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.com. Hey, we want to welcome to Veterans Radio
today a friend, Robert Neer. Dr. Robert Neer,
U .S. Army. Bob, how you doing? I am well. Thanks
for having me. Well, Robert and I are on a couple
of boards together and working on projects, and
he recently published some information and some
research he was doing for his PhD dissertation.
I said, ooh, this is interesting. We've got to
follow up on this. But before we get into the
academic study stuff, Robert, you were in the
US Army from June of 05 to April of 2010. How
did a nice kid like you end up in the army? You
know, I was romantic and I wanted to serve my
country. I also didn't mind the benefits that
they were offering for college. Now, was this
a family thing? I mean, did you have a dad or
uncles who serve? Where did the desire come from?
Yeah, so my my grandpa who I kind of grew up
with he served and it didn't talk about it much,
but I knew he served and Besides that I really
didn't have a lot of people around me that served
in the military I just knew that I could not
afford college and I wanted to go on I wanted
to go down a route that was paid for But I also
like I said being romantic. I wanted to serve
my country and just serve people Well, Robert
is a father, a husband. The blended family has
three kids. All of that kind of comes together
post -service, doesn't it? Oh, yeah. Yep. Absolutely.
Well, let's talk a little bit about your education
because I, you know, mentioned you recently received
your PhD from Western Michigan University. You
also hold a master's of public administration
and from Pennsylvania State University a bachelor's
of science degree in leadership from Grand Valley
State University and a general studies associate
degree from the Central Texas College. Now this
is a kid who couldn't afford college, right?
Yep. You kind of went all the way on your education.
Talk to us a little bit about that. Yeah, thanks
for pointing that out. I had no desire to continue
to go. You know, I got my first degree while
I was still just getting out of the Army, which
was an associate's degree, and I had a desire
to understand leadership a little bit better.
just from my experiences in active duty and a
little bit in the National Guard after that.
So I sought the leadership in business program
through Grand Valley. And after that, I was in
the public service at that time, working for
DHHS in the state of Michigan. And I had a desire
to understand public administration a little
bit better. I had my GI bill left. So I doubled
down and got it done. And I had no desire to
go back, but the program director, Dr. Kieran
Fogarty, uh he was I kind of came across him
in a work professional setting um and when I
was working in non -profit field and he's just
a great leader good person and he was the director
of that program kind of recruited me um I ended
up going through the program took me a little
bit longer than I thought because I was the deputy
director for the state of Michigan's veteran
affairs for the four and a half years. So that
took quite a bit of my time. So it was postponed
and I had to jump back into it after I left that
role and I was able to get it done, finished
up in this last year. And so I wanted to... Chase
the program, which was a PhD in interdisciplinary
health sciences. And it helps me understand a
lot about research and the systemic ways that
you do scientific research to make sure that
you're doing it properly and you are, you know,
you're not biased and you're doing it in a way
that supports the mission of what you're trying
to accomplish with your research. So just a wonderful
program. I was very blessed to take it and I'm
happy to be done with it. Yeah, I'm sure. But
the reason we're talking is because we're going
to talk not about, oh, this is just my opinion.
We all got opinions, right? This is research
-based with some conclusions, some information
that I want to get across to folks. But that's
the key to realize that there was rigorous research
put to this work. But before we get there, I'm
going to jump in a little fast here. Talk to
us about your time in the Army. Yeah, yeah, I
was in from 2005 in June after high school until
April 2010 I got done with basic training and
an AIT and I Was told that I was going over to
Seattle. I wasn't too keen on being on the other
side of the nation So I thought how do I get
on this side and one of my drill sergeants said
well go airborne and you'll be at brag So I went
airborne and I got stationed in Alaska even further
You gotta love Army intelligence, right? So I
went up to Alaska and we prepared, it was a brand
new brigade, the fourth of the 25th Infantry
Division, an airborne brigade that stood up in
Alaska in Anchorage. And I think 2004 we deployed
in 2006, the end of 2006, I found myself overseas
in Kuwait for a month or so, and then I went
up into Afghanistan during the second surge.
