Over-prescription is making veterans dependent on pharmaceutical drugs
I drove home from the doctor’s office as sad and depressed as I’d ever been in my life. Sitting on the seat beside me were two bags. One contained a small bottle of Ambien, to help me sleep. The other contained sample boxes of Lexapro, an antidepressant.
For the last three months — the three months since I’d come home from Iraq — I’d been unable to sleep. Every night at ten o’clock, no matter how tired I was, I’d come alive. I’d feel that familiar tension. In Iraq, night was when bad things happened. Night was when friends died. Night was when we had to make our tough choices. When I was outside the wire, it was often at night. Night was when the detainees rolled in. At night I had to be alert.
But not at home. At home I needed sleep. The kids would be up at 7:00 a.m. I had to be at work around 8:00. I supervised a dozen lawyers and practiced law against attorneys from some of America’s best law firms. I had to be sharp. I was anything but.
And so I went to the doctor — like so many other American vets. I wanted to sleep again. I wanted to feel normal again. I didn’t go to the VA (who needs that kind of wait?), so I went to a local doctor, who told me that I didn’t exactly have post-traumatic stress disorder, I mainly just had post-traumatic stress. My brain chemistry had changed while I was downrange, he explained, and now I was wired to wake up at night and catch sleep when I could. He said I needed help. The pills were the help.
I’ve thought about that day many times as I’ve met more and more vets who have struggled after coming home. As a JAG officer, you get to know soldiers better than many other staff officers do. They’ll drop by to ask about a family issue, or to discuss their finances, or to ask for career and educational advice. When you’re a reserve officer, they know you also work in the “real world,” and I’ve helped dozens of men and women work on their résumés — trying to write about their military experience in ways that civilian employers would understand.
When I was with men (and it was mostly men) who’d had rough deployments — or who’d been deployed multiple times — I’d always ask, “How are you doing? Everything okay?” Most of the time the answer was a quick, “I’m cool.” Often enough, however, it was something else — some variation of “Sir, I don’t know. I just don’t feel like myself.”
Then they’d open up. They couldn’t sleep, so they had to take Ambien. They were depressed, so they were taking Lexapro. They had chronic neck and back pain after hanging 90 pounds of gear on their frame day after day, month after month, so they took Lortab. They were anxious, so they took Xanax. But it wasn’t helping, they said. They felt sluggish. They had trouble staying motivated. They just didn’t feel right.
But how could they? It was as if their VA doctor had simply listened to a list of symptoms, located a pill to address each complaint, loaded up the patient with prescriptions, and called it “treating” a soldier for PTSD. But the treatment left young men in the prime of their lives with hollowed eyes and slurred speech. They didn’t want to live like that — and they hated what they’d become — but they had PTSD, right? What choice did they have?
And so it goes, the cycle for “treating” American veterans. Under pressure for failing to take care of them, the VA and civilian doctors dramatically over-diagnose PTSD, over-prescribe often-addictive pills, and then wonder why their patients often report profound dissatisfaction with their lives.
The numbers are staggering. In 2014, the VA reported that it had treated almost 375,000 returning Afghanistan and Iraq vets for PTSD, and it estimated that roughly one in five post-9/11 veterans suffered from the disorder. The contrast with the British army is striking. While the U.S. dealt with a PTSD epidemic, the Brits — whose soldiers also fought hard in Iraq and Afghanistan — reported that only 7 percent of their returning combat soldiers suffered from PTSD. The proportion of noncombat soldiers suffering from PTSD was only between 2 and 5 percent.
Are the Brits more stoic than Americans? Can they better handle the trauma of war? Perhaps at the margins, but certainly not enough to account for the dramatic difference in the percentages.
So what is the explanation? The VA publishes a list of PTSD symptoms, and these lists are repeated endlessly during post-deployment briefings. Having trouble sleeping? You might have PTSD. Are you startled by loud noises? You might have PTSD. Do you keep busy to avoid thinking about a traumatic event? You might have PTSD. As I surveyed the list, I could check off approximately half the symptoms.
