Dr. John Renner, a Spectrum Health Systems' board member and associate chief of psychiatry for the VA Boston Healthcare System, sits down for a Q&A
Veterans returning home from combat are at an increased risk for substance abuse. Many turn to substance misuse (drinking, drugs, or smoking) as a way to cope with post-traumatic stress disorder (PTSD). In the wars in Iraq and Afghanistan, about 1 in 10 returning soldiers seen in the Veteran’s Administration (VA) have a problem with alcohol or other drugs.
As we approach Veteran’s Day, we at Spectrum Health Systems are committed to shining a light on the impact addiction can have on our veterans, as well as share ways to combat the disease. We recently sat down with John Renner, M.D., a Spectrum board member and associate chief of psychiatry for the VA Boston Healthcare System to discuss the topic.
Dr. Renner completed his psychiatry training at Tufts-New England Medical Center before serving as a psychiatrist with the US Navy in Vietnam in 1969. When he returned to Boston a year later, he ran the outpatient addiction program at Mass General Hospital. While he never anticipated working in addiction after returning from Vietnam, he decided to stay in the field, and ultimately took a job at the Boston VA in 1979 – where he remains to this day. Forty-five years ago, Dr. Renner became involved with Spectrum Health Systems when he began serving as a board member at Project Turnabout, Spectrum’s residential treatment program for men in Weymouth.
He also currently serves as the associate director of the Boston University Medical Center General Psychiatry Residency Program and director of their Addiction Psychiatry Residency as well as vice-chair of the American Psychiatric Association Council on Addiction Psychiatry, and president of the American Academy of Addiction Psychiatry.
Q: Why do so many veterans suffer from addiction and what is the biggest challenge they face in overcoming the disease?
A: In many cases, the introduction to opiates begins when pain-medications are prescribed after a serious combat injury. Many veterans seeking help for an addiction disorder are also struggling with severe PTSD. This type of dual diagnosis becomes increasingly difficult to manage without also incorporating mental health treatment.
The most important piece of advice I can give to veterans suffering with an addiction disorder is to recognize that, similar to Spectrum, there is a broad range of treatment resources in the VA and addiction treatment is very effective. Organizations like the VA take addiction seriously and have the capability to help veterans who need both addiction treatment and mental health services. You will typically find in other treatment systems that mental health care is peripheral, but I believe that it’s absolutely essential in the recovery process for many of our veterans. The VA is well organized to provide that type of integrated dual diagnosis treatment.
Q: What is the best way for veterans to stay healthy when they return home?
A: To prevent post-deployment depression and addiction, finding a supportive community is very important. While overseas, military personnel form strong bonds and they often miss that level of comradery when they arrive home. Whether they join veterans’ groups or integrate themselves into the local community in other meaningful ways, the sense of belonging is key.
Veterans often see themselves as resourceful, tough people. They may have a difficult time asking for help and admitting to having a problem they can’t control. If a veteran you love is struggling with a substance use disorder, it’s important that they are able to acknowledge that they require treatment – and that they accept that it’s okay to seek help.
Q: How would you recommend broaching the topic of treatment for veterans and their families?
A: The same way you would anybody else that you love. Those of us who work in addictions know that most people live in denial of their problem for a long time. Veterans need to be gently told that they are having problems and to reassured that it is OK to ask for help. Many people in early recovery convince themselves that they’ve learned their lesson and won’t do it again. In order for treatment to be successful, however, the person struggling with an addiction disorder needs to admit that this is serious problem and that it will take major change to achieve recovery. They need to be willing to make the necessary changes. That is the important first step. The good news is there are treatment options available to all those willing to make this impactful change in their lives.
Q: What misperceptions stand in the way of providing treatment to veterans?
A: In the last year or so there has been a lot of negative publicity about the VA, which is unfortunate because it discourages people from asking for help. From my experience, the VA is extremely well-run and has very good resources for veterans, and the capacity to deal effectively with both mental health and addiction problems.
Q: What are some effective treatment methods for veterans? What steps do you take to treat them specifically?
A: Group therapy with other veterans can be very powerful. Veterans are often reluctant to talk about their combat experiences because of concern as to how other people will react. Because of this, they are much more comfortable with other veterans. In group therapy sessions they are able to openly discuss their experiences with PTSD and substance use disorders with people who will understand. They tend to bond very quickly and can forge relationships to help them move forward in their recovery. Beyond these helpful psychotherapy resources, the VA also has the full range of medication-assisted treatments that are critical to the success of addiction treatment, particularly for opioid use disorder. Most treatment begins with hospitalization for medication withdrawal treatment and stabilization. Veterans in the Boston area are fortunate that there are always inpatient beds available within our system.
Q: What resources on overcoming addiction would you recommend for veterans and their families?
A: Any way you can connect with people who are going through the same thing is valuable. Connect with your local VA, support groups, hotlines and veterans’ outreach centers. The Veterans Network has done a great job of rounding up some organizations that assist veterans across the country. Many veterans find themselves most comfortable in the more casual setting of the community based veterans outreach centers, which are operated by the VA but not located within VA Medical Centers. Others prefer being seen at a VA Medical Center where they have access to the full range of medical services. Unfortunately, some veterans feel alienated from the government and prefer care outside of the VA. Programs such as Home Base are leading regional and national efforts with a multi-disciplinary team of experts working together to help post-9/11 service members, veterans and their families heal from the invisible wounds of war including traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and related conditions. In general Home Base duplicates services that are otherwise available through the VA. In some cases, they are also able to care for individuals who are not eligible for VA services.
Q: What keeps you committed to helping veterans overcome addiction?
A: I see people arrive feeling depressed, demoralized and hopeless about their situations and themselves and I have the privilege of helping them recover and recapture the faith they once had in themselves and their future.
Many of the soldiers I work with say they enlisted in the military because they knew it was going to be tough, and they felt good about what they accomplished in the military. What they never anticipated was finding themselves addicted, homeless and having made a mess of their lives, sometimes as a result of having bravely served their country. Seeing them recover their self-esteem and helping them overcome this adversity is very gratifying.
Spectrum Health Systems thanks each and every veteran for serving our country. Join us on Nov. 13 at 10am ET on WTAG for a live interview with John Renner and Spectrum Health Systems' Airing Addiction host, Donna Pellegrino where they will continue this important conversation on how addiction is impacting our veterans. Listen here for a preview.