We were up there for about 15 months. We came
back. It was a very effective deployment. We
were very busy working the coin mission, counterinsurgency
under General Petraeus during that time. Like
I said, very busy, very successful mission. We
did lose a lot of people. I think we lost 79
from our brigade during that deployment, not
including our external assets from the National
Guard and reserves. So just very busy. We got
back 11 months of downtime and I was stop lost
involuntarily extended and sent back over to
Afghanistan. I was there for a little over 11
months. almost 12 month deployment came back
and I got out of the military and I ended up
joining the National Guard for two years and
staying right next to my home in Michigan and
kind of chasing academic pursuits in life with
my young family at the time. Well with two tours
in Afghanistan you really saw you know some of
the worst of that 20 year war It's one of those
things that never leaves you, it doesn't. Yeah,
no, and just to clarify, I was first deployment
and I was 608 was in Iraq and my second one was
in Afghanistan. But yeah, you're absolutely correct.
It's a different culture, different world. I
was very blessed to be a battalion commander's
driver. So I was able to see quite a bit and
work across a lot of the country and, you know,
be out there with a lot of the people and get
to know people. So it was a lot of exposure for
a young lad. Well, and you know somebody who
just out of high school seeing all this really
shapes you and part of that shape was sort of
this accidental pattern of Well, I want to go
learn more about this. So I'm going to go back
and get some more education And you use the GI
bill as I say from an associate degree to bachelor's
degree to a master's degree and ultimately to
to the PhD which gets us to what we really kind
of want to talk about is the research topic that
you took on. Tell us a little bit about the topic
which was assessing the relationship between
combat exposure, wartime service, and barriers
to substance use disorder treatment in post -9
-11 vets. Kind of strikes home. Tell us how you
got there with this topic. Yeah, you know I'm
coming back from both of those deployments we
had a really good Kind of out processing where
individuals would go through a pretty rigorous
Psychological assessments and everybody knew
what to say and how to get through it and you
know, you saw a lot of alcoholism You saw a lot
of people kicked out of the military after deployments
Between my first and second deployment when we
came back our brigade was kind of known Which
wasn't great as having a really high DUI count
um for our soldiers and uh it was it was just
unfortunate you know it's always been an interest
of mine to see like what can we do why are people
not taking advantage of all these amazing services
that are out there is it stigma um what are these
barriers like um and when i was talking to my
uh director or my um academic advisor when we're
discussing what kind of dissertation we would
chase, this topic came up as it always has. I
want to see how do we help these people get through
these barriers, even if they're not real. They're
just perceived barriers, but to them that becomes
a real barrier if it's perceived barriers. So
I kind of wanted to assess and see what we could
do about it. I didn't make it that far, but we
did find a national data set through SAMHSA,
which I'll talk a little bit more about here
in a little bit. should that had most of the
data that we needed based off of what barriers
they perceived and why they weren't seeking treatment
if they did have a substance use disorder. So
it was something that was just extremely interesting.
You know, I've always it's been around seeing
a lot of people go down the wrong paths and not
get treatment for whatever reason. So I just
want to try to do my part and expose what we
could do a little different maybe to minimize.
people not going to seek treatment and seeing
that there's options for them. And I'm gonna
explain this acronym here, you can use it the
rest of the way, which is substance use disorders
or SUDs. And you were trying to sort out from
this large national survey on drug use and health,
what factors influence getting SUD treatment
or not. and those are the barriers you're talking
about. So what kind of barriers did you find
when you parsed all the data? Yeah, absolutely.
