Among the valuable lessons our nation learned in the aftermath of the Vietnam War was how important it is to "love the warrior" -- regardless of how you feel about the war itself. In towns big and small, citizens across America proudly welcomed our troops home from the Gulf War, just as they've supported them throughout the war in Iraq. But however popular the war, however long or brief the tour of duty, or how heart-felt the homecoming, it is safe to assume that combat will still have an emotional impact on those who witness it or participate in it.

"Being in combat is like being on a different planet," said Don Elverd, a psychologist at Hazelden and a veteran of the Vietnam War. "You're in an entirely different culture with a new set of rules, behaviors, and expectations. Typically, civilians don't have a sense of the incredible level of stress a soldier has been under. We try to dress it up with parades and music, but soldiers often feel disconnected and different when they come home."

It is normal for combat forces or others who have experienced some trauma to have difficulty managing feelings afterward and to experience stress reactions such as fear, depression, sleeplessness, anger, or emotional numbness. However, if stress symptoms worsen, go on for long periods of time, or interfere with job performance or other aspects of life, it is important that soldiers get professional help and be evaluated for post-traumatic stress disorder (PTSD)-a psychiatric disorder that can occur following the experience or witnessing of life-threatening events.

The National Center for Post-Traumatic Stress Disorder (NCPTSD) estimates that 31 percent of male Vietnam veterans and 27 percent of female Vietnam veterans will experience PTSD at some point in their lives. PTSD has also been detected among veterans of the 1991 Gulf War, with some estimates running as high as 8 percent. Many experts think the PTSD rate for veterans of the Iraq war could be higher than that, because combat was longer and, in some cases, more intense. And U.S. troops face ongoing fear and trauma in Iraq. PTSD also occurs among survivors of natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape.

According to the NCPTSD, post-traumatic stress and alcohol problems often occur together. People with alcohol use disorders are more likely than others to experience psychological trauma, and being diagnosed with PTSD increases the risk of developing an alcohol use disorder. For example, 60 to 80 percent of Vietnam veterans seeking PTSD treatment have alcohol use disorders. Dr. Michael Dieperink, medical director of the PTSD Team at the Veterans Administration Medical Center in Minneapolis, said that people with PTSD are often binge drinkers because they seek to suppress their PTSD symptoms when something reminds them of their trauma. This might be a loud noise, a plane overhead, or an overwhelming thought or memory.

Although alcohol can provide a temporary feeling of distraction and relief, it also reduces the ability to concentrate, enjoy life, and be productive. Excessive alcohol use can impair one's ability to sleep restfully and cope with trauma, memories, and stress. Alcohol use and intoxication also increase emotional numbing, social isolation, anger, depression, and hyper-vigilance. It can make PTSD symptoms worse and reduce the effectiveness of treatment.

"Most symptoms of PTSD get better for most people relatively quickly," Dieperink said. He recommends: "Don't drink to escape. Talk it over, and don't isolate yourself. Establish as normal a routine as you can, and get regular hours of sleep. If symptoms persist for more than a month, seek professional help." Loved ones should do their homework about trauma, stress and addiction so they can have necessary resources in place if needed. The National Center for Post-Traumatic Stress Disorder Web site at http://www.ncptsd.org/ contains extensive information about trauma, grief, stress, and related problems with alcohol dependency. It offers a list of helpful resources for clinicians, survivors of trauma, and families. In addition, specific information is available on how to help returning Iraq War veterans.

"Research shows that individuals can undergo high levels of stress if they think someone cares," said Elverd. "If a returning vet can't talk to you, encourage them to talk to an older veteran, a chaplain, or a professional who works with veterans."

When Elverd works with veterans in addiction recovery, he likens the AA model to their experiences in the military. "They know how to fit into a group of people who 'get it.' They know they don't have to like all of them. They know what it's like to fight for their lives with a group of people who are often disparaged."

--Published July 14, 2003