The Veteran's Guide to Fighting Pain and Addiction

0:00:13 William Moyers
Hello and welcome to another Let's Talk podcast. Produced and brought to you by Hazelden Betty Ford. I'm your host, William C. Moyers, and today we're joined by Kerry and Dustin Brockberg, who have written an important and insightful book, End Your Covert Mission: A Veteran's Guide to Fighting Pain and Addiction coming out now. Kerry Brockberg is a Licensed Psychologist working in the field of rehabilitation with a focus on individuals with chronic pain, brain injury, and other chronic illnesses and disabilities. Dustin Brockberg is a Licensed Psychologist working in the field of substance use and co-occurring disorders at Hazelden Betty Ford. In other words, he's my colleague. And Dustin served in the United States Army from 2004 to 2008, including a deployment in Iraq. Welcome to both of you.

0:01:00 Dustin Brockberg
Thanks for having us. [Kerry nods]

0:01:02 William Moyers
Tell us a little bit about your experience in Iraq.

0:01:05 Dustin Brockberg
So, when I went into the military, I joined as a tanker. So my fun joke is I fit into a tank, so small I could fit into it. [Moyers chuckles] But I joined out of really just a cause of wanting to serve my country and that cause just continued when I left the military and wanting to still serve my country and serve those that were wanting to heal. And so, a big part of it with this book is continuing to want to serve. And wanting to help those that are trying to heal from their time in the military. And those that are struggling with substance use, chronic pain, emotional pain, all those things.

0:01:42 William Moyers
And Kerry, where did you get your interest in pain management and in chronic pain?

0:01:48 Kerry Brockberg
So, my background is in working with folks with disabilities. And right out of school I decided which group should I work with and kinda came into the pain world. Had a lot of experience in training from my PhD program. And yeah, it just kind of fell in my lap. And I've been working gosh it's been three or four years now, working with folks with chronic pain and different disabilities. So yeah. [smiles, nods]

0:02:16 William Moyers
And for the record, we talked about this off-camera, but you all are new parents of twins.

0:02:22 Kerry Brockberg
[laughs] Yeah. Yeah.

0:02:24 William Moyers
So good thing that those twins came after you decided to write this book, right?

0:02:28 Kerry Brockberg
[laughs along with Dustin]
They were actually, I mean, I was pregnant during the time we were writing.

0:02:33 Dustin Brockberg
Yep. [grins, nods]

0:02:34 Kerry Brockberg
So, it's funny to—I don't know, they're here now. [chuckles]

0:02:37 Dustin Brockberg
Very good timing.

0:02:38 William Moyers
So tell us about the book—what prompted it?

0:02:43 Dustin Brockberg
I think one big reason was just the simple gap. There's just a huge hole. [Kerry nods] And in the literature, in the world of trying to bridge substance use, mental health, chronic pain, all into one book, into one source. I think there's also a huge issue of academia trying to understand, trying to explain, and talk to veterans in a way that they can understand, that they can connect. To big topics, big psychological ideas, big medical terms. That there's always some kind of a disconnect. And so our book is really more about we're gonna talk to you like a person, we're gonna swear, we're going to be honest, we're going to just give you some honest tools, ways to think about your world—

0:03:37 William Moyers
Mmm.

0:03:38 Dustin Brockberg
—And give it to you straight. And that's a big part of what this book is hoping to do is just to kind of meet them where they are. Give them some new tools but also throw away some really crappy ones that worked for a while.

0:03:51 William Moyers
Now, the book is specific to veterans, but pain management and chronic pain is an issue for lots and lots of people. What is the challenge in managing chronic pain? Nevermind the veterans for a moment, but just in general.

0:04:06 Kerry Brockberg
Yeah I would say that the hardest thing about having chronic pain is how long it is, the longevity of it. We're pretty programmed as humans to process acute pain which is you break your arm and you go get your cast and you're done in six to eight weeks. And you move forward. Whereas chronic pain is pain persisting over time. And a lot of people don't understand that. Especially within the veteran community. [Dustin nods]

0:04:32 William Moyers
Mmm.

0:04:33 Kerry Brockberg
There's kind of this perception of how do you still have that pain, how are you still experiencing that, why is that not done? You got that while you were serving. So it's something that is very universal but definitely more specific to the veteran community.

0:04:50 Dustin Brockberg
Yeah.

0:04:50 William Moyers
And of course the whole issue of chronic pain and its management is part of the reason why we have an opioid epidemic in this country. Because the panacea at one time was here's another script for 60 Percocets—

0:05:07 Dustin Brockberg
Mmm-hmm.

