WEBVTT 00:00:05.160 --> 00:00:08.980 All across America and around the world, this 00:00:08.980 --> 00:00:15.140 is Veterans Radio. This is Veterans Radio. Good 00:00:15.140 --> 00:00:18.600 day. I'm Jim Fossone. I'm the Officer of the 00:00:18.600 --> 00:00:20.699 Deck today here on Veterans Radio and thanks 00:00:20.699 --> 00:00:23.469 for joining us. We've got some interesting stories 00:00:23.469 --> 00:00:25.649 for you. We always want to remind you, you can 00:00:25.649 --> 00:00:28.750 find more about Veterans Radio at its Facebook 00:00:28.750 --> 00:00:32.429 site or at the web, veteransradio .org, where 00:00:32.429 --> 00:00:35.270 we're on the web 24 -7. You can find a lot of 00:00:35.270 --> 00:00:38.310 our podcasts there as well. We post new ones 00:00:38.310 --> 00:00:42.509 every Tuesday, so you can get a new story, a 00:00:42.509 --> 00:00:45.229 new interview, something you didn't know before 00:00:45.229 --> 00:00:49.210 by going to veteransradio .org. 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It provides water 00:01:38.760 --> 00:01:42.019 damage remediation, flood water removal, fire 00:01:42.019 --> 00:01:45.859 and smoke damage remediation, mold removal, biohazard 00:01:45.859 --> 00:01:50.900 cleanup. It also has a focus on veteran franchisees. 00:01:51.340 --> 00:01:54.400 You can learn more about them by going to puroclean 00:01:54.400 --> 00:01:58.620 .com. Hey, we want to welcome to Veterans Radio 00:01:58.620 --> 00:02:03.519 today a friend, Robert Neer. Dr. Robert Neer, 00:02:03.700 --> 00:02:07.280 U .S. Army. Bob, how you doing? I am well. Thanks 00:02:07.280 --> 00:02:10.400 for having me. Well, Robert and I are on a couple 00:02:10.400 --> 00:02:13.500 of boards together and working on projects, and 00:02:13.500 --> 00:02:18.060 he recently published some information and some 00:02:18.060 --> 00:02:20.560 research he was doing for his PhD dissertation. 00:02:20.740 --> 00:02:22.740 I said, ooh, this is interesting. We've got to 00:02:22.740 --> 00:02:25.900 follow up on this. But before we get into the 00:02:25.900 --> 00:02:31.319 academic study stuff, Robert, you were in the 00:02:31.319 --> 00:02:35.800 US Army from June of 05 to April of 2010. How 00:02:35.800 --> 00:02:39.699 did a nice kid like you end up in the army? You 00:02:39.699 --> 00:02:42.300 know, I was romantic and I wanted to serve my 00:02:42.300 --> 00:02:45.379 country. I also didn't mind the benefits that 00:02:45.379 --> 00:02:48.080 they were offering for college. Now, was this 00:02:48.080 --> 00:02:51.979 a family thing? I mean, did you have a dad or 00:02:51.979 --> 00:02:56.280 uncles who serve? Where did the desire come from? 00:02:56.789 --> 00:02:59.770 Yeah, so my my grandpa who I kind of grew up 00:02:59.770 --> 00:03:02.830 with he served and it didn't talk about it much, 00:03:02.930 --> 00:03:05.969 but I knew he served and Besides that I really 00:03:05.969 --> 00:03:07.669 didn't have a lot of people around me that served 00:03:07.669 --> 00:03:11.710 in the military I just knew that I could not 00:03:11.710 --> 00:03:15.729 afford college and I wanted to go on I wanted 00:03:15.729 --> 00:03:18.830 to go down a route that was paid for But I also 00:03:18.830 --> 00:03:21.430 like I said being romantic. I wanted to serve 00:03:21.430 --> 00:03:25.979 my country and just serve people Well, Robert 00:03:25.979 --> 00:03:32.259 is a father, a husband. The blended family has 00:03:32.259 --> 00:03:36.539 three kids. All of that kind of comes together 00:03:36.539 --> 00:03:39.740 post -service, doesn't it? Oh, yeah. Yep. Absolutely. 00:03:40.030 --> 00:03:44.009 Well, let's talk a little bit about your education 00:03:44.009 --> 00:03:48.949 because I, you know, mentioned you recently received 00:03:48.949 --> 00:03:52.849 your PhD from Western Michigan University. You 00:03:52.849 --> 00:03:55.270 also hold a master's of public administration 00:03:55.270 --> 00:03:59.569 and from Pennsylvania State University a bachelor's 00:03:59.569 --> 00:04:03.050 of science degree in leadership from Grand Valley 00:04:03.050 --> 00:04:05.389 State University and a general studies associate 00:04:05.389 --> 00:04:09.469 degree from the Central Texas College. Now this 00:04:09.469 --> 00:04:11.770 is a kid who couldn't afford college, right? 00:04:12.370 --> 00:04:15.449 Yep. You kind of went all the way on your education. 00:04:16.110 --> 00:04:19.149 Talk to us a little bit about that. Yeah, thanks 00:04:19.149 --> 00:04:22.629 for pointing that out. I had no desire to continue 00:04:22.629 --> 00:04:26.290 to go. You know, I got my first degree while 00:04:26.290 --> 00:04:29.430 I was still just getting out of the Army, which 00:04:29.430 --> 00:04:31.449 was an associate's degree, and I had a desire 00:04:31.449 --> 00:04:33.149 to understand leadership a little bit better. 