It’s a recipe for over-diagnosis. People who come back from war — especially if they were either in combat arms or deployed with a combat-arms unit — are going to experience dramatic psychological changes. It’s inevitable. Young men will find themselves grieving death perhaps for the first time in their lives. They’ll face stress that civilians can’t possibly imagine, and they’ll feel fear at a level they could never have anticipated. What does “normal” life look like after an experience like that? Is it even possible to be “normal” again? Yet rather than prepare soldiers for a new normal, we try vainly to “fix” what’s allegedly broken. And we do it with pills.
In 2014, an inspector-general report found that the VA was systematically over-medicating its patients — even to the point of death. The findings were horrifying. A stunning 93 percent of long-term narcotics patients in VA hospitals were also prescribed benzodiazepines, a combination that increases the risk of a fatal overdose. Fewer than half of narcotics patients on multiple drugs “had their medications reviewed by VA staff,” according to CBS News. One vet told CBS News that he’d lost more friends at home to narcotics than he’d lost overseas to enemy action.
Wisconsin’s Senate race is being roiled by a report on the VA facility at Tomah, a place so notorious for freely writing narcotics prescriptions that it gained the nickname “Candyland.” Senator Ron Johnson and his Democratic challenger, former senator Russ Feingold, are locked in a war of words over the scandal, with a familiar question hovering over the controversy: Who knew? The facility has been linked to multiple fatal overdoses.
It is difficult for veterans to reverse course once they become dependent on their prescriptions. Many of the over-prescribed drugs are extraordinarily addictive, and young soldiers are now facing rehab and long-term care not just for PTSD but also for drug dependence. They came to the VA for help getting through a difficult life experience, many were diagnosed with a malady they did not have, and now they’re addicted to drugs they never truly needed.
I’ve often reflected on the vast and yawning gap between my expectations and reality. I went to war as one of the oldest members of my unit — a 38-year-old captain who’d joined later in life. I thought that the extra years would give me the maturity I needed to absorb the shock of war. I thought I could go to war and return more or less the same person.
I was wrong — profoundly wrong. When I came home, grief clung to me. My personality had changed. I was far more aggressive and far less tolerant of others than I’d ever been before. And I just couldn’t sleep. No matter how exhausted I was.
And so there I was, in my car, staring at medications I never thought I’d take. Medication was how other people handled their problems. But now I was “other people.” I didn’t know what else to do.
That first night, I took the Ambien, and I didn’t remember anything from 11:00 p.m. until my alarm rang the next morning. I felt terrible. I hated that I couldn’t remember part of the night before, I didn’t feel rested, and I felt mildly hung over. But I took it again and again, and I just felt worse. I felt boxed in. I could sleep only with Ambien, but when I slept, I didn’t truly rest. I was becoming the exact person I’d seen others become.
So I stopped. I didn’t take another Ambien, and I didn’t take a single Lexapro. Instead, I prayed and I talked. I prayed that God would grant me rest, and I opened up more to friends and family — describing the men they’d never known but who’d become closer than brothers to me, and describing what it was like to stand at attention saluting them one last time as their bodies were carried away.
Gradually, things got better. I slept a little more each night as my body retrained itself, remembering that here at home the night is not full of stress and fury. As I got more sleep, I got less aggressive, less irritable.
But I never became normal again. Or, more precisely, I had a new normal. My wife says I’m dramatically different from the man she married, and she says that it’s mostly for the better. My experience was nothing like that of some of the heroes I served with, but war changes us all. There is not a pill made that can change us back.
There are veterans who truly suffer from PTSD — complete with symptoms that are the stuff of nightmares. But there are many other veterans who don’t suffer from PTSD but are treated for it. There are many veterans who can learn to manage their pain, but they’re drugged to the point of near-death.
I still have the Lexapro boxes. They sit in my medicine cabinet — right next to a small bottle of now-expired Ambien pills. They remind me of where I was, they remind me of God’s grace, and they remind me of the men and women who are trapped by their own prescriptions.
Here is the sad reality: Your husband or son can come home from war but get lost in a pill bottle — a pill bottle pushed into his hands by the instruments of America’s most dysfunctional medical bureaucracy. That’s not treatment, it’s abuse. And it’s abuse that is increasing the casualties of America’s longest war. The VA is killing men the Taliban couldn’t touch.