Returning service members and military veterans often confront trauma and other mental health challenges, and when they don’t receive help, it often ends in tragedy—with more than 6,000 military veterans dying every year to suicide. Army veteran and psychologist Dustin Brockberg, PhD, sheds light on the issues, speaking with host William C. Moyers about the tough emotional realities, mental health challenges and support opportunities for veterans and their families. Read the podcast transcript below or listen and subscribe on iTunes, Google Play or watch on YouTube. 0:00:13 William Moyers Here we are again, another podcast in Hazelden Betty Ford's series, Let's Talk. I'm your host, William C. Moyers, welcome! We're glad you've tuned in. Today our topic is Veterans, substance use and mental health disorders. Our guest is Dr. Dustin Brockberg, my colleague and a Psychologist at Hazelden Betty Ford. Whose expertise is treatment of co-occurring disorders, psychological assessment, trauma, sleep hygiene, and chronic pain. Thank you, Dr. Brockberg, for joining us today. 0:00:45 Dr. Dustin Brockberg Thank you so much for having me. 0:00:46 William Moyers Good to see you. Can you just share with our audience a little bit about your own personal perspective that fuels your passion and your expertise? 0:00:53 Dr. Dustin Brockberg Sure. Yeah a big part of my fuel and passion to be in this field and more specifically with veterans, is that I also identify as a veteran. And I served in the Army for four years. And completed a hardship tour in Korea and a deployment to Iraq. And I was able to see firsthand what happens to veterans, both in the substance use and mental health fields of things. 0:01:20 William Moyers Thanks for sharing that. And thank you for your service to our country. [Dr. Brockberg nods in thanks] Does the Army or does the military in general prepare their soldiers, sailors, and airmen, for sort of that mental health dynamic that you're going to experience? 0:01:335 Dr. Dustin Brockberg You know, it's interesting that you ask that. It's in a lot of ways, yes and no. I think that they are very mindful of what serving in the military can include, which it could include combat, it could combat loss of limb, it could include various types of mental health diagnoses, things like that. But it's also hard to prepare someone for something they don't know they're gonna experience. And so, they do the best they can to try and train people to get used to certain situations and understand what can happen. But I think it's been really warming to see the organizations that have come out to help veterans when they go home. Because there's a lot of dynamics that play out with that. 0:02:16 William Moyers So we know the physical hardships of serving in the military but what are some of the mental health challenges that veterans return home with that you see? 0:02:27 Dr. Dustin Brockberg For sure. You know one of the primary things that I believe is a cornerstone of why we have a lot of mental health issues is a mixture of military and veteran culture colliding. And also this sense of re-integration that gets lost. So, in the military, there is definitely a push to be strong, to be emotionally and physically, you know, on top of your game, and that's really driven into us to kind of keep pushing and help others and do all these things. And we have the sense of selflessness that often comes with a lot of veterans. And that often continues to carry over when they leave. And they still wanna be mentally and emotionally, physically strong. And it's a very learned behavior, it's a very learned idea. And that can in some ways be counterintuitive because it develops a sense of stigma, it develops a sense of 'I need to figure this out on my own.' And that isn't always that helpful. In regards to the re-integration part of things, you know, different branches and different types of military such as active duty versus National Guard, approaches reintegration differently. But, you know, for example just thinking of active duty military, when they leave the military, they're out. Right? There's no more connection to their previous unit. All the unit—all the people scattered across the United States. And your network is lost. Your support system is lost. A lot of times. And that isn't necessarily the case for National Guard as much because there's still connected to their state and they still meet with some and things like that. But, that definitely plays a big role in that. And in regards to mental health diagnoses, we tend to see primarily a lot of things related to depression and anxiety, trauma, panic disorders, things of that nature. 0:04:10 William Moyers Do you have to have experienced combat to come back from service with mental health conditions? 