00:04:33.529 --> 00:04:37.810 just from my experiences in active duty and a 00:04:37.810 --> 00:04:39.589 little bit in the National Guard after that. 00:04:41.259 --> 00:04:43.639 So I sought the leadership in business program 00:04:43.639 --> 00:04:47.139 through Grand Valley. And after that, I was in 00:04:47.139 --> 00:04:49.459 the public service at that time, working for 00:04:49.459 --> 00:04:52.740 DHHS in the state of Michigan. And I had a desire 00:04:52.740 --> 00:04:54.420 to understand public administration a little 00:04:54.420 --> 00:04:57.959 bit better. I had my GI bill left. So I doubled 00:04:57.959 --> 00:05:00.939 down and got it done. And I had no desire to 00:05:00.939 --> 00:05:05.160 go back, but the program director, Dr. Kieran 00:05:05.160 --> 00:05:08.589 Fogarty, uh he was I kind of came across him 00:05:08.589 --> 00:05:11.029 in a work professional setting um and when I 00:05:11.029 --> 00:05:14.129 was working in non -profit field and he's just 00:05:14.129 --> 00:05:17.230 a great leader good person and he was the director 00:05:17.230 --> 00:05:20.310 of that program kind of recruited me um I ended 00:05:20.310 --> 00:05:22.490 up going through the program took me a little 00:05:22.490 --> 00:05:25.170 bit longer than I thought because I was the deputy 00:05:25.170 --> 00:05:26.730 director for the state of Michigan's veteran 00:05:26.730 --> 00:05:29.850 affairs for the four and a half years. So that 00:05:29.850 --> 00:05:32.170 took quite a bit of my time. So it was postponed 00:05:32.170 --> 00:05:34.990 and I had to jump back into it after I left that 00:05:34.990 --> 00:05:36.889 role and I was able to get it done, finished 00:05:36.889 --> 00:05:41.329 up in this last year. And so I wanted to... Chase 00:05:41.329 --> 00:05:44.310 the program, which was a PhD in interdisciplinary 00:05:44.310 --> 00:05:47.410 health sciences. And it helps me understand a 00:05:47.410 --> 00:05:52.209 lot about research and the systemic ways that 00:05:52.209 --> 00:05:54.889 you do scientific research to make sure that 00:05:54.889 --> 00:05:57.769 you're doing it properly and you are, you know, 00:05:57.769 --> 00:06:00.170 you're not biased and you're doing it in a way 00:06:00.170 --> 00:06:02.889 that supports the mission of what you're trying 00:06:02.889 --> 00:06:05.629 to accomplish with your research. So just a wonderful 00:06:05.629 --> 00:06:08.850 program. I was very blessed to take it and I'm 00:06:08.850 --> 00:06:11.500 happy to be done with it. Yeah, I'm sure. But 00:06:11.500 --> 00:06:13.819 the reason we're talking is because we're going 00:06:13.819 --> 00:06:16.019 to talk not about, oh, this is just my opinion. 00:06:16.040 --> 00:06:19.779 We all got opinions, right? This is research 00:06:19.779 --> 00:06:22.540 -based with some conclusions, some information 00:06:22.540 --> 00:06:25.259 that I want to get across to folks. But that's 00:06:25.259 --> 00:06:29.279 the key to realize that there was rigorous research 00:06:29.279 --> 00:06:33.920 put to this work. But before we get there, I'm 00:06:33.920 --> 00:06:36.800 going to jump in a little fast here. Talk to 00:06:36.800 --> 00:06:40.540 us about your time in the Army. Yeah, yeah, I 00:06:40.540 --> 00:06:46.259 was in from 2005 in June after high school until 00:06:46.259 --> 00:06:50.620 April 2010 I got done with basic training and 00:06:50.620 --> 00:06:53.620 an AIT and I Was told that I was going over to 00:06:53.620 --> 00:06:56.339 Seattle. I wasn't too keen on being on the other 00:06:56.339 --> 00:06:58.579 side of the nation So I thought how do I get 00:06:58.579 --> 00:07:00.360 on this side and one of my drill sergeants said 00:07:00.360 --> 00:07:03.800 well go airborne and you'll be at brag So I went 00:07:03.800 --> 00:07:07.600 airborne and I got stationed in Alaska even further 00:07:09.640 --> 00:07:16.019 You gotta love Army intelligence, right? So I 00:07:16.019 --> 00:07:19.360 went up to Alaska and we prepared, it was a brand 00:07:19.360 --> 00:07:22.060 new brigade, the fourth of the 25th Infantry 00:07:22.060 --> 00:07:24.519 Division, an airborne brigade that stood up in 00:07:24.519 --> 00:07:28.660 Alaska in Anchorage. And I think 2004 we deployed 00:07:28.660 --> 00:07:33.970 in 2006, the end of 2006, I found myself overseas 00:07:33.970 --> 00:07:37.189 in Kuwait for a month or so, and then I went 00:07:37.189 --> 00:07:39.389 up into Afghanistan during the second surge. 00:07:40.069 --> 00:07:42.410 We were up there for about 15 months. We came 00:07:42.410 --> 00:07:45.350 back. It was a very effective deployment. We 00:07:45.350 --> 00:07:49.810 were very busy working the coin mission, counterinsurgency 00:07:49.810 --> 00:07:54.490 under General Petraeus during that time. Like 00:07:54.490 --> 00:07:57.250 I said, very busy, very successful mission. We 00:07:57.250 --> 00:07:59.569 did lose a lot of people. I think we lost 79 00:07:59.569 --> 00:08:02.829 from our brigade during that deployment, not 00:08:02.829 --> 00:08:05.009 including our external assets from the National 00:08:05.009 --> 00:08:08.529 Guard and reserves. So just very busy. We got 00:08:08.529 --> 00:08:13.370 back 11 months of downtime and I was stop lost 00:08:13.370 --> 00:08:16.310 involuntarily extended and sent back over to 00:08:16.310 --> 00:08:19.110 Afghanistan. I was there for a little over 11 00:08:19.110 --> 00:08:22.850 months. almost 12 month deployment came back 00:08:22.850 --> 00:08:27.029 and I got out of the military and I ended up 00:08:27.029 --> 00:08:29.649 joining the National Guard for two years and 00:08:29.649 --> 00:08:32.090 staying right next to my home in Michigan and 00:08:32.090 --> 00:08:35.090 kind of chasing academic pursuits in life with 00:08:35.090 --> 00:08:39.429 my young family at the time. Well with two tours 00:08:39.429 --> 00:08:45.549 in Afghanistan you really saw you know some of 00:08:45.549 --> 00:08:51.620 the worst of that 20 year war It's one of those 00:08:51.620 --> 00:08:54.259 things that never leaves you, it doesn't. Yeah, 00:08:54.340 --> 00:08:57.299 no, and just to clarify, I was first deployment 00:08:57.299 --> 00:08:59.960 and I was 608 was in Iraq and my second one was 00:08:59.960 --> 00:09:01.980 in Afghanistan. But yeah, you're absolutely correct. 