11/08/09 - General Stephen N. Xenakis

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Drug Policy Alliance conference & report: "Healing a Broken System: Veterans Battling Addiction and Incarceration" with General Stephen N. Xenakis, M.D., Guy Gambill, veterans’ advocate, Abel Moreno, Arizona Vets 4 Vets

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Transcript

Cultural Baggage, November 8, 2009

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Broadcasting on the Drug Truth Network, this is Cultural Baggage.

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It's not only inhumane it is really fundamentally Un-American... "NO MORE" "DRUG WAR" "NO MORE" "DRUG WAR" "NO MORE" "DRUG WAR" "NO MORE" "DRUG WAR"

My Name is Dean Becker. I don't condone or encourage the use of any drugs - legal or illegal. I report the unvarnished truth about the pharmaceutical, banking, prison and judicial nightmare that feeds on eternal drug war.

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Dean Becker: Welcome to this edition of Cultural Baggage. Today we are going to salute veterans and we are going to talk about some of the problems we have inflicted upon ourselves via these eternal wars which we insist on waging. The good folks at the Drug Policy Alliance just issued a major report, Healing a Broken System: Veterans battling addiction and incarceration. And on the release date on that report, they had a teleconference dealing with that subject. I would like to share some of that with you now.

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Nearly a quarter of a million veterans are behind bars right now serving sentences related to crimes motivated in part by drug or alcohol addiction or mental health problems and that the average veteran is serving a longer than average sentence than non veterans for the very same offenses.

Roughly one third of veterans returning from Iraq and Afghanistan report symptoms of post traumatic stress disorder - something you will hear more about from our speakers, they might be referring to it in short PTSD – and also veterans suffer from traumatic brain injury, depression, mental illness and other kinds of disabilities at higher rates than normal.

And left untreated, each of these medical conditions are contributory factors to substance abuse, addiction, fatal drug or alcohol overdose, homelessness and suicide as well as a host of legal violations, particularly non violent drug offenses which the states often treat quite punitively.

Those are some of the key problems that veterans are facing now and have long faced throughout the decades. The key recommendations that our experts in this report make to improve the health, safety and well being of the men and women in our armed forces are as follows:

One, that changes need to be made to state and federal laws to focus on treatment instead of incarceration for veterans who commit non violent drug related offenses. I’ll repeat that. Stated federal laws need to be changed so that veterans can receive treatment instead of incarceration for non violent drug related offenses.

In additions, government agencies – local, state and federal need to adopt overdose prevention policies as well as other harm reduction programs targeting veterans who misuse substances or alcohol or who use prescription medications in order to prevent fatal overdose.

Thirdly there needs to be a dramatic expansion at the state and federal level of medication assisted therapy such as methadone and bupronorphine to treat opiod dependence. Methadone is the gold standard treatment for heroin and opiod dependence and yet it is largely unavailable to most people who need methadone treatment especially veterans and so access to methadone and other medications and therapy need to be dramatically expanded.

The report, again, Healing a broken system: Veterans battling addiction and incarceration. The full report can be found on the Drug Policy Alliance website, www.drugpolicy.org. So I encourage people to go to the website and obtain a full copy of that report.

I am now going to turn to our distinguished panel of speakers. We have eight speakers this morning each of the is going to spend a couple of minutes focusing on a different aspect veterans face in respect to obtaining adequate substance abuse and mental health services. We are terrifically excited to have these speakers. We want to thank them for their service to our country and their ongoing service to veterans, to veterans’ families and to people suffering from substance abuse and mental health disorders.

It is no coincidence that we are having this report rolled out today and this conference today, one week before Veteran’s Day and we are hoping that the attention on this very important issue will focus more attention starting today and thru upcoming days including Veterans Day so that we can get these issues in front of the public and start improving access to substance abuse treatment for veterans.

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Dean Becker: Please note that this conference took place before the tragic occurrence at Fort Hood.

