It was the early 2000’s and I was juggling a full-time job as a case manager at a not-for-profit community mental health agency, attending night classes and doing an internship for my Master’s in Counseling.
While working at the agency, there were many memorable individuals who were called consumers at the time. I distinctly remembered one gentleman, who I will call The Vet. He was known to the clinic as a ‘raging alcoholic.’ Even though he was assigned to another case manager, on occasion, he had to interact with other case managers including me.
He was an older Caucasian man, slight built, always dirty, clothes torn and disheveled. He staggered and slurred his speech. The smell of alcohol emanated from his pores and he had a persistent red tint skin color which was more than likely due to his chronic alcohol abuse.
He had moments of sobriety. They very rare and short lived. When he was sober, his appearance and demeanor were in stark contrast to the man who spent many years using alcohol to quiet his demons. He was homeless and consistently refused to live in an enclosed space.
A Chance Encounter
It was during one of my internship days at the inpatient hospital that treated co-occurring disorders (mental health disorder and substance abuse disorders) that I noticed The Vet. He was a frequent flyer to inpatient for both mental health and substance use.
Once a patient was admitted to the psychiatric unit or hospital, they attended mandatory individual and group therapy. The Vet was in attendance for one of those mandatory groups. I was surprised to see him inpatient because he had vocalized a resistance to treatment. I admittedly wondered if he would benefit from this stint.
Inpatient mental health is a great resource for treatment; however, many patients struggle after leaving inpatient. While in the hospital, there are set rules, it is very structured, and they attend a myriad of treatments which can lead to the patients feeling emotionally and psychologically safe. However, once the patients leave the sanctity of inpatient, they struggle with incorporating what they learnt with the stress of everyday life.
Trauma and Substance Abuse
If you saw The Vet begging on the street corner, you would immediately avoid and dismiss him as just another alcoholic who destroyed his life. However, there was so much more than meets the eye.
The Vet decided to share his story in group and it was powerful. It was obviously very difficult for him as his sobriety forced his thoughts back to where it all started.
He was a soldier in Vietnam and he was in combat. He saw death and caused other’s death. He survived and returned home to his family; however, the war came back with him. The Vet talked about nightmares which were very vivid and during one of those nights, he nearly hurt his own family. He repeatedly relived his combat experiences day and night.
The Vet talked about one particular incident during deployment. He had to kill a combatant who was a child. He could not forgive himself and that guilt was internalized.
The Vet made a difficult decision for the safety of his family to leave them and never went back. He also chose to be homeless because being in an enclosed space brought back the memories. He used alcohol to drown out those nightmares and he kept drinking because when he stopped, the nightmares and memories flooded back.
He was more than likely diagnosed with Post Traumatic Stress Disorder. However, when people looked at The Vet, they saw an alcoholic but when you dug deeper, you saw trauma that created a substance addiction.
A Familiar Story
The longer you work in mental health, the more deja vu you experience, and the more stories start to blend. The Iraq war brought about more public awareness of PTSD symptoms. However, I would like to emphasize that PTSD is not just about war, it is about trauma. Trauma can be caused by a single or series of events that have a negative and significant impact that disrupts a person’s life.
People can experience a traumatic event but do not develop PTSD symptoms. For example, A person in a car accident can exhibit some stress but recovers to have an average functioning life. In contrast, someone else in a car accident can continue to experience psychological disruption such as nightmare, fear of driving, depression or anxiety that impacts his/her life and could meet the criteria for PTSD.
Trauma Therapy and Healing
It has been years and I am not sure what came of The Vet. He was my first veteran with co-occurring disorders but definitely not the last. Trauma looks different for each person and so does healing. Healing does not mean the trauma is erased, it means it no longer binds you or defines you. It means you are no longer reactive or avoidant but have learn to take control.
The longer trauma controls the mind and body; the more work that is needed. Many people start therapy expecting quick results to resolve pain that festered for years. They become disappointed and disillusioned very quickly. However, healing is a process that can have setbacks at times. It is important to manage your expectations and be aware that there will be some painful wounds that need to be reopened before healing can begin properly.
Charé 