00:09:02.759 --> 00:09:04.820 It's a different culture, different world. I 00:09:04.820 --> 00:09:07.299 was very blessed to be a battalion commander's 00:09:07.299 --> 00:09:10.620 driver. So I was able to see quite a bit and 00:09:10.620 --> 00:09:12.980 work across a lot of the country and, you know, 00:09:12.980 --> 00:09:14.500 be out there with a lot of the people and get 00:09:14.500 --> 00:09:16.840 to know people. So it was a lot of exposure for 00:09:16.840 --> 00:09:21.179 a young lad. Well, and you know somebody who 00:09:21.179 --> 00:09:24.519 just out of high school seeing all this really 00:09:24.519 --> 00:09:27.419 shapes you and part of that shape was sort of 00:09:27.419 --> 00:09:31.139 this accidental pattern of Well, I want to go 00:09:31.139 --> 00:09:32.980 learn more about this. So I'm going to go back 00:09:32.980 --> 00:09:36.659 and get some more education And you use the GI 00:09:36.659 --> 00:09:40.259 bill as I say from an associate degree to bachelor's 00:09:40.259 --> 00:09:42.659 degree to a master's degree and ultimately to 00:09:42.659 --> 00:09:46.220 to the PhD which gets us to what we really kind 00:09:46.220 --> 00:09:50.179 of want to talk about is the research topic that 00:09:50.179 --> 00:09:57.360 you took on. Tell us a little bit about the topic 00:09:57.360 --> 00:10:00.419 which was assessing the relationship between 00:10:00.419 --> 00:10:03.620 combat exposure, wartime service, and barriers 00:10:03.620 --> 00:10:07.419 to substance use disorder treatment in post -9 00:10:07.419 --> 00:10:11.039 -11 vets. Kind of strikes home. Tell us how you 00:10:11.039 --> 00:10:15.320 got there with this topic. Yeah, you know I'm 00:10:15.320 --> 00:10:17.220 coming back from both of those deployments we 00:10:17.220 --> 00:10:21.019 had a really good Kind of out processing where 00:10:21.019 --> 00:10:23.460 individuals would go through a pretty rigorous 00:10:23.460 --> 00:10:25.940 Psychological assessments and everybody knew 00:10:25.940 --> 00:10:28.460 what to say and how to get through it and you 00:10:28.460 --> 00:10:31.039 know, you saw a lot of alcoholism You saw a lot 00:10:31.039 --> 00:10:33.820 of people kicked out of the military after deployments 00:10:33.820 --> 00:10:36.200 Between my first and second deployment when we 00:10:36.200 --> 00:10:40.379 came back our brigade was kind of known Which 00:10:40.379 --> 00:10:43.840 wasn't great as having a really high DUI count 00:10:43.870 --> 00:10:47.269 um for our soldiers and uh it was it was just 00:10:47.269 --> 00:10:49.629 unfortunate you know it's always been an interest 00:10:49.629 --> 00:10:51.909 of mine to see like what can we do why are people 00:10:51.909 --> 00:10:53.990 not taking advantage of all these amazing services 00:10:53.990 --> 00:10:57.830 that are out there is it stigma um what are these 00:10:57.830 --> 00:11:01.049 barriers like um and when i was talking to my 00:11:01.049 --> 00:11:04.940 uh director or my um academic advisor when we're 00:11:04.940 --> 00:11:06.580 discussing what kind of dissertation we would 00:11:06.580 --> 00:11:10.500 chase, this topic came up as it always has. I 00:11:10.500 --> 00:11:12.580 want to see how do we help these people get through 00:11:12.580 --> 00:11:15.360 these barriers, even if they're not real. They're 00:11:15.360 --> 00:11:17.679 just perceived barriers, but to them that becomes 00:11:17.679 --> 00:11:20.340 a real barrier if it's perceived barriers. So 00:11:20.340 --> 00:11:23.279 I kind of wanted to assess and see what we could 00:11:23.279 --> 00:11:27.179 do about it. I didn't make it that far, but we 00:11:27.179 --> 00:11:29.960 did find a national data set through SAMHSA, 00:11:29.960 --> 00:11:32.240 which I'll talk a little bit more about here 00:11:32.240 --> 00:11:35.789 in a little bit. should that had most of the 00:11:35.789 --> 00:11:38.690 data that we needed based off of what barriers 00:11:38.690 --> 00:11:41.870 they perceived and why they weren't seeking treatment 00:11:41.870 --> 00:11:44.029 if they did have a substance use disorder. So 00:11:44.029 --> 00:11:45.870 it was something that was just extremely interesting. 00:11:46.090 --> 00:11:47.950 You know, I've always it's been around seeing 00:11:47.950 --> 00:11:50.789 a lot of people go down the wrong paths and not 00:11:50.789 --> 00:11:53.090 get treatment for whatever reason. So I just 00:11:53.090 --> 00:11:56.029 want to try to do my part and expose what we 00:11:56.029 --> 00:11:59.289 could do a little different maybe to minimize. 00:11:59.759 --> 00:12:03.899 people not going to seek treatment and seeing 00:12:03.899 --> 00:12:06.960 that there's options for them. And I'm gonna 00:12:06.960 --> 00:12:10.360 explain this acronym here, you can use it the 00:12:10.360 --> 00:12:13.500 rest of the way, which is substance use disorders 00:12:13.500 --> 00:12:17.740 or SUDs. And you were trying to sort out from 00:12:17.740 --> 00:12:22.720 this large national survey on drug use and health, 00:12:24.220 --> 00:12:28.019 what factors influence getting SUD treatment 00:12:28.019 --> 00:12:33.090 or not. and those are the barriers you're talking 00:12:33.090 --> 00:12:35.889 about. So what kind of barriers did you find 00:12:35.889 --> 00:12:39.909 when you parsed all the data? Yeah, absolutely. 