So this study was found and I should have backed
up a little bit and talked about it so that the
primary research questions were what is the relationship
or what was the relationship between post 9 -11
combat exposure and perceived barriers such as
stigma, access to care, and financial constraints
that would influence veterans' help seeking behaviors
and substance use disorders. And that's pretty
specific because I wanted to assess the modern
warfare in post -911. So I did not look at all
veterans all the way back. I only took the study
sample that we had for post -9 -11 veterans out
of that larger sample. The next question was,
what was the relationship between demographic
factors such as age, gender, race, ethnicity,
income was another one, and treatment seeking
behavior among these post -9 -11 veterans. So
I was really focused on those two areas. And
it's extremely significant because the goal was
to address critical gaps and sub treatment access
for post 9 -11 veterans because each generation
has a different, I wouldn't say ambiant, but
a different experience. They have a different
culture. For the most part, veterans are pretty...
similar but that generational differences do
make a difference with their experience and you
know a little bit more wisdom with time from
our Vietnam veterans leading the path and advocating
so much for all these benefits that maybe all
these post 9 -11 veterans aren't taking advantage
of, if that makes sense. It does and one of the
things that was a key finding that you had was
sort of the degree of sudden prevalence between
9 -11 combat veterans, 9 -11, non -combat veterans
in the general population. Explain to us a little
bit about that differential and why trying to
sort out what the barriers are to treatment,
why that's so important for combat -exposed veterans.
Yeah, so like I said, that three main were stigma.
They're in the national data set, which was Like
I said, I'll go through it all here in a second.
But the national data set that we used, it had
three primary categories. It was basically financial.
It was your stigma or culture around it. And
then the last one was access to care. So logistical
barriers. So stigma, financial constraints, and
access to care. And those were the main perceived
barriers that are going to influence whether
or not people did seek treatment or not. And
what we found was that anecdotal costs or financial
constraints were kind of a key finding that were
a perceived problem and it made veterans 28 %
less likely to go seek treatment if they had
those perceived barriers or financial constraints
in their life. We did find that if you had over
$75 ,000 a year in income, you were 3 .42 times
more likely to seek treatment if you acknowledged
that you had a substance use disorder than those
who were less than $75 ,000, which was pretty
significant considering, you know, it's three
and a half times more likely to seek treatment
than those who are less than $75 ,000. And then
there was no indication. One thing that we found,
which we were seeking to see if there was an
indication or a significance, was that veterans
who were exposed to combat in Overseas or whatever
their self -designated combat exposure that There
was no significance in them seeking treatment
or being more likely to seek treatment. That's
a really when I read your Research I was really
surprised by that because combat exposed veterans
were almost double likelihood of a SUD situation
than non -combat veterans, and I don't know,
two and a half times or something, greater than
the general population. you know the guys with
the problem seem to be okay well they're combo
exposed veterans so that probably is going to
factor into why they do don't don't go and get
treatment but that didn't turn out to be a driver
at all did it? No and that's the thing with this
study I should talk about it real quick on the
data set that he used so that way people can
reference it. The data set is a very well -known
national survey on drug use and health, which
is also NISDA. And it is from SAMHSA, which is
the Substance Abuse and Mental Health Services
Administration for America. They do this very
large survey across the whole nation on an annual
basis. And from my study, there was about 15,
just over 59 ,000 participants in the survey.
But I focused on Well, also, out of those 59
,000 participants, about 1 ,980, they had service
in the military. And 838 of those out of the
entire 59 ,838 were post -9 -11 veterans. And
then post -9 -11 veterans who served in combat
was about 450 out of those 830. So that was,
you know, just to give you a kind of idea of
how big the data set is and how well -known it
is before we dive into the results that you're
discussing, because what we did find was that
veterans, which let me reference this. I believe
it's 9 .6 % of the general population had a self
-identified substance use disorder. Non -combat
veterans from the same population had a 12 .8
% likelihood of a prevalence, and combat -exposed
veterans was 21 .5%, meaning that one in five
veterans self -identified that they, or acknowledged
that they have a substance use disorder. Yeah,
again, you'd think, okay, I understand why the
guys in direct combat have a higher likelihood
of substance. use disorder. But that then gets
me to, well, they're probably the guys who are
getting the most amount of treatment. But it's
sort of different than that. The data tells you
a different story. Tell us what the data tells
you. Yeah, the data, as I mentioned earlier,
there was no significance in any of the perceived
barriers or likelihood that combat veterans would
seek treatment at a higher rate. And we don't
know that We don't know the reason for that.
