Do Veterans Struggling with Addiction Require Specialized Treatment?

This post originally appeared on VICE UK.

Like dozens of other young British soldiers who served in Afghanistan, Grant Thomas left the Army minus a leg. Only, his injury was not caused by the gunfire he dodged while serving as an 18-year-old private in the Parachute Regiment. Nor did he step on a buried Taliban bomb.

Thomas lost his limb after kicking through a plate glass window in a moment of drunken frustration in June of 2010, nine months after returning from tour. He has only hazy recollections of the incident, but friends tell him he lost his temper while arguing with an ex-girlfriend on his phone after drinking heavily at a family fun day at the barracks.

Now 25, Thomas, still bearing the muscular build and close-cropped hair typical of a Para, makes himself comfortable by unscrewing a carbon-fiber blade moulded to the stump of his right leg and leaning the springy assemblage against his chair. As much as he loved his six years in the Army, which he joined at 16 to escape the drugs and joblessness blighting his home near Liverpool, he can't help but feel a little rueful about the irresistible peer pressure to drink himself into oblivion.

"Every time I drank it was police cells, hospital, or me getting knocked out and carried back," he said, speaking at Tom Harrison House, a newly-established rehabilitation center for ex-forces battling addiction located in Liverpool's Broad Green area. "I just put a mask on and say I'm fine, but eventually every man will break. It got to the point where I had nothing left—that I wanted to stick a bullet in my head."

Thomas's sleek prosthetic is a rare tangible symbol of the damage done by alcohol to the British Army, where a hard-drinking culture poses risks to the most vulnerable that can be every bit as deadly as serving in a war zone. In two years meeting ex-forces across the country to research my new book, Aftershock, the Untold Story of Surviving Peace, I saw the impact firsthand: broken relationships, lost jobs, violent offenses, and, in the worst cases, a fatal descent into alcohol-related illness or suicide.

The battles fought by Thomas and others at Tom Harrison House, a rare example of a British military charity set up primarily to treat addiction, suggest that remarkable transformations are possible with the right support. But their stories also shed light on why the system is failing many other former service personnel who are being left to fight their dependence on drugs and alcohol alone.

"Every layer of this field is just permeated with shame," said Jacquie Johnston-Lynch, a former social worker and addictions specialist who founded and runs Tom Harrison House. "There's shame on the part of the guys who come to us, and shame on the part of the MoD [Ministry of Defence]. Families are ashamed as well. No wonder our guys go to the bottom of the pile."

Alcohol has been central to military life since armies began; the term "Dutch courage" derives from the gin that fortified 17th century English troops fighting in the Low Countries in the Thirty Years' War. During the harsh winter at the start of the First World War, the Army reintroduced a rum ration to stiffen resolve. Only in more recent years have researchers begun to quantify the scale of the military's alcohol problem.

In a paper published in 2007, the King's Centre for Military Health Research found that the rate of "hazardous" drinking among military males was 67 percent, compared with 38 percent for civilian peers. When it came to "severe" problems, proportions in the military were almost three times higher for men and nine times higher for women. Those at greatest risk included young soldiers who had seen combat—men like Grant Thomas.

Significantly, the figures suggested that the prevalence of alcohol misuse was far greater than that of post-traumatic stress disorder (PTSD), the psychological injury often associated in the public mind with soldiers, which affects an estimated seven percent of those who serve in front-line roles, according to the King's Centre.

Despite the scale of the problem, there is a glaring lack of specialist addictions support for former service personnel. In theory, they can access services run by the NHS, which has appointed a network of "Veterans Champions" to improve mental health care for ex-forces. But funding for such care is under huge pressure and clinics often cannot help former soldiers if they have active trauma symptoms, which can trigger aggressive outbursts or attempts at self-harm. Former combatants, for their part, are often understandably wary of opening up about their most painful war-time memories among civilians they have only just met.

"This is the elephant in the room," said Keron Fletcher, a retired consultant psychiatrist with 17 years of experience of working with ex-forces with addictions. "This is the biggest mental health problem among serving and former personnel, but there's an appalling lack of support."