00:12:40.090 --> 00:12:43.429 So this study was found and I should have backed 00:12:43.429 --> 00:12:46.889 up a little bit and talked about it so that the 00:12:46.889 --> 00:12:49.750 primary research questions were what is the relationship 00:12:49.750 --> 00:12:51.850 or what was the relationship between post 9 -11 00:12:51.850 --> 00:12:55.450 combat exposure and perceived barriers such as 00:12:55.450 --> 00:12:59.159 stigma, access to care, and financial constraints 00:12:59.159 --> 00:13:01.740 that would influence veterans' help seeking behaviors 00:13:01.740 --> 00:13:05.320 and substance use disorders. And that's pretty 00:13:05.320 --> 00:13:08.220 specific because I wanted to assess the modern 00:13:08.220 --> 00:13:11.820 warfare in post -911. So I did not look at all 00:13:11.820 --> 00:13:15.179 veterans all the way back. I only took the study 00:13:15.179 --> 00:13:18.580 sample that we had for post -9 -11 veterans out 00:13:18.580 --> 00:13:21.919 of that larger sample. The next question was, 00:13:22.000 --> 00:13:23.720 what was the relationship between demographic 00:13:23.720 --> 00:13:26.139 factors such as age, gender, race, ethnicity, 00:13:27.039 --> 00:13:29.080 income was another one, and treatment seeking 00:13:29.080 --> 00:13:31.779 behavior among these post -9 -11 veterans. So 00:13:31.779 --> 00:13:35.440 I was really focused on those two areas. And 00:13:35.440 --> 00:13:39.360 it's extremely significant because the goal was 00:13:39.360 --> 00:13:41.620 to address critical gaps and sub treatment access 00:13:41.620 --> 00:13:44.580 for post 9 -11 veterans because each generation 00:13:44.580 --> 00:13:48.340 has a different, I wouldn't say ambiant, but 00:13:48.340 --> 00:13:51.740 a different experience. They have a different 00:13:51.740 --> 00:13:55.240 culture. For the most part, veterans are pretty... 00:13:56.199 --> 00:13:59.000 similar but that generational differences do 00:13:59.000 --> 00:14:00.899 make a difference with their experience and you 00:14:00.899 --> 00:14:03.159 know a little bit more wisdom with time from 00:14:03.159 --> 00:14:05.460 our Vietnam veterans leading the path and advocating 00:14:05.460 --> 00:14:07.740 so much for all these benefits that maybe all 00:14:07.740 --> 00:14:09.620 these post 9 -11 veterans aren't taking advantage 00:14:09.620 --> 00:14:12.799 of, if that makes sense. It does and one of the 00:14:12.799 --> 00:14:17.279 things that was a key finding that you had was 00:14:17.279 --> 00:14:22.840 sort of the degree of sudden prevalence between 00:14:22.840 --> 00:14:27.570 9 -11 combat veterans, 9 -11, non -combat veterans 00:14:27.570 --> 00:14:31.830 in the general population. Explain to us a little 00:14:31.830 --> 00:14:34.950 bit about that differential and why trying to 00:14:34.950 --> 00:14:36.970 sort out what the barriers are to treatment, 00:14:37.070 --> 00:14:40.169 why that's so important for combat -exposed veterans. 00:14:41.529 --> 00:14:45.870 Yeah, so like I said, that three main were stigma. 00:14:46.950 --> 00:14:52.139 They're in the national data set, which was Like 00:14:52.139 --> 00:14:53.460 I said, I'll go through it all here in a second. 00:14:53.720 --> 00:14:55.820 But the national data set that we used, it had 00:14:55.820 --> 00:14:58.639 three primary categories. It was basically financial. 00:14:59.639 --> 00:15:03.700 It was your stigma or culture around it. And 00:15:03.700 --> 00:15:07.299 then the last one was access to care. So logistical 00:15:07.299 --> 00:15:09.779 barriers. So stigma, financial constraints, and 00:15:09.779 --> 00:15:13.379 access to care. And those were the main perceived 00:15:13.379 --> 00:15:16.080 barriers that are going to influence whether 00:15:16.080 --> 00:15:17.779 or not people did seek treatment or not. And 00:15:17.779 --> 00:15:23.480 what we found was that anecdotal costs or financial 00:15:23.480 --> 00:15:27.039 constraints were kind of a key finding that were 00:15:27.039 --> 00:15:31.659 a perceived problem and it made veterans 28 % 00:15:31.659 --> 00:15:35.399 less likely to go seek treatment if they had 00:15:35.399 --> 00:15:37.879 those perceived barriers or financial constraints 00:15:37.879 --> 00:15:42.620 in their life. We did find that if you had over 00:15:42.620 --> 00:15:47.120 $75 ,000 a year in income, you were 3 .42 times 00:15:47.120 --> 00:15:50.860 more likely to seek treatment if you acknowledged 00:15:50.860 --> 00:15:53.580 that you had a substance use disorder than those 00:15:53.580 --> 00:15:57.340 who were less than $75 ,000, which was pretty 00:15:57.340 --> 00:15:59.220 significant considering, you know, it's three 00:15:59.220 --> 00:16:01.379 and a half times more likely to seek treatment 00:16:01.379 --> 00:16:05.659 than those who are less than $75 ,000. And then 00:16:05.659 --> 00:16:10.080 there was no indication. One thing that we found, 00:16:10.240 --> 00:16:12.379 which we were seeking to see if there was an 00:16:12.379 --> 00:16:16.399 indication or a significance, was that veterans 00:16:16.399 --> 00:16:21.139 who were exposed to combat in Overseas or whatever 00:16:21.139 --> 00:16:26.679 their self -designated combat exposure that There 00:16:26.679 --> 00:16:29.200 was no significance in them seeking treatment 00:16:29.200 --> 00:16:31.679 or being more likely to seek treatment. That's 00:16:31.679 --> 00:16:38.000 a really when I read your Research I was really 00:16:38.000 --> 00:16:42.039 surprised by that because combat exposed veterans 00:16:42.490 --> 00:16:48.950 were almost double likelihood of a SUD situation 00:16:48.950 --> 00:16:53.929 than non -combat veterans, and I don't know, 00:16:54.029 --> 00:16:59.110 two and a half times or something, greater than 00:16:59.110 --> 00:17:02.269 the general population. you know the guys with 00:17:02.269 --> 00:17:05.069 the problem seem to be okay well they're combo 00:17:05.069 --> 00:17:09.230 exposed veterans so that probably is going to 00:17:09.230 --> 00:17:13.569 factor into why they do don't don't go and get 00:17:13.569 --> 00:17:16.950 treatment but that didn't turn out to be a driver 00:17:16.950 --> 00:17:19.950 at all did it? No and that's the thing with this 00:17:19.950 --> 00:17:22.650 study I should talk about it real quick on the 00:17:22.650 --> 00:17:24.869 data set that he used so that way people can 00:17:24.869 --> 00:17:27.970 reference it. The data set is a very well -known 00:17:27.970 --> 00:17:30.369 national survey on drug use and health, which 00:17:30.369 --> 00:17:34.329 is also NISDA. And it is from SAMHSA, which is 00:17:34.329 --> 00:17:35.990 the Substance Abuse and Mental Health Services 00:17:35.990 --> 00:17:39.230 Administration for America. They do this very 00:17:39.230 --> 00:17:43.349 large survey across the whole nation on an annual 00:17:43.349 --> 00:17:47.009 basis. And from my study, there was about 15, 00:17:47.109 --> 00:17:49.490 just over 59 ,000 participants in the survey. 00:17:50.109 --> 00:17:53.390 But I focused on Well, also, out of those 59 00:17:53.390 --> 00:17:59.490 ,000 participants, about 1 ,980, they had service 00:17:59.490 --> 00:18:04.549 in the military. And 838 of those out of the 00:18:04.549 --> 00:18:09.289 entire 59 ,838 were post -9 -11 veterans. And 00:18:09.289 --> 00:18:11.789 then post -9 -11 veterans who served in combat 00:18:11.789 --> 00:18:17.309 was about 450 out of those 830. So that was, 00:18:17.369 --> 00:18:20.099 you know, just to give you a kind of idea of 00:18:20.099 --> 00:18:22.700 how big the data set is and how well -known it 00:18:22.700 --> 00:18:26.380 is before we dive into the results that you're 00:18:26.380 --> 00:18:30.240 discussing, because what we did find was that 00:18:30.240 --> 00:18:35.799 veterans, which let me reference this. I believe 00:18:35.799 --> 00:18:41.579 it's 9 .6 % of the general population had a self 00:18:41.579 --> 00:18:45.079 -identified substance use disorder. Non -combat 00:18:45.079 --> 00:18:47.940 veterans from the same population had a 12 .8 00:18:47.940 --> 00:18:53.000 % likelihood of a prevalence, and combat -exposed 00:18:53.000 --> 00:18:57.380 veterans was 21 .5%, meaning that one in five 00:18:57.380 --> 00:19:00.579 veterans self -identified that they, or acknowledged 00:19:00.579 --> 00:19:03.599 that they have a substance use disorder. Yeah, 00:19:03.799 --> 00:19:06.900 again, you'd think, okay, I understand why the 00:19:06.900 --> 00:19:11.640 guys in direct combat have a higher likelihood 00:19:11.640 --> 00:19:17.759 of substance. use disorder. But that then gets 00:19:17.759 --> 00:19:20.279 me to, well, they're probably the guys who are 00:19:20.279 --> 00:19:22.940 getting the most amount of treatment. But it's 00:19:22.940 --> 00:19:25.079 sort of different than that. The data tells you 00:19:25.079 --> 00:19:27.539 a different story. Tell us what the data tells 00:19:27.539 --> 00:19:31.000 you. Yeah, the data, as I mentioned earlier, 00:19:31.140 --> 00:19:34.859 there was no significance in any of the perceived 00:19:34.859 --> 00:19:37.839 barriers or likelihood that combat veterans would 00:19:37.839 --> 00:19:41.319 seek treatment at a higher rate. And we don't 00:19:41.319 --> 00:19:44.109 know that We don't know the reason for that. 00:19:44.269 --> 00:19:46.509 I don't have that data at my fingertips. There's 00:19:46.509 --> 00:19:49.369 many assumptions that we could say like, for 00:19:49.369 --> 00:19:52.569 example, those veterans, they know they have 00:19:52.569 --> 00:19:56.390 an issue or a problem because they're more likely 00:19:56.390 --> 00:19:58.250 to know because they have better out processing 00:19:58.250 --> 00:20:00.490 like what I had when I was getting out to acknowledge 00:20:00.490 --> 00:20:04.759 that these things are issues. as opposed to maybe 00:20:04.759 --> 00:20:07.259 those who don't deploy. So we don't know like 00:20:07.259 --> 00:20:09.839 what those are. But some of the big barriers 00:20:09.839 --> 00:20:11.839 that, you know, you think about in the military, 00:20:12.099 --> 00:20:15.339 that is in my literature review, with culture 00:20:15.339 --> 00:20:18.819 and military culture, is, you know, you're supposed, 00:20:18.960 --> 00:20:21.079 you're tough. You're supposed to be a tough person. 