0:05:07 William Moyers
—And that doesn't necessarily work.

0:05:09 Kerry Brockberg
Right. So our book is really trying to help folks understand different strategies aside from medication management. We do talk about medication management—

0:05:19 William Moyers
Mmm-hmm.

0:05:19 Kerry Brockberg
—Sometimes it's very appropriate. Sometimes it's something that veterans need to continue on with and we definitely talk about talking to your provider. But our book definitely focuses on, you know, probably a hundred different strategies on how to manage pain. Without meds.

0:05:38 William Moyers
And I wanna come back to that in just a minute—

0:05:40 Kerry Brockberg
Yeah.

0:05:40 William Moyers
—On some of those strategies. But I'm interested in the title of the book, specifically the emphasis on End Your Covert Mission.

0:05:50 Dustin Brockberg
Mmm-hmm. Mmm-hmm. So as you eluded to aside from just veterans, this book is geared towards veterans, it's geared towards those that maybe have learned to hide their pain. That have learned to go forth in their mission— [Kerry nods]

0:06:04 William Moyers
Mmm.

0:06:06 Dustin Brockberg
—Despite pain. That have learned that it's very important to finish their mission despite any consequences that have happened. That if you're bleeding, if you're wounded, if you're hurt, the mission comes first. How many folks do you know that have been told family comes first, right? No matter what, family comes first. Their kids come first. Everybody else comes first. Right? Those are all missions that we've been told in our life. Veterans have similar missions. And so this book is a way to reprogram, rethink about that mentality, that we wanna end this mission that everything else comes first. That we can actually start a new mission. That you come first. That you can actually heal. That you can actually start a new world in your life. But that might mean that we have to put down some of these old missions that you've been taught. Which includes this idea that you don't show pain. You don't talk. You don't show emotion. All those things that a lot of veterans have subscribed to, that have been told that is normal. And I wouldn't even say just veterans subscribe to that. I would say many folks struggling with substance abuse subscribe to that.

0:07:15 William Moyers
Hmm. Mmm-hmm.

0:07:15 Dustin Brockberg
I would say a lot of folks in certain genders, races, ethnicities, ability status, all kinds of different groups, have subscribed to those ideas.

0:07:24 William Moyers
And so what feeds into that is the shame and the stigma.

0:07:27 Dustin Brockberg
Absolutely. [Kerry nods]

0:07:27 William Moyers
Right. We all know shame and stigma around mental illness and addiction. But if you are a veteran, it's heightened even more, right?

0:07:33 Dustin Brockberg
Absolutely. Absolutely. And that's a whole different cohort that takes it to almost a deeper level.

0:07:39 William Moyers
Yes.

0:07:39 Dustin Brockberg
Because of the stigma and the shame that kind of comes I'll say with that. And even the idea I mean we talk about this in the book as well, the idea of needing to be mentally ready. That if we're not ready, if we're not able to go on in the mission, we're failing the person next to us.

0:07:54 William Moyers
Mmm-hmm. Mmm-hmm.

0:07:55 Dustin Brockberg
And so, we can't not be good to go.

0:07:58 William Moyers
Mmm.

0:07:58 Dustin Brockberg
And that is a whole different mentality we have to get rid of.

0:08:02 William Moyers
Is the issue of chronic pain one of physical chronic pain, or do you address in the book the issue of trauma and those other sorts of pain that might not be a pain that manifests itself in an elbow, in a knee, or a neck?

0:08:19 Kerry Brockberg
Yeah. I love that you're bringing that up.

0:08:21 Dustin Brockberg
Mmm-hmm.

0:08:21 Kerry Brockberg
—Because that's a big part of our book is trying to dismantle the idea that pain is just physical.

0:08:27 William Moyers
Yes.

0:08:28 Kerry Brockberg
So we talk about physical pain, emotional pain, and social pain in our book. Physical pain is something that's a little easier to broach for veterans because just the concept of, you know, this is what happened when I was serving. And Dustin even talks about sometimes how it can be an honor—

0:08:48 William Moyers
Sure.

0:08:49 Kerry Brockberg
—To experience some sort of battle wound I think is what we call it—

0:08:52 Dustin Brockberg
Mmm-hmm.

0:08:53 William Moyers
A purple heart!

0:08:54 Kerry Brockberg
Yeah, sure. So we talk about physical pain of course but also, the emotional and social pain. A lot of veterans experience issues with grief. And I think we talk about grief and loss from a mental health standpoint. But we really don't categorize it as like a pain experience. And this is gonna help folks kind of relearn that. And then socially like getting back and leaving the military, coming into different communities. Your family, your work. I've worked with a lot of vets that it's hard, it's really difficult, to integrate back into communities that don't understand or have the same value system—

0:09:37 William Moyers
Mmm-hmm.

