The Official Voice of Vietnam Veterans of America, Inc. ®
An organization chartered by the U.S. Congress
March/April 2005
FEATUREVietnam Veterans and Alcoholism
Article Reprint Date, August 1984
BY THOMAS BRINSON AND VINCE TREANOR For the past two-and-a-half years we have had the opportunity to work with alcoholic Vietnam veterans. This has enabled us to deal with two of the most significant aspects of our past lives, our experiences as Vietnam veterans and our involvement with the disease of alcoholism.
THE WORLD OF THE VIETNAM VETERAN
To understand Vietnam veterans, it is first necessary to acquire some understanding of the Vietnam War. It was America’s longest war, spanning the twelve-year period from 1963 to 1975. Of the estimated 2.5 million individuals who served in Vietnam, some 58,000 Americans lost their lives. Another 300,000 were wounded, and some 2,500 today [August 1984] are unaccounted for.
The Vietnam War has been characterized as having the following five basic differences from other wars Americans have fought:
First, the inescapable fact is that the Vietnam War is the first armed conflict which the United States has lost. The Vietnam warrior returned to his homeland not as a heroic victor, but as a disgraced scapegoat.
Secondly, it was a guerrilla war. Violence knew no boundaries. Many civilians were killed or wounded. There were few safe areas, no defined areas of front and rear zones. The enemy was illusive, invisible and as likely to be a twelve-year-old girl as a pajama-clad peasant. Armies didn’t meet head-on where superior American firepower could best be utilized. Rather, Vietnam combatants were sniped at, rocketed, mortared, and booby-trapped by an unseen foe. Terrain, the climate, and accidents also took their daily toll.
Thirdly, to a great extent due to the brutality of the war which was nightly displayed on TV screens across the nation, the Vietnam War resulted in divisive controversy at home. For the first time in our history, large numbers of people seriously challenged the legitimacy of a national policy to wage war. The returning Vietnam vet was often branded by his college-aged peers as a baby-killer, an aggressor, an object of derision.
Fourthly, the individual rotation pattern utilized during the Vietnam War prevented soldiers from effectively working through their combat experiences before being plunged back into American society. Veterans of World War II fought together as whole units for the duration of the war. Coming home in the close confines of troop ships, they had the opportunity to process their mutually experienced combat traumas.
Most soldiers in Vietnam, on the other hand, were individually assigned as green newcomers to units in the field from Replacement Battalions. After surviving their year’s tour of duty, they were sent home alone on a commercial airliner, often wearing jungle fatigues freshly covered with mud.
Literally, within a brief 24-36-hour period, a combat soldier could be plucked away from his buddies in the middle of a firefight and deposited into the chaos of an urban traffic jam with no accommodations for jet-lag, much less for the culture-shock of readjustment to American life.
Lastly, returning Vietnam veterans had to integrate themselves into an economy suffering from “stagflation.” Several years behind most of their peers, Vietnam veterans were often the last to be hired and thereby the first to be laid off in a shrinking economy. In addition, they received a G.I. Bill that was inadequate to provide for education and training.
ARE WE A HIGH-RISK POPULATION?
Demographically, Vietnam veterans comprise only a small minority of America’s largest, most influential generation (Baskir and Strauss, 1978). Of the 26 million men who were draft-eligible during the war, roughly a third, some 9 million men, entered military service. Of these, the Pentagon estimates some 2.5 million men served in-country Vietnam, and of that number about 1.5 million were exposed regularly to periods of combat.
In other words, about one in ten men of the affluent, baby-boom generation have survived a life experience significantly different from most of their peers—exposure to combat in Vietnam. Large numbers of minorities in American society were disproportionately called upon for service in Vietnam (Baskir and Strauss, 1978). Pre-existing cultural, political, and racial biases have made readjustment for these veterans especially difficult.
In addition, the Vietnam veteran was our nation’s youngest soldier. Whereas the average age of the World War II combatant was 26 years, the average age of the Vietnam veteran was 19. One can readily appreciate the monumental impact the brutality resulting from combat in Vietnam would have upon a 19-year-old, an adolescent with a barely formed identity still searching for suitable roles in adult life.