I don't have that data at my fingertips. There's
many assumptions that we could say like, for
example, those veterans, they know they have
an issue or a problem because they're more likely
to know because they have better out processing
like what I had when I was getting out to acknowledge
that these things are issues. as opposed to maybe
those who don't deploy. So we don't know like
what those are. But some of the big barriers
that, you know, you think about in the military,
that is in my literature review, with culture
and military culture, is, you know, you're supposed,
you're tough. You're supposed to be a tough person.
You don't ask for help. There's promotion potential
that may go away if these things come to light.
There's a lot of potential issues with you mentioning
it in the military culture, even though it's
presented in a way that it's okay to ask for
help. You'll see, I don't know if you've seen
some of the policy changes, but even one just
recently that might have negative unintended
consequences is the one that holds E7 and aboves
now to the same standards as E6s and below when
it comes to DUIs and their punishments. meaning
that they can be demoted just as quick as the
younger, you know, the lower ranking individuals.
And that doesn't seem like much, and it seems
like a no -brainer that it'd be a good thing,
but that does compound the challenges in the
substance use field. You're gonna have more people
hiding it. You're gonna have more people not
seeking mental health support and treatment because
they don't wanna be exposed, which could be detrimental
to their careers, right? I do wanna get to your
recommendations, but there was another... set
of key findings that you've had from parsing
the data that I thought was interesting and we
should kind of tell people about. And that there
was a race and ethnic pattern that you were able
to discern that if I understand this right, white
veterans, non -Hispanic white veterans, were
roughly twice as likely as black veterans to
seek treatment. Am I reading that right, or is
that the percentage of folks with SUD's prevalence?
Yeah, no, that's absolutely correct. So the people
that are going to seek treatment based off of
this data set that was ran in 2022 showed that
race and ethnicity absolutely played a crucial
role in treatment seeking behavior. Specifically,
as you mentioned, non -Hispanic white veterans
had the highest treatment seeking rate at 6 .2%,
while non -Hispanic black veterans had a much
lower rate, which was 3 .8%, and Hispanic veterans
sought treatment at a similar rate, at 4 .5.
So that shows you that there are some cultural
barriers, not necessarily, that may be based
off of race and ethnicity, if that makes sense.
Yeah, I think it's important to realize those
cultural barriers exist, because you can't have
the same. if you will, recommendations or one
size doesn't fit all when you go through this
and see, yeah, different groups are being impacted
different ways. And before we run out of time,
I want you to talk about your recommendations
if you would. Oh yeah, so two more things to
mention and I'll talk about the recommendations
because they're key in there. Age was also a
strong predictor of treatment seeking behavior.
The age range 35 to 49 had the highest engagement
rate at 6 .9 % compared to those younger veterans,
which was only 2 .5 % seeking treatment and similar
rates, but it was definitely 35 to 49 is the
highest. And then on the other hand, there was
no statistical significance between male and
female, but males were a little bit more likely,
5 .4 % compared to 4 .8. of the female gutter
population. But with our key findings, you know,
it's pretty impressive to see all these things
come together. And, you know, it kind of reassures
your gut feeling of what's going on in the space.
And are there issues that we could be avoiding
by giving recommendations that we know are backed
by research? So we already talked about The key
findings of post 9 -11 veterans that were combat
exposed being two times more likely than the
general population to have a substance use disorder.