00:20:21.220 --> 00:20:24.579 You don't ask for help. There's promotion potential 00:20:24.579 --> 00:20:28.400 that may go away if these things come to light. 00:20:28.980 --> 00:20:31.579 There's a lot of potential issues with you mentioning 00:20:31.579 --> 00:20:34.319 it in the military culture, even though it's 00:20:34.319 --> 00:20:36.640 presented in a way that it's okay to ask for 00:20:36.640 --> 00:20:40.059 help. You'll see, I don't know if you've seen 00:20:40.059 --> 00:20:41.980 some of the policy changes, but even one just 00:20:41.980 --> 00:20:43.539 recently that might have negative unintended 00:20:43.539 --> 00:20:48.180 consequences is the one that holds E7 and aboves 00:20:48.180 --> 00:20:51.599 now to the same standards as E6s and below when 00:20:51.599 --> 00:20:55.809 it comes to DUIs and their punishments. meaning 00:20:55.809 --> 00:20:59.089 that they can be demoted just as quick as the 00:20:59.089 --> 00:21:01.529 younger, you know, the lower ranking individuals. 00:21:01.690 --> 00:21:03.589 And that doesn't seem like much, and it seems 00:21:03.589 --> 00:21:05.230 like a no -brainer that it'd be a good thing, 00:21:05.509 --> 00:21:08.470 but that does compound the challenges in the 00:21:08.470 --> 00:21:10.529 substance use field. You're gonna have more people 00:21:10.529 --> 00:21:12.109 hiding it. You're gonna have more people not 00:21:12.109 --> 00:21:14.910 seeking mental health support and treatment because 00:21:14.910 --> 00:21:17.670 they don't wanna be exposed, which could be detrimental 00:21:17.670 --> 00:21:20.869 to their careers, right? I do wanna get to your 00:21:20.869 --> 00:21:23.339 recommendations, but there was another... set 00:21:23.339 --> 00:21:26.700 of key findings that you've had from parsing 00:21:26.700 --> 00:21:30.380 the data that I thought was interesting and we 00:21:30.380 --> 00:21:35.660 should kind of tell people about. And that there 00:21:35.660 --> 00:21:40.000 was a race and ethnic pattern that you were able 00:21:40.000 --> 00:21:46.720 to discern that if I understand this right, white 00:21:46.720 --> 00:21:51.099 veterans, non -Hispanic white veterans, were 00:21:51.099 --> 00:21:55.339 roughly twice as likely as black veterans to 00:21:55.339 --> 00:21:58.900 seek treatment. Am I reading that right, or is 00:21:58.900 --> 00:22:02.559 that the percentage of folks with SUD's prevalence? 00:22:02.990 --> 00:22:05.509 Yeah, no, that's absolutely correct. So the people 00:22:05.509 --> 00:22:08.589 that are going to seek treatment based off of 00:22:08.589 --> 00:22:12.970 this data set that was ran in 2022 showed that 00:22:12.970 --> 00:22:15.170 race and ethnicity absolutely played a crucial 00:22:15.170 --> 00:22:17.890 role in treatment seeking behavior. Specifically, 00:22:18.130 --> 00:22:19.930 as you mentioned, non -Hispanic white veterans 00:22:19.930 --> 00:22:23.289 had the highest treatment seeking rate at 6 .2%, 00:22:23.289 --> 00:22:27.730 while non -Hispanic black veterans had a much 00:22:27.730 --> 00:22:32.009 lower rate, which was 3 .8%, and Hispanic veterans 00:22:32.009 --> 00:22:35.829 sought treatment at a similar rate, at 4 .5. 00:22:36.109 --> 00:22:38.130 So that shows you that there are some cultural 00:22:38.130 --> 00:22:42.970 barriers, not necessarily, that may be based 00:22:42.970 --> 00:22:45.049 off of race and ethnicity, if that makes sense. 00:22:45.470 --> 00:22:47.650 Yeah, I think it's important to realize those 00:22:47.650 --> 00:22:49.630 cultural barriers exist, because you can't have 00:22:49.630 --> 00:22:54.380 the same. if you will, recommendations or one 00:22:54.380 --> 00:22:57.440 size doesn't fit all when you go through this 00:22:57.440 --> 00:23:00.299 and see, yeah, different groups are being impacted 00:23:00.299 --> 00:23:02.880 different ways. And before we run out of time, 00:23:02.940 --> 00:23:04.940 I want you to talk about your recommendations 00:23:04.940 --> 00:23:07.920 if you would. Oh yeah, so two more things to 00:23:07.920 --> 00:23:09.220 mention and I'll talk about the recommendations 00:23:09.220 --> 00:23:12.849 because they're key in there. Age was also a 00:23:12.849 --> 00:23:14.829 strong predictor of treatment seeking behavior. 00:23:15.509 --> 00:23:18.549 The age range 35 to 49 had the highest engagement 00:23:18.549 --> 00:23:22.490 rate at 6 .9 % compared to those younger veterans, 00:23:22.549 --> 00:23:26.569 which was only 2 .5 % seeking treatment and similar 00:23:26.569 --> 00:23:29.210 rates, but it was definitely 35 to 49 is the 00:23:29.210 --> 00:23:32.849 highest. And then on the other hand, there was 00:23:32.849 --> 00:23:34.809 no statistical significance between male and 00:23:34.809 --> 00:23:38.970 female, but males were a little bit more likely, 00:23:39.069 --> 00:23:42.230 5 .4 % compared to 4 .8. of the female gutter 00:23:42.230 --> 00:23:45.450 population. But with our key findings, you know, 00:23:45.529 --> 00:23:49.990 it's pretty impressive to see all these things 00:23:49.990 --> 00:23:53.369 come together. And, you know, it kind of reassures 00:23:53.369 --> 00:23:56.930 your gut feeling of what's going on in the space. 00:23:57.849 --> 00:24:01.289 And are there issues that we could be avoiding 00:24:01.289 --> 00:24:04.410 by giving recommendations that we know are backed 00:24:04.410 --> 00:24:07.579 by research? So we already talked about The key 00:24:07.579 --> 00:24:09.799 findings of post 9 -11 veterans that were combat 00:24:09.799 --> 00:24:12.900 exposed being two times more likely than the 00:24:12.900 --> 00:24:17.500 general population to have a substance use disorder. 