At an age when most young men are typically forming lasting ideas about intimacy and relationships, soldiers in Vietnam were losing friends in painfully horrible ways, and perhaps learning that closeness hurts too much.Peter Marin (1981) in his perceptive article about Vietnam veterans eloquently observes:
“What they know is this: the world is real; the suffering of others is real; one’s actions can irrevocably determine the destiny of others; the mistakes one makes are often transmuted directly into others’ pain; there is sometimes no way to undo that pain; the dead remain dead, the maimed are forever maimed, and there is no way to deny one’s responsibility or culpability for those mistakes; for those mistakes are written, forever, and as if in fire, in others’ flesh.”
ALCOHOL-RELATED PROBLEMS AMONG VIETNAM VETERANSRecent publicity and television documentaries such as the PBS History of Vietnam last fall and media coverage of the Vietnam Veterans Memorial in Washington, D.C., have amply demonstrated the plight of Vietnam veterans, which continues years after their return from active duty in Vietnam.
The Veterans Administration estimates that between 500,000 and 700,000 Vietnam veterans still experience severe readjustment problems related to their duty in Vietnam. Significant numbers of these men are alcoholic.
The constellation of social, political, demographic, and economic factors discussed above, unique to Vietnam veterans, has resulted in a plethora of negative attitudes and feelings—guilt, low self-esteem, rage, alienation, bitterness, self-pity, grief, depression, etc. These form fertile ground for the development of alcohol-related problems.
The recent suicide in Peekskill, New York, reported in a New York Times feature article (Winerip, 1984) of a one-time prominent Vietnam veteran leader with a long history of alcoholism tragically illustrates the impact that alcohol-related problems can have on the readjustment difficulties of Vietnam veterans.
Several studies identify Vietnam veterans as high-risk for alcohol-related problems. Greden, Frenkel, and Morgan (1975) surveyed the alcohol use of 1,873 U.S. Army soldiers and reported that according to operational definitions based on total alcohol consumption and behaviors related to the drinking, 7 percent of the Vietnam veterans studied were alcoholic, another 5 percent were border-line alcoholic, and 24 percent were potentially alcoholic.
In other words, 36 percent of the Vietnam veterans studied demonstrated alcoholism or significant alcohol-related problems which could develop into alcoholism. The Center for Policy Research, Inc. (1981) concludes that the rate of alcohol problems among in-country veterans as a whole is significantly greater than the rate for era veterans and non-veterans. This study also found that exposure to combat had a strong effect on drinking—both the frequency of drinking and the reported amount of alcohol consumed increased significantly with the amount of exposure to combat.
Boscarino (1981) asserts in his analysis of data collected in 1977 that in-country veterans had substantially higher levels of alcohol consumption and binge-drinking episodes than comparable groups of era veterans and non-veterans.
He reiterates the speculation of President Carter’s Commission on Mental Health that alcohol abuse may become a special health problem among Vietnam veterans, suggesting that the drinking patterns among Vietnam veterans may be related to post-traumatic stress.
The cumulative message of these reports points to a significant incidence of alcohol-related problems among Vietnam veterans. Add to this the fact that the average age of the Vietnam veterans today is 36 years old, just the age when physical tolerance to alcohol generally begins to break down and the overt symptoms of progressive alcoholism most insidiously begin to manifest themselves, and it is reasonable to predict that Vietnam veterans will experience increasing numbers of alcohol-related problems during the remainder of the 1980s.
THE CORRELATION OF ALCOHOLISM WITH POST-TRAUMATIC STRESS DISORDER
Vietnam veterans are susceptible to Post-traumatic Stress Disorder. Those veterans who experienced prolonged exposure to heavy combat are especially vulnerable. Discussed in DSM III (1980) as a delayed stress reaction which may occur years after the initial life-threatening trauma, such as combat, is experienced, PTSD is described as manifesting a variety of disruptive symptoms which impact upon the emotional responses, cognitive functioning, and interpersonal relationships of affected individuals.
