Working with Service Members, Veterans, and their Families (SMVF)

People who work with Service Members, Veterans and their Families (SMVF) to prevent, treat and support recovery from addictions find that understanding the particular cultural context of military service increases their ability to engage and establish rapport. According to the Department of Veterans Affairs, in 2014, there were 379,772 Massachusetts living veterans between the ages of 18 and 84, about two-thirds of them aged 45 and older. You might not know that you are working with someone who served or a family member.

According to SAMHSA, 20% of active duty personnel meet criteria for heavy use of alcohol, which is more than 3 times the general population, and the post-9/11 military has experienced triple the prior rate of prescription drug abuse. Each era of service has particular experiences (for greater detail, see the Practice Guidance: Engaging Veterans in Treatment).

First contacts for immediate questions:

1. Veterans’ Crisis Line (Federal)

These services are free, confidential, and available 24/7/365 to any Veteran and their loved ones, even if they are not registered with Veterans Administration (VA) or enrolled in VA health care.

2.The Statewide Advocacy for Veterans' Empowerment (SAVE) Team (Massachusetts)

Resources in the Library (left sidebar) have additional phone numbers, links to documents, and contact information for organizations that provide services for SMVF and people who work with them. At a high level, information relates to several key topics:

  • Normalize asking “the question”: Ask people who come to your practice or program, “Have you served in the US Military?”
  • Battlemind: being combat-ready is ingrained during training, and this involves mental toughness, emotional control and sharing information only on a need-to-know basis.  This may be interpreted as “resistance” in a clinical setting unless the counselor is familiar with military culture.
  • Family: Service members and their families experience and prepare for unexpected and long absences.
  • Trauma: many service members have experienced trauma, and may have undiagnosed Post-Traumatic Stress Disorder and/or Traumatic Brain Injury.

Resources also provide suggestions for specific adaptations to help engage SMVF. Changes in approach, or even small changes in how furniture is arranged, can make a huge difference in engagement. For example:

  • After a training on military culture, a substance use and addictions clinician switched the location of her clients' chair so that clients could see the door, rather than have their back to it.  This change allowed clients with a service background to feel more comfortable, and engage.
  • Motivational Interviewing is an evidence-based practice for working with substance use and addictions, but for many people with Traumatic Brain Injury (TBI), it is too abstract. A program which works with patients who have substance use disorder and TBI adjusts the use of Motivational Interviewing, depending on the extent of the injury, employing more concrete approaches where needed.

Massachusetts now has Veterans Treatment Courts, which are designed to handle criminal cases involving defendants who have a history of military service through a coordinated effort among the veterans services delivery system, community-based providers, and the court, thereby improving public safety while dealing with the underlying issues of posttraumatic stress disorder, traumatic brain injury, and military sexual trauma.  Abstinence from drugs and alcohol, mandated treatment, swift accountability, and weekly interaction with the court are requirements of the Veterans Treatment Court. 

Other sections of the Careers of Substance website have information on how Service Members, Veterans and their Families can start or advance a career in substance use and addiction-related work (see Peer Support/Recovery Coaches, Jobsearch Tips and Links); and how organizations can benefit from hiring people who have served in the US Military (see Recruitment and Retention).  Such resources may be helpful to SMVF who have sought treatment, as they progress in their own recovery.