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Our first speaker this morning is Tom Tarantino who is a legislative associate for Iraq and Afghanistan Veterans of America, IAVA. Mr. Tarantino returned from active duty in Iraq in 2006 and has been dealing with many of the issues that our report concerns. So I am going to turn this over first to Tom. Thank you, Tom.

Tom Tarantino: I want to preface by saying you know I am not a mental health care professional. I am not dressed as professional, I am a soldier and am a former officer and I am a advocate for veterans affairs. I deal primarily with legislation and policy issues.

But there are a couple of the things I want to highlight that I thought were interesting and given my time I am not going to go into depth. IAVA publishes a lot of reports on a host of issues whether they be invisible injuries or housing and homelessness or careers or our most recent women in the military report.

So we are very familiar with how difficult it is to pull together information on an issue which is not just important but that there is not a whole lot of gathered source material. And so this report was important because this is something that has not been well covered or comprehensibly covered for some time and for issues of veterans in the justice system I think in my opinion is a bit of an information and policy hole that we have to fill.

There are two points in the report that I found particularly striking and they resonate with me both as a policy guy and a former military officer and someone who has had to deal with company command the year after coming home from Iraq. The first one is that you will notice that the justice numbers are from a survey done in 2004. And you will notice that they talk about veterans in general. They don’t necessarily talk very specifically about veterans of Iraq and Afghanistan although there is some information in that study.

But what I find interesting is that it is from 2004. And in 2004 there were over one million fewer veterans of Iraq and Afghanistan than there are today. So currently there is a hunger for knowledge and a hunger for data for those of us in the advocacy community that are trying to convince legislators that this is something that we have to address. And I can talk about that in a second.

The second point that I wanted to talk about to you is this concept of sort of service related drug dependence. This is an issue that it’s being talked about a lot in the veteran’s community but I don’t think it’s very well understood outside the military.

The ease of prescriptions while you are in country is absolutely staggering. We have often joked among soldiers while we were there to get things like Ambien or anti depressants and in some cases you know opiate pain medication you know we’d ask hey do you got your prescription and they would show you a little Ziploc bag with some Sharpie you know words written in a Sharpie on it. And that is essentially what passes for a prescription in many bases and sometimes that is just field expediency and life in a combat zone.

However the ease of obtaining prescription medication in country is thankfully is not, not mirrored back in garrison. But you have soldiers coming back from an environment that dealing with combat stress, they are coming from an environment where they are able to get medication and the medication is justifiably prescribed but it is also very loosely prescribed and there is very little records actually going on, at least there certainly wasn’t in 2005 or 2004 and 2006.

And then they come home and they have to come to the, the civilian records the medical system which thankfully is in the military is much more stringent on issuing drugs and there is no real connection in between them. And when you are going through combat adjustment related issues then this can create a severe problem.

So and that is something I wanted to point out because you honestly and to be really blunt, in country, I know crack dealers who are more discriminate with issuing drugs than some of the [ ] I saw in Iraq. And it was really alarming how many combat soldiers were given things like Ambien and and anti depressants without a whole lot of involvement with the command team in, is this person really fit for duty and I think that that’s an issue that needs to be addressed later on.

And just before I go I want to talk a little bit about some of the policy issues that are affecting this realm. How I talked about we don’t have good numbers. We really don’t know how many veterans are in jail right now. We have an idea but we don’t even know how many veterans are in the United States of America right now.

We have no method for tracking veterans unless they interact with some social service. And it largely depends on whether that social service even asks if they are veterans or not so what we need to do is have the Department of Justice and the Department of Defense compare lists. The Department of Justice has lists of people who have been arrested. It is collected quarterly and the Department of Defense has a list of everybody who has been in the military.

And it would be immensely helpful, not just to advocates but to congress, to the justice community to be able to get regular targeted data so that we can focus the very finite resources we have to combat this problem.