For Vietnam veterans, hallmark symptoms of PTSD include the following: 1) guilt, especially survivor guilt; 2) chronic anxiety and nervousness; 3) depression or deep sadness; 4) flashbacks; 5) startle reactions, jumpiness, hyper-alertness; 6) difficulty being intimate; 7) sleep disturbances and nightmares; 8) trouble concentrating; 9) intrusive, obsessional memories; 10) psychic numbing; 11) self-medication, especially with alcohol; 12) anger, rage, hostility; 13) distrust and alienation; 14) low self-esteem, negative self-image; 15) difficulty with authority; and 16) self-punishing and self-destructive patterns.Initially, the unbearable intensity of these distressing symptoms may be somewhat alleviated by drinking (La Coursiere, Godfrey, and Ruby, 1980). For example, a combat veteran may consume large amounts of alcohol before bed, which may appear to calm sleep disturbances and eliminate terrifying nightmares.
The heavy drinking may also seem to relieve anxiety and block out intrusive memories associated with combat incidents, and may induce psychic numbing, making it easier to withdraw emotionally.
Vietnam veterans may suffer from survivor guilt which manifests itself in a variety of ways to include: despair at surviving the war while buddies died terribly; anguish at not being wounded, knowing others lost limbs, sight, or mobility; feelings of failure—real or imagined—for things that were done or should have been done; feelings of incompetence or helplessness in combat situations that resulted in needless death and destruction; feelings of cowardice under fire; horror at acts performed under combat, especially against women and children; shame at having participated in or watched atrocities; or despair at having knowingly or accidentally killed fellow soldiers. Alcoholism literature has many references to the negative effect of guilt on drinking patterns.
Many Vietnam veterans have not been able to re-connect following their experiences of combat in Vietnam. The ensuing isolation and alienation has kept them from sharing their pain with friends and loved ones. The veteran who uses alcohol in order not to feel, as one veteran put it, “to experience oblivion,” compounds this isolation and alienation. Continued heavy drinking can lead to alcoholism.
In addition to becoming a problem in and of itself, La Coursiere et al. (1980) also observe that abusive use of alcohol significantly exacerbates the symptoms of PTSD. For example, as a depressant, alcohol may contribute to psychic or emotional numbing and induce depression. While in a depressed stage, a pattern of heavy drinking may lead to obsessive ruminations about combat experiences intensifying survivor guilt. Self-destructive actions may follow.The authors have noted excessive late-night, solitary drinking followed by reckless, high-speed driving, or use of guns to provide self-destructive confrontations with police among our Vietnam veterans clients. It is significant to note the high number of apparent suicides among Vietnam veterans since their return from Vietnam, many of which can be presumed to be alcohol-related.
Peripheral nerve damage due to heavy drinking may make some veterans more susceptible of hyperactivity, restlessness, and startle reactions. Alcohol may “trigger” flashback episodes, during which traumatic events experienced in combat are violently and frighteningly relived.
Since heavy drinking disturbs the natural sleep process, interrupting REM dream patterns, the veteran may become more vulnerable to the symptoms of PTSD.
A chronically stressful situation, such as combat, leaves some individuals with free-floating anxiety. Continual stress may actually cause damage to the autonomic nervous system. Many combat veterans may have nervous systems that are less capable of handling stress than normal persons. Numerous veterans speak about not feeling the same since Vietnam or of being “a nervous wreck” and not being able to talk about it with anybody, loved one or stranger.Compounding this combat-related stress, Vietnam veterans continue to face multiple problems in their struggle to readjust to American life. As we noted above, Vietnam veterans came home to a society at times hostile, ambivalent, or indifferent. They sought and were denied a forum for the discussion of the shattering, war-related events. They watched the country they fought for strive to erase a war it found uncomfortable and embarrassing. They struggled to obtain an education playing catch-up to many of their non-veteran peers while supporting their families on a highly inadequate G.I. Bill. They scrambled to compete for jobs in a rapidly shrinking economy.
Many veterans became increasingly bitter—their pariah-like treatment by American society led one of this paper’s authors to write a poem in the early seventies about the isolated, invisible veterans recognized only by other silent veterans, somewhat surreptiously—usually in a bar!
It is understandable why rage is a key problem for Vietnam veterans with drinking problems. Branded a killer, a sucker, a loser, how does one accept the painful memory of listening helplessly under intense enemy fire to a fellow soldier whose face has been half blown off screaming through the night to some God in the jungle to please let him die?