0:09:38 Kerry Brockberg
—As when you were in the military. So yeah, so we're really talking about pain from more of a holistic, we call it—

0:09:45 William Moyers
Across the spectrum.

0:09:45 Kerry Brockberg
Yep.

0:09:46 William Moyers
You call it what?

0:09:47 Kerry Brockberg
A biopsychosocial approach.

0:09:48 William Moyers
Yes. Right. Right, right.

0:09:49 Kerry Brockberg
Which isn't new. But it's something that might be new terms for veterans to hear. And we're excited about that, yeah.

0:09:57 Dustin Brockberg
Mmm-hmm.

0:09:58 William Moyers
Why is it that our country, our government, our military, has not been responsive to the needs of our service women and men when it comes to chronic pain or mental anguish?

0:10:17 Dustin Brockberg
Hmm. We're gonna need a whole 'nother podcast.

0:10:20 William Moyers
Yes. Yes.

0:10:20 Dustin Brockberg
No, I'm kidding. I think there is something that is called the cohort effect. That is important to think about.

0:10:31 William Moyers
Mmm.

0:10:32 Dustin Brockberg
Statistics have come out just in the last couple years that about it's something like 56 percent of OIF, OEF, OND veterans, so the Iraq-Afghanistan veterans, utilize the VA system. So only about half.

0:10:49 William Moyers
Wow.

0:10:49 Dustin Brockberg
Right? Same thing happened with Vietnam. Same thing happened with Korea. Gulf War. And this is a cohort effect. And so, that is an interesting finding in a sense that a lot of veterans initially don't seek out help from the VA which is the biggest health care system we use with veterans. Initially. The VA has now shifted and has a lot of initiatives now to allow them to use care within their communities, to say you know what, we're gonna help you find the care you need. Whether it's in the VA or elsewhere. And so I think the VA's done leaps and bounds trying to help. [Kerry nods]

0:11:22 William Moyers
Mmm-hmm.

0:11:23 Dustin Brockberg
I think they definitely have. And I think it's just gonna take more time, to be honest. And we're learning and learning and more and more, I think even in just the last 30 years, the more we've learned about mental health—

0:11:36 William Moyers
Yes.

0:11:36 Dustin Brockberg
—About veterans actually speaking up and saying hey, this is not working, even things from Agent Orange to now what we're finding with Gulf War and like burn pits that just recently came out in the news.

0:11:47 William Moyers
Mmm-hmm. Mmm-hmm.

0:11:48 Dustin Brockberg
Of all the—I think just yesterday the Senate just passed a bill on healthcare with burn pits. That's amazing. That's awesome that they're actually getting ahead of it. And those are the kind of initiatives that we can actually change the narrative on catching these things ahead of time versus waiting 20 years to then make initiatives to change healthcare for vets. So I think that the language is adjusting.

0:12:11 Kerry Brockberg
Pain has changed, too. So—

0:12:12 Dustin Brockberg
Yeah.

0:12:13 Kerry Brockberg
—Thinking about exactly how you brought that up. I think how pain is treated has been—has definitely changed over time.

0:12:19 Dustin Brockberg
Mmm-hmm. Yeah.

0:12:20 William Moyers
Yes.

0:12:21 Kerry Brockberg
So our understanding, increased research, understanding what opioids impact on the body. I mean it's changed so much. So I think there's a bigger push because we have increased understanding now of, you know, how this is impacting.

0:12:36 Dustin Brockberg
And I think going off that too even nowadays, whether or not with COVID—one of the blessings of COVID which is weird to say that, but one of the blessings of COVID is virtual care.

0:12:46 William Moyers
Yes.

0:12:47 Dustin Brockberg
A lot of veterans are rural. Right?

0:12:48 William Moyers
Yes.

0:12:49 Dustin Brockberg
And so now there's so much more virtual care, virtual therapy, virtual neuropsych testing, whatever it is. That a lot more veterans are now getting care from that perspective.

0:12:58 William Moyers
Mmm-hmm.

0:12:59 Dustin Brockberg
And that's great.

0:13:00 William Moyers
Mmm-hmm.

0:13:01 Dustin Brockberg
And before, we didn't have as much of that. And now we actually have a lot more means to reach a lot more people. And so, more healthcare systems are doing that. And that's another great way to actually get the people the help they need.

0:13:12 William Moyers
Sure. Yes.

