILLION A YEAR ON MENTAL HEALTH CARE, AND WILL NEED MORE RESOURCES IN THE FUTURE. IINSTITUTE OF MEDICINE IS CURRENTLY REVIEWING THE DIAGNOSIS OF PTSD, AND I LOOK FORWARD TO LEARNING OF THEIR FINDINGS. THROUGH IT ALL, CADCA AND COMMUNITY COALITIONS WILL PLEDGE TO DO OUR BEST TO IMPROVE THE COMMUNITY CLIMATE FOR OUR VETS. YOU KNOW, PRESIDENT JOHN F. KENNEDY ONCE SAID, "A NATION REVEALS ITSELF NOT ONLY BY THE

THE CITIZENS IT PRODUCES, BUT ALSO BY THE CITIZENS IT HONORS, THE CITIZENS IT REMEMBERS." LET US REMEMBER THOSE WHO HAVE DIED IN DEFENSE OF OUR COUNTRY, BUT LET US COMMIT OURSELVES FULLY TO THOSE LIVING VETERANS, SO THAT THEY CAN ENJOY FULL AND PRODUCTIVE LIVES. THANK YOU.

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