For years, many vets have lived trying to suppress such memories and the burning rage that accompanies them. To be told by someone, even a loved one or a well-meaning alcoholism counselor perhaps, “Why don’t you just let go of the past and forget it?” only increases the rage.
The abusive use of alcohol can tap into this rage and release it uncontrolled. In our practice we have observed the following: a veteran gets drunk and like anyone else when drunk, his judgment is impaired and his inhibitions are released. He doesn’t care about being hurt; he may even look for it as self-punishment. More often than not, he gets into a fight.
In military training, soldiers are taught to react when threatened with aggressive, even violent behavior. In Vietnam there were no rules. Violence was sanctioned, rewarded, and reinforced as crucial to survival.
A combat veteran recently related his feelings of horror when on his first combat assault he looked up at the lead chopper coming in to pick up his unit and read, “Forty-seven killing days till Christmas” painted on the fuselage. When a veteran is intoxicated, this learned behavior of violent reaction may re-emerge whether or not the threat is real. An alcohol-induced flashback may occur.
We’ve worked with veterans who while intoxicated have seriously hurt another. This often occurs as the result of a derogatory remark about Vietnam made by a non-veteran. Later, in a sober state, the guilt concerning loss of control and explosive, violent behavior sends the veteran into a deep depression. At such times, he views himself as worthless, and very often thoughts of suicide predominate.
The authors contend that there is a much stronger correlation between alcohol abuse and the symptoms of PTSD than has previously been acknowledged in treatment programs for Vietnam veterans. Unless alcoholism among Vietnam veterans is aggressively treated in a drug-free, abstinence-model program, there will be little lasting change in PTSD symptomatology.
Continued drinking, or abuse of prescribed medications such as valium, for an alcoholic veteran experiencing PTSD results not only in the progression of active alcoholism, but also in an exacerbation of the distressing and disruptive symptoms of PTSD.
TREATMENT CONSIDERATIONS FOR ALCOHOLIC VIETNAM VETERANS
Alcoholism professionals who treat alcoholic Vietnam veterans must examine attitudes and beliefs about the war, its warriors, and the impact of the war on American society, becoming familiar with the history of the war and specific resources relating to veterans’ issues readily available in most urban communities.For example, there are 135 Vet Centers operated by the Veterans Administration throughout the United States. These Vet Centers are staffed to a large extent by Vietnam veterans professionally and personally familiar with the problems of readjustment for Vietnam veterans.
Staff in the Vet Center program regularly receive training related to intervention with and treatment of Vietnam veterans. It is critical that alcoholism treatment programs utilize such resources of their clients who are combat veterans.
Both the alcoholism and issues relating to PTSD must be treated aggressively and simultaneously. Treatment plans which deal only with one to the exclusion of the other are doomed to failure. Either the veteran will use his abusive drinking to sabotage successful readjustment, or he will use his PTSD symptoms as an excuse to continue drinking.
For alcoholic Vietnam veterans abstinence must first be established before substantive resolution of the symptoms of PTSD can be achieved. For treatment to be successful, repressed and often explosive feelings must be directly confronted and worked through. This is often a long and painful process during which the veteran who lacks a strong network of support and compassionate counseling will be extremely vulnerable to relapse.
A major obstacle to treatment is lack of trust by many Vietnam veterans. Vietnam veterans are characterized as being mistrustful, not only of institutions and authority figures, but of most individuals as well, including family and friends.
Many veterans relate that it is only within the company of fellow veterans that they can comfortably let down the defensive barriers and ease up on the wariness with which they deal with the world.Group counseling in which alcoholic veterans work with and relate to each other is strongly recommended. The use of sober, recovering combat veterans as peer counselors in the group will facilitate the establishment of trust and credibility.
Such veterans can also act as strong role models for active AA involvement. This can have a ripple effect in the community in terms of recovering veterans doing 12 Step work with other veterans, creating a community of recovery veterans. This in itself gives veterans a growing sense of self-growth, purpose and strength, and a renewed sense of pride.It is imperative that at least one of the group leaders be a combat veteran trained in alcoholism counseling and familiar with PTSD.
Last summer we facilitated such a group of sober, combat veterans. The group began as a twelve-session closed group which focused on aspects of early recovery as they related to unresolved issues concerning Vietnam duty. The group was so productive that it has continued as an open-ended group where readjustment difficulties are dealt with in depth and actively worked on.