And this is something that members of the house veteran’s affairs committee have asked during this round table on incarcerated veterans they had last month. This was the number one question, why don’t we have data on this? So I think that is something that’s going to be looked at next year.

Also we need the Department of Veteran’s Affairs to lift their ban on treatment of incarcerated veterans. I was pleased to see that Secretary [ ] wanted to focus on vocational and job placement for veterans leaving the prison system. I was very pleased to learn that the Department of Veteran’s Affairs now has a justice coordinator at every VA medical center.

But they are still waiting outside the prison door and they are not treating the veterans when they need it the most and that is while they are incarcerated. And I think that is something that we are going to have to look in to. It doesn’t have to be legislatively. This is a regulation that they can change on their own.

So there’s a couple of policy issues and I just wanted to you know thank Tony and everyone on this call. I think [ ] and General [ ] are going to be far more enlightening than I am as they are the true experts. I am just a grunt they send to Capitol Hill every once in a while.

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Dean Becker: You are listening to Cultural Baggage on the Drug Truth Network. We are tuning in to a recent teleconference sponsored by the Drug Policy Alliance on the same day they released a major new report, Healing a Broken System: Veterans Battling Addiction and Incarceration. You can learn more by visiting their website which is drugpolicy.org.

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We are now going to move to General Stephen N. Xenakis who in addition to being a general is also a medical doctor. He is a special advisor to the chairman of the Joint Chiefs of Staff, warrior and family support. He has had a distinguished career in the US army as well as in health care management, academic medicine and clinical practice. General Xenakis.

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Stephen N. Xenakis: Hi and good afternoon. Thanks for inviting me to participate. And [ ] thank both of you for your remarks cause I think that you are spot on on identifying the issues that are critical to this to this particular set of conditions and to these individuals and hopefully we can point to a way forward.

And you really covered the points where we are concerned and I think from the time that we started on this project a couple of years ago at the start of Admiral Mullins tenure we realized that the care, feeding and support of the veterans is a national concern and responsibility. And it’s not just something that belongs to the respective departments and it’s it goes to the communities.

And the national leader ship has its own responsibility to try and knit those together. And that is what we are looking to do is knit that knit all those various services in the institutions together so that in the end that soldier or marine who served and come home and maybe ended up unfortunately incarcerated or having problems with substance abuse gets treatment from all the various sources that are available.

I think you point to a couple of things that we need that this report sheds light on and Mr. Tarantino you have really added something else that is important is the fact that our culture is a culture of, it’s… treatment has now become very chemically based. And in a way we need to raise awareness about that.

You hear anecdotally any number of reports like you said that prescriptions, medications are widely available for good intent. And that the prevailing practice in some ways is to if a person has got a sleeping problem, well we’ll give them an Ambien and not necessarily do other things that are not pharmacological that could also help with what they are experiencing to help them sleep and handle their anxiety. That is as much a national cultural issue but is clearly an issue that we need to focus on in the combat theater.

And I think the whole issue of figuring out how we deliver the treatments is something we are interested in and how we configure all that. Turns out records are not shared and so the DOD records are not necessarily available to the VA. They are definitely not available to the community organizations and so that we can track a person over time and connect their medical history. And that is a priority for us so that if we are able to do that we can start to better configure what we are going to do.

So I would like to say that our leadership here hardly endorses what you all are doing. It’s, again, as I think has already been said, it is really important that this information is out. That people are aware of it and that we follow it with the best action plans we can at this time because that is a large number of people.

I mean two hundred and fifty thousand people is a large number of soldiers and marines and sailors and airmen who have been affected and we as a country have a responsibility to assist them and support them. So thanks a lot.

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Thank you, General. Our next speaker is Guy Gambill who is a long time community organizer and advocate for veterans, the homeless and for criminal justice reform as it pertains to veterans. Guy?

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Guy Gambill: Yeah, thank you very much Tony. And thank you General Xenakis. I guess to place this in context we go back to the Vietnam era and what happened. We in 1985 Tom referred to the second or the first Department of Justice, Bureau of Justice study. There were two, one brought data from 1985 through 1998.

