In the Vietnam War era, they called them the "walking wounded"--the soldiers who came back from combat with vacant stares and heavy hearts, scarred by the horrors of war. As the conflict in Iraq enters the fifth year, more and more U.S. troops, both men and women, are joining the ranks of the walking wounded.

According to a study published on March 12, 2007 by researchers at the University of California and San Francisco Veterans Affairs Medical Center, about one-third of returning Iraq and Afghanistan soldiers have addiction or mental disorders such as post-traumatic stress disorder (PTSD), anxiety, or depression. Experts say the prevalence of PTSD increases as the dangers of combat increase. A 2004 study in the New England Journal of Medicine reported that 71 percent of Army troops and 86 percent of Marines in Iraq said they have been in a firefight, and 90 percent reported being shot at.

The military publication Stars and Stripes reported in December 2005 that Army researchers saw alcohol misuse rise from 13 percent to 21 percent among soldiers one year after they returned from deployment in Iraq and Afghanistan. They also reported an increase in anger and aggression issues from 11 percent to 22 percent after deployment, and a substantial rise in marital problems.

The March 13 New York Times stated that binge drinking in the Army rose 30 percent between 2002 and 2005, and one in four soldiers said they drink heavily--the highest rate since 1985.

Despite a ban on alcohol and drugs in Iraq and Afghanistan, liquor like "hajji juice," a clear Iraqi moonshine, is often smuggled onto bases. Troops also get alcohol from friends back home who mail it in bottles marked for mouthwash. Alcohol problems, stated the Times, often fuel the most violent crimes committed by U.S. troops in Iraq and Afghanistan.

Don Elverd, a Hazelden psychologist and Vietnam combat veteran who often speaks to military and veterans' groups about combat stress and substance abuse, said pre-deployment education and training for soldiers and their families (available from military-operational stress control teams) is essential. He says that training promotes psychological armor and builds upon an individual's strengths, values and character. Furthermore, several personal characteristics that strengthen post-deployment resiliency have been identified; these include a positive attitude, core beliefs and values, spirituality, an ability to connect with others, humor, and "cognitive flexibility"--the ability to reevaluate a situation from a different perspective for meaningfulness.

Although efforts are taken to identify and treat trauma when it occurs by having mental health units embedded in Iraq, soldiers are often reluctant to seek help, fearing their comrades will no longer trust them to "have their backs" and their officers may suspect them of being weak or cowardly. This fear of being stigmatized often follows soldiers home, keeping them silent because they are worried about losing benefits or advancing their military careers if they seek help. Oftentimes, discharged veterans who do not seek help must wait weeks or months to get it because of understaffed and overcrowded veterans medical facilities.

Elverd urges troubled soldiers and veterans to talk with other veterans who have sought help. Vietnam veterans, who are familiar with post-deployment difficulties, have often been found to be valuable resources for veterans of the Middle East. "Because they understand what many of their experiences have been, another combat vet provides mutual credibility and respect," says Elverd.

Because PTSD and substance abuse often occur together (60-80 percent of Vietnam vets treated for PTSD have alcohol use disorders), Elverd suggests that veterans attend Alcoholics Anonymous (AA) groups for veterans. "Twelve Step support is enormous because it provides a sense of community for those who may feel marginalized. There is a tendency to isolate during post-deployment. In AA, vets learn how to utilize community to gain strength and get through the hard places.

"In war, soldiers learn how to operate in a chaotic and unpredictable environment where they assume everyone is the enemy, but war-zone skills are not good skills for use at home," emphasizes Elverd. As returning soldiers transition and re-learn more appropriate skills, Elverd urges their loved ones to be patient. "Thank them for their service and allow them to teach you by saying, 'I can't relate to your experience, but I care about what happened to you.' Listen attentively, respect and love them, and help them recover their resiliency."

The National Center for Post-Traumatic Stress Disorder Web site has extensive information for families and veterans. Military OneSource (800-342-9647) is a resource for all branches of the service. Local veterans outreach counseling services, AA and Al-Anon can also be of help.

--Published June 11, 2007