0:04:21 Dr. Dustin Brockberg No, no I would say not, I would say no to that. I think people often make an assumption that if you're in combat, you must have experienced trauma. And that is a very big misconception. It really depends on how the person reacts and actually experiences all these different events that happen. There's also plenty of for example combat units that never do combat. And whereas you can see units that maybe, for example, a cook that you would never expect to have trauma, has trauma. And so it's really kind of more of everyone's gonna experience it differently, everyone's gonna be exposed to things differently. 0:05:00 William Moyers Why is suicide such an issue with our returning service men and service women? [Dr. Brockberg nods] Or never mind the returning service men and women, but even in the active military. Why is suicide there? 0:05:13 Dr. Dustin Brockberg Yeah. It's a question that I think a lot of people are trying to continue to answer and the VA is working very hard to answer that question. And I think a lot of it, you know, we do know that a lot of veterans tend to be younger when they first come home. And that's a very big risk factor in some sense for being very impulsive, which leads into substance use and leads into other areas that increases their kind of likelihood of some of that. We also know that when someone has a co-occurring disorder, they're at higher risk of suicide. When they have substance use concerns, they're at a higher risk of suicide. And so, some of those pieces definitely play a big role in the suicide rates that are happening. And just to speak to what you said as well about active duty versus veteran, a big phrase that we often hear is the '22 a Day.' Is the phrase we hear a lot. 22 veterans die a day. [Moyers shakes head] And I actually looked this up last night to make sure that that was actually correct and the VA just posted statistics on this in November suggesting that in fact, 17.6 veterans die per day. And the 22 a day actually likely includes active duty members that are also completing suicide. So it's still a very prevalent issue, there's a lot of statistics and understanding geographically of kinda what type of veterans tend to be kind of experiencing this. And how this plays out. We also know that, you know, previous trauma plays a big role and helps somebody who actually perceives trauma in the future. So, there's all different kinda ways of looking at it. 0:06:44 William Moyers Dr. Brockberg, are younger veterans more susceptible to these mental health challenges than older veterans? 0:06:52 Dr. Dustin Brockberg That's a really interesting question. I would say yes and no. I mean I do think from the mental health field, we do see type of mental health issues that vary based on age or cohort. We also know there is a cohort dynamic of how veterans seek help. So, for example it's quite common when veterans are going through a conflict like Vietnam, the initial response is actually to not use the VA and not use certain resources. But over the course of time you see them starting to kind of go back into that system and actually ask for that help. But that plays into the idea of still thinking I can do it on my own. And this is a cohort effect that we see across Desert Storm, we've seen it across Vietnam, we're seeing it across current conflicts. And so, there's plenty of veterans that do seek help. But right now, OIF/OEF veterans, so Iraq and Afghanistan veterans, the current stat is about 50 percent seek services. [Moyers shakes head] So, it's over half. That are not actually asking for help. And they may not need help, it depends. But a lot of folks are not utilizing services that are there for them. 0:07:58 William Moyers I wanna come back and talk about what some of those services are and how people can access them through the VA and other resources. But before I do, just touch briefly if you would on rates of substance use issues. And if not specific rates, you know, are veterans more susceptible to substance use? 0:08:18 Dr. Dustin Brockberg [nods] I would say absolutely. You know, in a lot of ways, it's going back to the idea of military culture. You know when you go on a military base, there tends to be a lot of barracks and a lot of almost like dorm-type structures in place. And so, it's very common in the military to party on base, it's very common that you have a lot of access to alcohol on base. Some bases even have different rules of how old you need to be. I mean there's all different kind of things to think about with that. And so, that is almost like a precursor to how they tend to cope. And how they tend to also celebrate different events in their life. An interesting thing too to think about is a lot of military members utilize nicotine. [Moyers nods] So we also a high proportion of folks that are smoking and folks that are also dipping and that happens early on in their time in the military. And so, over the course of time being in deployments, going through your entire length of service, you tend to see higher rates of alcohol use, nicotine use, things like that. Which again could be a precursor for issues down the road. 0:09:28 William Moyers So, regarding our service men and women who return from active