And in 1985 what we saw in that Bureau of Justice report was that twenty-one percent of all state inmates in prison, state prison inmates, were veterans; twenty-three percent of all federal inmates. Now you think about what were the, what was the makeup of that population and about a third of them they were there for drug offenses.

We look at… I try to characterize this. I try to be smarter than the problem this time. We have scads of research to talk about one of the hallmark things the PTSD, the tendency to self medicate. People do that with drugs. People do that with alcohol and that tendency to use those self medicating moments of managing your PTSD or your psychological trauma tend to have you, land in a category of people who are much more likely to have justice contact.

That being said, we know, we understand a lot better now than we did back during the Vietnam era and immediately afterwards and we have the option of placing policies on the books that are smart.

Now Tom talked some about the justice data problems. He is right. We have a very hard time getting our arms around exactly how many people are in prison or jail federal and state and why is that.

Well, the federal data privacy act was enacted in 1968 and in 1972 at a time in our national history when a lot of veterans weren’t raising their hands screaming to be counted. It was very unpopular in some quarters to be a veteran. That set a tendency in some government agencies not to collect data on veteran status. Amongst those were county jails. So you have community corrective facilities not asking at the point of booking about veteran status and that is carried forward.

Part of the problem here is going to be it is not entirely up to the federal government to fix this. It is going to be part of the burden is going to fall on the states and this goes back to what I look at as a parallel set of movements in justice reform with veteran’s issues that really haven’t had the dialogue that needs to take place yet.

I date the modern justice reform movement from Justice Kennedy’s speech to the ABA Hall of Delegates in 2002 and 2003 when he noted that we have created a society that arrests too many people, incarcerates them for far too long and when they come out the other side of the justice system, the collateral consequences and sanctions. The mark of a criminal record is as a major would phrase it, it keeps them from getting jobs, form getting housing, from getting other needed services and thus the recidivism rates go up.

With veterans you know we have a chance to meet this at the front end this time. So there is some really neat things going on right now in the country. Chicago PD and LAPD for examples kind of what I would characterize as front end interventions for veterans.

They are doing ride alongs in LA with the police department and pure specialists are going to recognize their fellow Iraq and Afghanistan veterans and help police get them where they need to be, hopefully not jail. Same thing in Chicago they have a crisis intervention training for they have trained their first hundred officers and these guys are going out with their specialists. All these first hundred officers in Chicago PD are all Iraq and Afghanistan veterans.

So they try to grab these guys at first point of contact and where possible get them into treatment rather than locking them up in jail. This is fiscally wise. It is just plain smarter to get a guy into treatment and get him the support he needs, the peer support he needs so that he doesn’t cycle through the system and in to homelessness and in to facilities again and again and again for forty years like many Vietnam veterans did.

Again, we can be smarter than the problem this time. We have tons of research now that shows that early intervention, peer led interventions work very well. They are very effective. And if we can catch this on this front end this time we are going to be a lot better off longitudinally. We don’t want to have you know hundred thousand veterans on the street like we do now.

So I think one of the things I’ll reiterate again that has to happen is there has to be a dialogue between the veteran’s service organizations groups like the Drug Policy Alliance, Legal Action Center, the Veer institute, all the big justice reform groups in Washington need to sit down and talk with the veterans groups and some of the homeless providers and national advocacy organizations and the military and formulate policy based on research.

All too often we do all sorts of research, we come up with recommendations and then they are not followed. If I could do anything here it would be to exhort congress to have the political courage to be smarter than the problem this time. It is fiscally wise. We cannot afford to not do that at this juncture in our national history. Thank you.

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Hi, sorry. Our next speaker is Mr. Abel Moreno. Mr. Moreno is a former army sergeant who served in combat in both Iraq and Afghanistan. He is now a staff member of Vets for Vets. Mr. Moreno.