0:13:13 Dustin Brockberg
So. Yeah.

0:13:14 William Moyers
Yes. We don't wanna give away what's in the book but we wanna talk about just in the few minutes that we have left a couple of your favorites. Kerry, we'll start with you. Give me two of the favorite steps—you said you have over a hundred of 'em—what are two of the practical steps that you'd like to share with the audience?

0:13:28 Kerry Brockberg
Yeah the strategies. Yeah we call them our Tangible Next Steps.

0:13:32 William Moyers
Yes.

0:13:33 Kerry Brockberg
So, kind of at the end of each chapter we provide actual things that vets can go and try to do. One of my favorite ones that we put in there is using your five senses.

0:13:43 William Moyers
Hmm.

0:13:43 Kerry Brockberg
I think that's one that's really underutilized. Think about it. Like we all have our five senses going on all the time. If we we're tuned into it, we would all be on overload. But if we kind of intentionally think about oh I'm gonna utilize my five senses to help me relax in this moment.

0:14:02 William Moyers
Mmm-hmm.

0:14:02 Kerry Brockberg
You know, you wake up, you might have your cup of coffee I know I did this morning with our twins. [smiles] And you might not even think twice having that cup of coffee, but if you shift the brain over to, you know, what am I smelling right now, what am I tasting, what do I feel—

0:14:18 William Moyers
Mmm.

0:14:18 Kerry Brockberg
—Going through those five senses to help you relax. Sometimes we see—and not just sometimes—but we notice that the body can calm down and we talk about like the biology of how pain works in the body and if we can relax the system, we can calm down that pain.

0:14:37 William Moyers
Mmm.

0:14:37 Kerry Brockberg
So that's one of my favorite ones. I talk about that with my clients all the time.

0:14:41 William Moyers
Mmm-hmm.

0:14:42 Kerry Brockberg
Using the five senses. Do you wanna do the other one, or?

0:14:45 William Moyers
Yeah. Do one, Dustin. [smiles]

0:14:46 Kerry Brockberg
[chuckles] Yeah. What's your favorite?

0:14:47 William Moyers
What's one of your favorites?

0:14:48 Dustin Brockberg
Oh. Well I have a lot. [Moyers chuckles] So, I would say another aspect that I would wanna comment on would just be understanding more of naming like veteran culture is a big one. That I like to think about.

0:15:03 William Moyers
Hmm.

0:15:03 Dustin Brockberg
And that is something that we don't really talk a lot about. And that's just kind of identifying kind of like where you actually identify your culture, where you identify where you actually seek help. [Kerry nods] Like where you can actually think about where you find your support system, where you don't. I think one of the things that a lot of veterans identify is this idea of 'I can only get help from other veterans.' Right?

0:15:26 William Moyers
Ah.

0:15:26 Dustin Brockberg
And that's an interesting idea. And so one of the things in the book that we talk about is how can we shift that narrative to also find other communities that we can seek help from.

0:15:34 William Moyers
Ah. Yes.

0:15:36 Dustin Brockberg
And so one of the Tangible Next Steps that we talk about is broadening that perspective.

0:15:41 William Moyers
Yes.

0:15:42 Dustin Brockberg
To increase your support system. Still honoring the fact that many veterans can share and understand your narrative, but there's also a lot of veterans that also might not understand your narrative. Right?

0:15:50 William Moyers
Ahh.

0:15:51 Dustin Brockberg
And so, being able to kind of broaden that perspective can be really helpful.

0:15:55 William Moyers
It makes sense that this book is gonna be published by Hazelden's Publishing because we're in the—our mission is to help people.

0:16:02 Dustin Brockberg
Mmm-hmm.

0:16:03 William Moyers
But we've been—we've come to the game sort of late in terms of recognizing what veterans specifically need. What are we doing these days to help veterans? Besides publish your book.

0:16:15 Kerry Brockberg
[Dustin smiles] Well the VA is taking a lot—you brought this up earlier, Dustin—but the VA is taking a lot of steps specifically to help with pain and pain reduction.

0:16:22 William Moyers
Yeah.

0:16:23 Kerry Brockberg
A lot of education, a lot of helping providers understand the circumstances for vets. Helping vets understand, you know, pain addiction. I would say that's a big thing—

0:16:36 Dustin Brockberg
Yeah.

0:16:37 Kerry Brockberg
—For the VA specifically.

0:16:38 William Moyers
Mmm-hmm.