combat zones or return from just their tours of duty wherever they are around the world, if they know that—if they sense they've got a problem, what's your suggestion and where can they turn? 0:09:44 Dr. Dustin Brockberg [nods] Yeah. You know, in a lot of ways, for some people, the VA is a daunting resource. I personally am a big advocate of the VA, there's a lot of great clinicians out there and a lot of good services they offer. A lot of times, when a veteran is reaching out and wanting help, the most important thing at the end of the day is to just listen to them. Understand where they're coming from, understand what they're asking for, and then also appreciate that when they ask you for help, that's actually their first step of asking for help. Right? So they've already actually crossed that barrier of 'I'm gonna be willing to kind of admit that something's not okay.' In regards to what we can also suggest to them if they feel like the VA is not a resource they want or they live in a very rural setting where the VA is not able to kinda access, there's a lot of veteran centers. Or I think short is like "vet centers" that are all throughout major metro areas too, that are often run by veterans. And it's a different resource that's outside of your health record that you can kind of talk and appreciate the kind of actual overall connection that you can have with people there. 0:10:57 Dr. Dustin Brockberg [continues] Outside of the vet centers, you have programs like the Wounded Warrior Project that is highly funded to provide services to veterans. Not only for people with physical disabilities but also mental health related issues. And so, I think that's a big misconception is you must be wounded in order to utilize that, and that's really not true. [Moyers nods] Because a lot of people—people are wounded for a lot of different reasons. Both mentally, physically, and emotionally. 0:11:24 William Moyers And that speaks to the stigma that you talked about earlier. I mean when we see a veteran come home having lost a limb or wearing a Purple Heart, we admire that person and we have empathy for that person. Some of us wanna be like that person. [Dr. Brockberg nods] But when a veteran comes home with what's hurting inside, that's a completely different perspective. 0:11:45 Dr. Dustin Brockberg Yeah. Absolutely. Absolutely. And it can be hard in some ways to also fully understand or even try to actually connect to veterans because of these kinds of unique experiences. But in a lot of ways I actually believe that it's very similar to substance use. That when somebody walks into a door and says 'Hey, I identify as an alcoholic or an addict,' and if a person is not—has not experienced anything like that in their life, it can be a similar 'I don't know what to say, I admire that they're getting help, I admire that they're doing these things.' And it's really more of being able to meet with them and kind of find the actual middle ground to connect. 0:12:22 William Moyers We have about two minutes left, Dr. Brockberg— 0:12:25 Dr. Dustin Brockberg Okay. 0:12:25 William Moyers —Let me ask you this question: but what about families? Families of service men and women? [Dr. Brockberg nods] Whether they be active or retired, they too are vulnerable, yes? 0:12:34 Dr. Dustin Brockberg Absolutely. Absolutely. So one of the things that we see a lot of times is there's a much higher divorce rate in the military. We also notice that, you know, some people will actually deploy for a year, come back for three months, and then re-deploy again. So that creates a lot of hardship on the actual family back home. Which is very much a part of the military family. And they play a humongous role in the support of veterans but also in the support of the military community and they're a big facet of that. And so, we do see a lot of mental health issues within that community as well. And the good thing is is that when they're in the military, they are able to access care usually on base for things like that. But, you know, other things that we also notice and I wanna mention this to you about veterans in general is the VA has created a program where it's called, you know, First Choice or their Choice program. Where veterans can actively choose to find services outside of the VA and the VA will still pay for it. 0:13:33 William Moyers Dr. Brockberg, thank you for taking the time today to share with us your own experience and to give hope to our veterans that there is hope out there, there are services available. [Dr. Brockberg nods] And we appreciate you bringing that message to us today. Good to see you! 0:13:49 Dr. Dustin Brockberg Absolutely. Thanks so much for having me. 0:13:51 William Moyers [turns to camera] We hope you found this program helpful. Please join us for another edition of Let's Talk. And make sure to tell your family and friends, colleagues, fellow veterans, and fellow travelers, to check out our podcast too. Please stay safe and healthy in these times and always. See you again.