March 19 marked the second anniversary of the Iraq War. Thousands of families continue to send their courageous sons, daughters, husbands, wives, fathers, and mothers to the uncertainty of guerilla warfare, where more than 1,665 U.S. troops have been killed and over 11,000 injured.

"This war has gotten up close and personal and a lot more stressful," said Don Elverd, a Hazelden psychologist and a combat veteran wounded in his tour of duty in Vietnam. "Sometimes there are just four or five soldiers walking down an alley, not knowing what to expect."

The physical costs of war are great, but it is more difficult to gauge the mental and emotional toll it takes on soldiers and their loved ones. A July 2004 study in The New England Journal of Medicine found that up to 17 percent of troops returning from Iraq were already suffering from post-traumatic stress disorder (PTSD) or other readjustment problems. Preliminary data from an ongoing Veterans Affairs (VA) study suggest that female soldiers appear even more vulnerable to PTSD than their male counterparts. Of the mental health problems diagnosed at VA hospitals, PTSD was most common among Iraq veterans, followed by alcohol or other drug abuse.

Despite it being a Muslim country, U.S. soldiers in Iraq report having access to drugs and alcohol, which many use to numb feelings of homesickness, fear, and grief. Many return home with emotions shut down or ready to explode with hair-trigger anger. Many complain of sleeplessness and hypervigilance--still perpetually on guard as they were in Iraq. In an attempt to "turn off their brains" and rid themselves of flashbacks or other PTSD symptoms, too many try to self-medicate with drugs and alcohol.

The National Center for Post-Traumatic Stress Disorder (NCPTSD) says that people with PTSD are more likely than others with similar backgrounds to have alcohol use disorders. An alarming 60-80 percent of Vietnam veterans who seek PTSD treatment have alcohol disorders, and experts who work with Iraq veterans are already reporting a high incidence of substance abuse among their clients. As any recovering alcoholic can tell you, any respite drugs and alcohol may offer is temporary, and, as addiction overtakes your life, you risk losing your job, family and self-worth.

Fortunately, mental health experts have gotten a lot smarter about PTSD. Prior to deployment, troops and families learn how to manage stress and what they might experience when soldiers return. During deployment, mental health units are embedded in Iraq to help deal with trauma when it occurs. Experts like Elverd sometimes meet with these teams to ready them for what they might experience. Because so many of today's troops are not "regular" military, they may be less prepared for the trauma of combat, said Elverd. "Many are guardsmen with families, jobs, kids and mortgages who go to a war zone with a lot of emotional baggage."

Unfortunately, fear of being labeled weak, cowardly, or a danger to their comrades keeps some soldiers from seeking assistance in a war zone. Although the VA is working diligently to change things, the fear of being stigmatized can also follow soldiers home, preventing them from getting help for PTSD and other problems while they are still in the military.

Elverd said many people experience an acute stress reaction immediately after a traumatic event, but that usually diminishes in one month. 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 the individual get evaluated for PTSD. In Elverd's ideal world, our troops would have a follow-up "check-in" six months after they return from combat in addition to the other information they receive.

Because coexisting PTSD and alcohol use disorders exacerbate one another, it is best to seek help from a PTSD specialist who has expertise in treating addictive disorders. According to the National Center for Post-Traumatic Stress Disorder, addiction relapse prevention should include tools to cope with PTSD symptoms.

The NCPTSD Web site (http://www.ncptsd.org/) contains extensive information about trauma, grief, stress and related problems with alcohol dependency. In addition, specific information is available on how to help returning Iraq War veterans. In addition, Military OneSource (http://www.militaryonesource.com/; 800-342-9647) is described as a "one-stop," 24-hour resource for all branches of the service.

--Published June 13, 2005