The headline in the May 15th USA front page article was entitled, “Psychiatrist: Army must ‘man up’ over killings. In this article Army Psychiatrist Patrick Lillard was referring to decisions which led up to “that night four years ago when a drunken soldier shot to death a sheriff’s deputy along a shoulder of an expressway outside this base (Fort Gordon, Georgia) and then turned the rifle on himself.”
This article written by Greg Zoroya of USA TODAY, should be the basis of discussions about:
· How serious we take the disease of addition and its consequent affect on one’s brain.
· How treatment decisions are made in the military.
· How National Guard Troops serving their country on active duty are treated when they get injured or have a medical condition such as addiction.
· The role of we health care professionals in modeling the treatment of addiction as a disease and not as someone misbehaving.
Perhaps we could begin by asking some of the following questions:
Who should be making decisions about care for an illness? Should a non-medical officers in the Army or any other non-medical person be able to overrule the recommendations of a medical doctor? Dr. Lillard had twice recommended that the soldier, Specialist Christopher Hodges, receive at least a month of intensive treatment.
What do we need to do to convince counselors, commanding officers and the general public to take the disease of addiction seriously and then take steps necessary to insure that treatment is mandated when someone’s thinking is impaired? Our current laws and rules in and out of the military make it nearly impossible to mandate treatment.
What do we need to do to ensure that inpatient and residential treatment facilities staffed by trained, competent professionals are available 24 hours a day seven days a week? Currently even if someone is ready to get help one seldom has access to inpatient medical care where that person can be safely detoxed and then get the follow up treatment necessary for healing/recovery. Inpatient care does more than address the possibility of an immediate medical crisis. It addresses the need to be in a safe, closed facility where the drug of choice is not available.
How do we treat those who are members of a National Guard when they are injured or have a serious medical condition? The young man was on active duty from the Tennessee National Guard. His company commander said his decision to not follow the advice of Dr. Lillard “stemmed from the fact that Hodges was a member of the Tennessee National Guard and only temporarily on active duty while attending air-traffic control training at Fort Gordon. Mullins said that he thought Hodges would return to the National Guard before hospitalization could begin. Sadly even though I am a veteran and work with veterans until a few years ago I was under the impression that anyone who was on active duty regardless of whether their point of origin for via the regular military service or the National Guard were treated the same when it came to medical needs. I naively did not think one’s point of origin mattered if one needed medical attention or ongoing treatment at the Veterans Administration facilities. Apparently the relationship between the National Guard and the regular service is much more complicated than I used to think. If one is permanently injured by serving on active duty, but is a member of the National Guard one is not immediately eligible for the same benefits as one who originated as a member of the regular service. If one is serving one’s country in the armed services and needs help it should not matter. Specialist Hodges needed treatment, deserved treatment, and those who were affected by his addiction deserved protection. It should have happened the day Dr. Lillard recommended it. Treatment should have continued as long as it was needed. We need to address whatever budget issues and other political issues which affect how individuals on active duty are treated.
It is helpful to use terms such as “man up? Although commonly used, it is an outdated, sexist term which does not take into account the fact that (1) the Army and the general public has both men and women in it (2) someone who is ill cannot just “man up” or “woman u” or “person up”. Yes, there are times when all of us need to call upon all the strength and courage we can muster. I have suggested to others and myself that it is time to pull up one’s big girl or big boy pants and do what we need to do. Sometimes I have used this phase with someone about needing to get treatment for his or her addiction. I know that we all know what the term means and it has some validity, but it has also been used to send someone back into battle after several tours of combat duty or to just quit drinking or to ignore one’s mental illness. Dr. Lillard is suggesting that the Army personnel have the courage to admit that how they handled this and similar cases is irresponsible at best.
If one does not believe that alcoholism is a serious disease ask any adult who grew up with an alcoholic parent. Ask any parent who has a child of whatever age whose diseased brain is terrorizing the family. Ask any relative of someone who has been killed by someone under the influence of alcohol. Ask any doctor who treats individuals with advanced, often life threating diseases which are directly caused by alcoholism. Ask anyone who has tried to force an out of control addict into treatment about the laws in their state and/or the attitude of health care professionals.
We health care and addiction professionals also need to start being more consistent. Half the time we say it is a disease and work hard to get insurance to pay for treatment for this medical condition. Yet, when the person cannot stay sober or clean we often get angry, accuse them of not really trying and we may even throw them out of treatment. We cannot have it both ways. It sometimes seems as if we want to treat addicts whose minds are already healed. That obviously makes no sense at all. Either the whole treatment option is a scam and we need to just “man up” and get a real job or we need to be consistent about treating addicts with the compassion we treat a person with any other disease.
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