00:24:17.640 --> 00:24:21.539 We talked about male and female and the high 00:24:21.539 --> 00:24:25.839 and low rates of age, racial disparities, and 00:24:25.839 --> 00:24:29.160 the higher income being an increased likelihood 00:24:29.160 --> 00:24:32.740 of seeking treatment by 3 .4%, but also the perceived 00:24:32.740 --> 00:24:35.990 barrier reduced likelihood of seeking treatment 00:24:35.990 --> 00:24:38.390 by 28 % meaning that as we talked in the beginning 00:24:38.390 --> 00:24:42.410 that if you had less or if you perceive that 00:24:42.410 --> 00:24:44.009 financial constraints were going to be an issue 00:24:44.009 --> 00:24:47.390 you were 28 % right off the bat less likely to 00:24:47.390 --> 00:24:51.329 even seek treatment. So some of the recommendations 00:24:51.329 --> 00:24:54.529 that I made, could I jump into those? Yeah please 00:24:54.529 --> 00:24:56.849 do. I think there's five of them here that I 00:24:56.849 --> 00:25:00.579 want you to cover. Okay, yeah, so the first one 00:25:00.579 --> 00:25:02.960 obviously is to expand financial support by covering 00:25:02.960 --> 00:25:05.839 indirect costs such as transportation, child 00:25:05.839 --> 00:25:08.680 care, because we found out that ancillary costs 00:25:08.680 --> 00:25:12.359 are kind of a deterrent when it comes to seeking 00:25:12.359 --> 00:25:14.500 treatment because insurance doesn't necessarily 00:25:14.500 --> 00:25:17.119 cover everything. They would maybe cover the 00:25:17.119 --> 00:25:20.059 treatment, but there's a lot more complexities 00:25:20.059 --> 00:25:22.380 going on in everybody's life that maybe we should 00:25:22.380 --> 00:25:25.559 be cognizant of when we're getting people into 00:25:25.559 --> 00:25:28.250 treatment for substance use. there are some programs 00:25:28.250 --> 00:25:30.529 out there that are very effective but I would 00:25:30.529 --> 00:25:34.289 advocate to you know promote those but also funding 00:25:34.289 --> 00:25:37.289 for gender specific with integrated care meaning 00:25:37.289 --> 00:25:40.670 that we would bring all care together not just 00:25:40.670 --> 00:25:42.869 their substance use disorder care but also their 00:25:42.869 --> 00:25:45.329 mental health care their physical health care 00:25:45.329 --> 00:25:49.569 in one location so that way that individual can 00:25:49.569 --> 00:25:53.250 have a full you know supported substance use 00:25:53.250 --> 00:25:56.769 treatment experience. We also, second recommendation 00:25:56.769 --> 00:25:59.710 was to reduce stigma by utilizing veteran led 00:25:59.710 --> 00:26:02.589 campaigns and peer support while increasing access 00:26:02.589 --> 00:26:06.210 to confidential treatment options, which that's 00:26:06.210 --> 00:26:08.849 already kind of being done and there's research, 00:26:08.930 --> 00:26:10.509 a lot of research being done in those areas, 00:26:10.589 --> 00:26:12.569 but I just want to encourage that and say the 00:26:12.569 --> 00:26:14.849 data supports it. We need to continue to increase 00:26:14.849 --> 00:26:19.180 it. The third was to enhance cultural competence 00:26:19.180 --> 00:26:21.460 by training providers and culturally tailored 00:26:21.460 --> 00:26:25.119 care. We know that, you know, individuals that 00:26:25.119 --> 00:26:28.460 come in that maybe had a sheltered life or they've 00:26:28.460 --> 00:26:31.099 had limited exposure to different cultures with 00:26:31.099 --> 00:26:34.359 ethnicities or races are less likely to have 00:26:34.359 --> 00:26:37.039 a strong relationship with individuals of different 00:26:37.039 --> 00:26:41.089 races and ethnicities. And so what we recommend 00:26:41.089 --> 00:26:44.210 is focusing on these specific needs of minority 00:26:44.210 --> 00:26:46.890 veterans and female veterans because that's going 00:26:46.890 --> 00:26:49.089 to help build up these providers by training 00:26:49.089 --> 00:26:51.470 them appropriately on how to interact and engage 00:26:51.470 --> 00:26:55.009 with most effectively. And the fourth one was 00:26:55.009 --> 00:26:58.049 to improve access by standardizing trauma -informed 00:26:58.269 --> 00:27:01.009 integrated care models by expanding telehealth 00:27:01.009 --> 00:27:04.450 services. So we strongly believe there's a lot 00:27:04.450 --> 00:27:06.490 of research out there that shows that this is, 00:27:06.490 --> 00:27:08.210 it already works, and you can see a lot of that 00:27:08.210 --> 00:27:10.430 in my literature review. You can see it out there 00:27:10.430 --> 00:27:13.529 by yourself and your own research just by showing 00:27:13.529 --> 00:27:16.789 and exploring a little bit that integrated care 00:27:16.789 --> 00:27:19.509 models and telehealth services are really opening 00:27:19.509 --> 00:27:22.329 doors that weren't there before for geographically 00:27:22.329 --> 00:27:24.589 displaced veterans that may have limited access 00:27:24.589 --> 00:27:28.940 to care. And then the fifth one, It also helps 00:27:28.940 --> 00:27:31.359 with the financial constraints as well. So it 00:27:31.359 --> 00:27:35.819 does help mitigate the high financial constraints 