We talked about male and female and the high
and low rates of age, racial disparities, and
the higher income being an increased likelihood
of seeking treatment by 3 .4%, but also the perceived
barrier reduced likelihood of seeking treatment
by 28 % meaning that as we talked in the beginning
that if you had less or if you perceive that
financial constraints were going to be an issue
you were 28 % right off the bat less likely to
even seek treatment. So some of the recommendations
that I made, could I jump into those? Yeah please
do. I think there's five of them here that I
want you to cover. Okay, yeah, so the first one
obviously is to expand financial support by covering
indirect costs such as transportation, child
care, because we found out that ancillary costs
are kind of a deterrent when it comes to seeking
treatment because insurance doesn't necessarily
cover everything. They would maybe cover the
treatment, but there's a lot more complexities
going on in everybody's life that maybe we should
be cognizant of when we're getting people into
treatment for substance use. there are some programs
out there that are very effective but I would
advocate to you know promote those but also funding
for gender specific with integrated care meaning
that we would bring all care together not just
their substance use disorder care but also their
mental health care their physical health care
in one location so that way that individual can
have a full you know supported substance use
treatment experience. We also, second recommendation
was to reduce stigma by utilizing veteran led
campaigns and peer support while increasing access
to confidential treatment options, which that's
already kind of being done and there's research,
a lot of research being done in those areas,
but I just want to encourage that and say the
data supports it. We need to continue to increase
it. The third was to enhance cultural competence
by training providers and culturally tailored
care. We know that, you know, individuals that
come in that maybe had a sheltered life or they've
had limited exposure to different cultures with
ethnicities or races are less likely to have
a strong relationship with individuals of different
races and ethnicities. And so what we recommend
is focusing on these specific needs of minority
veterans and female veterans because that's going
to help build up these providers by training
them appropriately on how to interact and engage
with most effectively. And the fourth one was
to improve access by standardizing trauma -informed
integrated care models by expanding telehealth
services. So we strongly believe there's a lot
of research out there that shows that this is,
it already works, and you can see a lot of that
in my literature review. You can see it out there
by yourself and your own research just by showing
and exploring a little bit that integrated care
models and telehealth services are really opening
doors that weren't there before for geographically
displaced veterans that may have limited access
to care. And then the fifth one, It also helps
with the financial constraints as well. So it
does help mitigate the high financial constraints
of treatment from facilities when you can do
some of it from home. And then the last one here
was I recommended to address disparities by targeting
outreach efforts for minority and low income
veterans and kind of debunking myths, which I
know we're already working towards that, but
we're not quite there with a consistent message
across the nation. And we just need to strengthen
partnerships between the VA and community organizations,
which once again, the VA is really working hard
to do this. We're just not quite there yet. We
just got to continue to advocate and push that
needle because as we see in research across the
board from many colleagues and individuals out
there doing this kind of work, that there's more
to do. Well, what's again, I'll go back to we
all have a gut feeling on some of this and and
hey, we need to get our veterans who have substance
use disorders in the treatment. Well, we may
have that gut feeling, wow, this is a barrier,
that's a barrier. That's why it's nice to have
the research done and have, you know, give some
support to gut feeling or changing in that gut
feeling. We've been talking to Robert Neer, a
PhD, airborne artillery man, U .S. Army for,
I think that's about five, six years. Couple
of overseas deployments and afterwards made his
way all the way up through the academic roster.
to ultimately get a doctorate, and this is some
of the dissertation research that he's done.
Robert, did you finish this up where you thought
it was gonna go, or did it give you like, oh,
I wasn't expecting that? You know, it was very
in line with current low literature that's out
there. There was a few findings that were really
interesting that we had discussed throughout
this time period. I was really hoping to see
if I could expose the probability or likelihood
that a combat veteran is going to seek treatment
or not, when there's really not any significance
in the study that I was able to find. But I would
advocate for other researchers out there to maybe
do more qualitative work, not necessarily all
quantitative, like what was done in the study,
so that we could really see. What are the perceived
barriers? We're looking for that aha moment of
how do we break down this wall and get people
that need the help into the care they need so
they can be productive members of society again.
That's really all we're trying to do. Well, it's
certainly a noble goal and we appreciate the
time that you took today to talk to Veterans
Radio listeners and explain a little bit of this
to us. kind of reinforces some of our good feelings,
Robert, here. I really appreciate the time that
you gave us today, Bob. Yeah, thank you so much,
Jim. I can't say enough how much I appreciate
what you all do on the radio. I just love to
listen and love to hear it, so keep up the good
work and thanks for having me on. And I want
to thank everybody for listening to Veterans
Radio today. I am Jim Fossone. It's been a pleasure
to be your host. I'm a Veterans disability lawyer
at Legal Help for Veterans, and you can reach
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