0:16:40 Dustin Brockberg
Yeah I would say within the context of Hazelden, I know Hazelden recently is also publishing a mindfulness and meditation book—

0:16:47 William Moyers
Yes. Yes. [nods]

0:16:47 Dustin Brockberg
—That's coming out here a little alongside our book. I don't know if it's in the same timeframe but that's gonna be great. Different meditations from other veterans that are kind of being published. I also know we're now accepting a lot of Tricare insurances to get more veterans in our doors, which is wonderful. Which previously was a big—big issue—

0:17:05 William Moyers
Mmm.

0:17:06 Dustin Brockberg
—For a lot of just getting the care they need. I know there's new support systems, new support groups coming out as well. There's a lot new—a lot of new AA, NA groups coming out that are veteran-specific. I also have heard some rumors that there's even some partnerships with the VA and Hazelden kinda coming out as well. Which is kinda cool.

0:17:22 William Moyers
Mmm-hmm. And of course we have a Chief Medical Officer, Dr. Alta DeRoo—

0:17:27 Dustin Brockberg
We do, yeah!

0:17:27 William Moyers
—Who is a Naval Aviator, a veteran, of many missions.

0:17:29 Dustin Brockberg
Yeah. Mmm-hmm.

0:17:32 William Moyers
And I think having her leading from that perspective as a CMO will be beneficial as well.

0:17:39 Dustin Brockberg
Mmm-hmm. Absolutely.

0:17:40 William Moyers
But your book is gonna be critical and who do you hope will read this book?

0:17:45 Dustin Brockberg
Mmm.

0:17:45 Kerry Brockberg
All vets. All vets. And anyone that is connected to a veteran—

0:17:50 William Moyers
Yes!

0:17:50 Kerry Brockberg
—I think you know my unique perspective, I'm not a veteran myself—

0:17:51 Dustin Brockberg
Yeah.

0:17:52 William Moyers
Mmm-hmm.

0:17:53 Kerry Brockberg
—But being the wife of a veteran has been so eye-opening.

0:17:58 William Moyers
Mmm-hmm.

0:17:58 Kerry Brockberg
You know, we talk a little bit about our story of you know learning his stories and me asking questions. And I think it could be beneficial for anyone that's connected to a veteran. Even folks with chronic pain that are not veteran-identified.

0:18:14 Dustin Brockberg
Mmm-hmm.

0:18:15 Kerry Brockberg
They probably could benefit too. There's a lot of great content in there. So. [nods]

0:18:19 Dustin Brockberg
Yeah.

0:18:20 William Moyers
And Dustin, what about a clinical audience?

0:18:24 Dustin Brockberg
I would say, again, along with veterans would definitely benefit reading this book. But I think many folks that generally, to my point earlier, that struggle to let out their pain, that understand that maybe don't wanna show what's going on underneath can be really helpful to understand this book. Because yes we are using the veteran audience as a way to kinda talk about this. But there's a lot of good strategies in there. That anyone that just struggles to just talk about their stuff can be really helpful to understand this book. I would also say anyone that has a family member that is a veteran, anyone that is a clinician—

0:19:05 William Moyers
Yes.

0:19:04 Dustin Brockberg
—That's working with veterans, that's working with substance use—

0:18:07 William Moyers
Yes.

0:19:07 Dustin Brockberg
—Could really benefit from this book. A lot of times we also just have people that have family members of family members that are veterans. And that will be helpful to understand that perspective. So I think there's a lot of folks that can benefit from reading our book.

0:19:22 William Moyers
So Dustin, we gotta go but before we do, what's your message of hope to veterans and their families who are tuning in today?

0:19:29 Dustin Brockberg
My message to every veteran that's listening to this is to take a chance.

0:19:34 William Moyers
Mmm.

0:19:34 Dustin Brockberg
To allow themselves some grace to read this book, to maybe allow one message to hit home. To see if maybe they can put down one piece of gear that maybe no longer is working.

0:19:51 William Moyers
Mmm.

0:19:51 Dustin Brockberg
And let one new piece of gear maybe change their life. Right? It doesn't take a lot of gear to change. But if they can put down one thing and turn something in, it can maybe make a big difference in their life. That they don't have to go their entire life with pain. That's my hope for them.

0:20:07 William Moyers
Thanks for that message of hope and indeed maybe those veterans can put down a piece of gear and pick up a new piece of gear: an asset, your new book, out now. Thank you, Dustin and Kerry, for being with us today. [to camera] And thanks to all of you for joining us. On behalf of our Executive Producer, Lisa Stangl, and the crackerjack team at Blue Moon Productions, we're grateful that you've joined us for this Let's Talk podcast. And remember, it's okay to ask for help. Treatment works. Recovery is real. Take good care and we'll see ya again.