00:27:35.819 --> 00:27:39.140 of treatment from facilities when you can do 00:27:39.140 --> 00:27:42.220 some of it from home. And then the last one here 00:27:42.220 --> 00:27:45.519 was I recommended to address disparities by targeting 00:27:45.519 --> 00:27:48.279 outreach efforts for minority and low income 00:27:48.279 --> 00:27:51.519 veterans and kind of debunking myths, which I 00:27:51.519 --> 00:27:53.259 know we're already working towards that, but 00:27:53.259 --> 00:27:55.720 we're not quite there with a consistent message 00:27:55.720 --> 00:27:58.299 across the nation. And we just need to strengthen 00:27:58.299 --> 00:28:00.839 partnerships between the VA and community organizations, 00:28:01.400 --> 00:28:03.160 which once again, the VA is really working hard 00:28:03.160 --> 00:28:05.539 to do this. We're just not quite there yet. We 00:28:05.539 --> 00:28:07.539 just got to continue to advocate and push that 00:28:07.539 --> 00:28:10.700 needle because as we see in research across the 00:28:10.700 --> 00:28:12.640 board from many colleagues and individuals out 00:28:12.640 --> 00:28:14.480 there doing this kind of work, that there's more 00:28:14.480 --> 00:28:17.680 to do. Well, what's again, I'll go back to we 00:28:17.680 --> 00:28:21.000 all have a gut feeling on some of this and and 00:28:21.000 --> 00:28:24.220 hey, we need to get our veterans who have substance 00:28:24.220 --> 00:28:27.269 use disorders in the treatment. Well, we may 00:28:27.269 --> 00:28:29.309 have that gut feeling, wow, this is a barrier, 00:28:29.390 --> 00:28:31.289 that's a barrier. That's why it's nice to have 00:28:31.289 --> 00:28:34.549 the research done and have, you know, give some 00:28:34.549 --> 00:28:37.470 support to gut feeling or changing in that gut 00:28:37.470 --> 00:28:42.710 feeling. We've been talking to Robert Neer, a 00:28:42.710 --> 00:28:47.130 PhD, airborne artillery man, U .S. Army for, 00:28:47.230 --> 00:28:49.589 I think that's about five, six years. Couple 00:28:49.589 --> 00:28:53.650 of overseas deployments and afterwards made his 00:28:53.650 --> 00:28:55.869 way all the way up through the academic roster. 00:28:56.250 --> 00:29:00.109 to ultimately get a doctorate, and this is some 00:29:00.109 --> 00:29:03.190 of the dissertation research that he's done. 00:29:05.069 --> 00:29:07.250 Robert, did you finish this up where you thought 00:29:07.250 --> 00:29:09.769 it was gonna go, or did it give you like, oh, 00:29:09.769 --> 00:29:13.990 I wasn't expecting that? You know, it was very 00:29:13.990 --> 00:29:16.170 in line with current low literature that's out 00:29:16.170 --> 00:29:19.369 there. There was a few findings that were really 00:29:19.369 --> 00:29:22.670 interesting that we had discussed throughout 00:29:22.670 --> 00:29:25.750 this time period. I was really hoping to see 00:29:25.750 --> 00:29:31.710 if I could expose the probability or likelihood 00:29:31.710 --> 00:29:33.769 that a combat veteran is going to seek treatment 00:29:33.769 --> 00:29:36.569 or not, when there's really not any significance 00:29:36.569 --> 00:29:39.630 in the study that I was able to find. But I would 00:29:39.630 --> 00:29:42.690 advocate for other researchers out there to maybe 00:29:42.690 --> 00:29:45.589 do more qualitative work, not necessarily all 00:29:45.589 --> 00:29:47.630 quantitative, like what was done in the study, 00:29:48.069 --> 00:29:50.930 so that we could really see. What are the perceived 00:29:50.930 --> 00:29:53.890 barriers? We're looking for that aha moment of 00:29:53.890 --> 00:29:56.509 how do we break down this wall and get people 00:29:56.509 --> 00:29:59.109 that need the help into the care they need so 00:29:59.109 --> 00:30:01.250 they can be productive members of society again. 00:30:01.569 --> 00:30:04.089 That's really all we're trying to do. Well, it's 00:30:04.089 --> 00:30:06.170 certainly a noble goal and we appreciate the 00:30:06.170 --> 00:30:08.650 time that you took today to talk to Veterans 00:30:08.650 --> 00:30:11.609 Radio listeners and explain a little bit of this 00:30:11.609 --> 00:30:16.740 to us. kind of reinforces some of our good feelings, 00:30:16.759 --> 00:30:19.180 Robert, here. I really appreciate the time that 00:30:19.180 --> 00:30:21.660 you gave us today, Bob. Yeah, thank you so much, 00:30:21.759 --> 00:30:23.660 Jim. I can't say enough how much I appreciate 00:30:23.660 --> 00:30:25.259 what you all do on the radio. I just love to 00:30:25.259 --> 00:30:27.460 listen and love to hear it, so keep up the good 00:30:27.460 --> 00:30:31.500 work and thanks for having me on. And I want 00:30:31.500 --> 00:30:33.279 to thank everybody for listening to Veterans 00:30:33.279 --> 00:30:37.099 Radio today. I am Jim Fossone. It's been a pleasure 00:30:37.099 --> 00:30:39.660 to be your host. I'm a Veterans disability lawyer 00:30:39.660 --> 00:30:42.480 at Legal Help for Veterans, and you can reach 00:30:42.480 --> 00:30:48.970 us at 800 693 -4800 or legalhelpforveterans .com 00:30:48.970 --> 00:30:51.950 on the web. You can follow Veterans Radio on 00:30:51.950 --> 00:30:54.990 Facebook and listen to its podcasts and internet 00:30:54.990 --> 00:30:59.589 radio shows by visiting us at veteransradio .org. 00:30:59.809 --> 00:31:03.529 That's veteransradio .org. 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