Through the group process of sharing, support, and concentration, alcoholic veterans are helped not only to accept their alcoholism and an abstinent lifestyle, but also to come to terms with the residual moral pain caused by their combat experiences.
Such a group experience can generate a renewed sense of peer bonding, a feeling again of camaraderie. Slowly, a sense of trust emerges, creating a climate in which the strengths one had in Vietnam, long since forgotten, can be found again.
Courage, pride, sacrifice, high-level performance under extreme stress and brutal conditions, a sense of community, service to country, endurance, survival skills, caring for other men, strength of will—all discarded in the years since, buried under isolation and bitterness—are allowed to surface, take form to be used constructively again.
As the negative aspects of PTSD and alcoholism are discussed and worked on, so too are these strengths developed. Group members evolve a sense of purpose, a positive identity. They discover new meanings and directions in their lives.
There is a growing need to work with families of Vietnam veterans, many of them blended families, who have lived in an environment of constant stress for years. A concurrently run partners group is important. Veterans can too easily begin to relate as a re-creation of their old platoon and become a self-enclosed world. A place where partners can work on themselves can help break the isolation. Partners can begin to communicate and view themselves as human beings who have been terribly hurt.
Many children of Vietnam vets are now teenagers with the double stressors of alcoholism and the effects of PTSD in the family system. They are ripe to develop drug and/or alcohol problems themselves. Some alcoholic veterans are adult children of alcoholics who had no intervention or knowledge of alcoholism before they went to Vietnam. They were already emotionally damaged before being exposed to the brutality of combat situations.
Family members need to be educated about PTSD, so they can understand what’s been happening and can let go of the guilt, deal constructively with the anger, and begin to work on themselves.
CONCLUSION
It’s been a long road for many Vietnam veterans, and a lot of them have not been able to hang on. For many, help was too late in coming. One of the authors recalls a particular morning in Vietnam:
“We’d been up all night through a horrendous firefight. It was a situation which all of us felt could have been avoided. We’d felt like we’d been used as bait. One of my badly wounded men, who’d stayed up the night so others could leave by medevac, came up to me screaming, ‘When are they going to learn; when the hell are they going to listen?’”It’s time to listen, time to learn. People are not expendable. What we’ve been talking about is healing. Throughout the ages, warriors have been given rites of passage back into society.
A lot of men who fought in Vietnam have felt that what they did in Vietnam made them permanent exiles from society. When they came home, the country confirmed this feeling. There were not rites of passage for Vietnam veterans.
For many veterans, feeling like outcasts living on the edge of society, not finding places to fit in, even with a bottle, life has been a living hell. There is so much more healing to be done. Who can understand this more than the people working in the field of alcoholism?
References
American Psychiatric Association (1980), Diagnostic and Statistical Manual of Mental Disorders. (3rd ed.) Washington, D.C.
Baskir, L.M., and Strauss, W.A. (1978), Chance and Circumstance: The Draft, The War, and The Vietnam Generation. New York: Vintage Press.
Boscarino, J. (1981). “Current excessive drinking among Vietnam veterans: A comparison with other veterans and non-veterans,” International Journal of Social Psychiatry, 27(3), 204-212.
Center for Policy Research, Inc. (1981), Legacies of Vietnam. New York.
Greden, J.F., Frenkel, S.I., and Morgan, D.W. (1975), “Alcohol use in the Army: Patterns and associated behaviors,” American Journal of Psychiatry, 132 (1), 11-16.
La Coursiere, R.B., Godfrey, K.E., and Ruby, L.M. (1980), “Traumatic neurosis in the etiology of alcoholism: Vietnam combat and other trauma,” American Journal of Psychiatry, 137 (8), 966-8.
Marin, P. (1981, November), “Living in Moral Pain, Psychology Today, pp. 68-80.
Winerip, M. (1984, January 31), “Story of a V.A. Patient: A Long Road to Suicide,” New York Times, pp. B1, B4.
The authors presented their findings at the 40th NCA Forum in Detroit on April 13, 1984. Both served as Army officers in Vietnam, are members of Chapter 8, and are associates at the Breakthrough Center, 648 Franklin Ave., Garden City, NY 11530.
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