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Abel Moreno: Yeah, I think I would like to highlight the some of the issues that I read in this report and also I would like to just thank everybody for being here, number one in giving us the opportunity. One of the most [ ] opportunities I [ ] to when I got to

[technical issue]

We look at those issues and then we look at the next portion of this that was brought up was that nineteen percent of current conflict veterans who have received VA care have been diagnosed with substance abuse or dependence. I look down and I see veterans do not qualify for substance abuse disability benefits unless they have PTSD.

When I go back to that world of behavior health I am looking at that [ ] dual diagnosis and what we are seeing and what I happen to deal with when I work for Vets for Vets in working the peer support aspect is that you know PTSD leads to substance abuse or substance abuse can walk its way into PTSD. And that is something we really need to work at.

What I would like to really impress is that as a society, as a community throughout the United States and through all the places that are needing help and recognizing the educational aspect it needs to be taken forward with today’s veterans and prior service veterans prior war veterans is that substance abuse is a culture. Substance abuse and alcoholism have something has raged throughout time and now has reared its ugly face in such a way that it is actually morphed into a new type of substance abuse.

One of the things at work that I do that I do right now is I work with my father as you are going to hear from very soon on the weekends at a methadone clinic. And what I have seen and when I have come home it is the lack thereof of the education of the substance abuse cult. We can no longer run away from the ideal that it doesn’t exist. We can no longer run away from the idea that people are not substance abusing when we have serious situations that are two conflicts going on at once. The obviousness that PTSD and the [ ] exist is clear that there is going to be substance abuse issues.

When we look at you know being able to over excessively use the amount of pain mitigating medications that are offered right now for someone who has been wounded in combat. For Percoset is the means to being able to sustain outside of using physical therapy.

I think when we look at those situations we are creating a [ ] for today’s current veterans and for the whole society at that as that is a pain popping pill medication mitigated ideal. We need to get back to the basics of how do we influence and also be able to characterize the need from there out. OK.

One of the things I want to leave with everybody as why I am working as I work for Vets for Vets and I work at still on Saturdays at a methadone clinic is when we talk about what the records need and how we put together a concise and comprised outreach program for returning veterans, because one thing that Tom hit on was that we need lists of peoples names in order to, to provide adequate services in order to show the numbers in order to show quantified data that this is exactly what is going on. Only will we be able then to attack the situation at the head and meet it with mitigated variety of services that we can provide that adequately. Thank you.

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Dean Becker: Alright my friends, that is about all we have time for. I urge you to go to the website of the Drug Policy Alliance which is drugpolicy.org. There you can hear the whole teleconference. You can read the report and you can do your part for a veteran.

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[PSA]
It’s time to play Name That Drug by it’s Side Effects!

Headache, unexplained muscle pain or weakness, allergic reactions, swelling of the face, lips, tongue and or throat, difficulty in breathing, rash, hives, joint pain, liver problems, nauseau, inflammation of the pancreas and gall bladder.

Time’s up!

The answer: Vitorin, from Merck Schering-Plough Pharmaceuticals, a Singapore company, LLC, for high cholesterol.

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[PSA]

[singing]
He is the drug czar
Wages an eternal war on free will
He knows all, the drug czar knows all
He is in charge of the truth
So he tells nothing but lies
He professes such great sorrow
For the thousands of his minions who die
He is the drug czar
Waging his eternal war
On our free will…

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Dean Becker: Here is hoping that you will tune in to this week’s Century of Lies program. It features Mr. Cliff Thornton of efficacy-online.org. We are talking about free will and the future of the drug war. And as always I remind you that because of prohibition, you don't know what's in that bag, please, be careful.

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To the Drug Truth Network listeners around the world, this is Dean Becker for Cultural Baggage and the Unvarnished Truth.

This show produced at the Pacifica studios of KPFT, Houston.

Tap dancing on the edge on an abyss.