Britain's military charity sector, which serves a quasi-official role in caring for ex-forces, has mostly treated addiction as an afterthought. The emphasis has tended to be on guiding soldiers through the often fraught transition to civilian life by helping them find decent homes, jobs, and support in their communities rather than tailoring specific services for the notoriously difficult business of beating addiction and preventing relapse.

In 2014, a government report found that some 350 service charities offering a wide range of welfare support or psychological intervention raised a combined annual income of £400 million [$600 million]. Tom Harrison House, which runs on a shoestring, says it is the only charity running a residential rehabilitation program exclusively for veterans and reservists with drug or alcohol problems—though many others support clients in the often exhausting task of navigating over-stretched civilian addiction services.

Johnston-Lynch saw the difficulties of treating ex-forces in existing rehab centers firsthand when she was managing the Liverpool branch of a national addictions charity. Noting an unusually high drop-out rate in the first few weeks, she discovered that almost all of those who had left early were ex-military.

"They said: 'We didn't want to break down in front of people because, if we did, that would be disloyal to people who were still serving,'" she said. "There's a group of men who are just so fearful around civilians that the only place in which they'll do it is with other veterans."

The realization prompted Johnston-Lynch to quit her job and raise money from donors to create Tom Harrison House, named after a grandfather of the project director who had served in the Navy in the Second World War. Occupying an imposing Victorian residence in a quiet suburban street, the charity began admitting clients in July of 2014, and more than 50 people have since passed through its program, which can last from 12 to 22 weeks.

"We just took a leap of faith and said: 'Right, lets do it,'" said Johnston-Lynch. "We're not big flag-wavers. We're more about the injustice—particularly for men who come from working-class communities."

The charity offers group work, weekly sessions of equine therapy, yoga and mindfulness, and one-on-one support. The idea is to restore a sense of connection and purpose by helping clients to confront the underlying drivers of their substance abuse and repair relationships.

While civilians in rehab can take weeks to form meaningful bonds, Johnston-Lynch said the camaraderie shared by ex-forces means they rapidly connect in no-holds-barred group therapy sessions characterized by a plain-speaking military bluntness that would make the average civilian wince. Graduates can stay involved as volunteers, and staff keep in contact with them via a WhatsApp group.

"They take all their military principles and use them in a treatment center, which puts them on a path of recovery much quicker," Johnston-Lynch said. "If we know somebody has relapsed we call that 'warrior down' and we go and see if they need help."

Among the volunteers is an ex-soldier named Tony, who served in Northern Ireland in the 1970s and had become so emaciated drinking three to four bottles of white wine a day that he could barely walk up the stairs when he was admitted on his 60th birthday. Cleaners later removed 130 empty bottles from his home.

"At the end of the day, this is very much like a war zone, because the consequence of not getting yourself clean and sober is death," he said.

Now sober, Tony visits Tom Harrison House to support younger men such as Thomas. The ex-Para said he had left the Army with about £350,000 [$530,000] in compensation, insurance, and other payments, but soon squandered his savings as his drinking gave way to new addictions to cocaine and online roulette.

"I'd got paranoid the Taliban were coming through the door. I'd have knives stashed around the room," Thomas said. "I'd gamble to take my mind off it."

He eventually attended a private rehab center, but his descriptions of his experiences in Afghanistan upset other clients. After two weeks he called his dealer, who threw him a packet of cocaine over the wall. At the ten-week mark in Tom Harrison House, by contrast, Thomas has suffered no similar relapse and has deleted 200 of 240 contacts on his phone—keen to sever ties with anyone he fears might lead him back down a path of drink and drugs.

Among much larger military charities, there is a growing recognition of the need to do more. Combat Stress—Britain's biggest mental health charity for veterans—has ear-marked £2 million [$3 million] for a community-based scheme to help ex-forces better engage with NHS addiction services so they can become sober enough to start its six-week in-patient program for treating PTSD. Help for Heroes, which raises more than £30 million [$45 million] a year, has begun offering support with problem drinking face-to-face or via phone or Skype as part of its new Hidden Wounds psychological wellbeing service.

But such initiatives are only scratching the surface, and there is still a lack of specialized care for one of the most vulnerable groups of ex-forces—those who drink to blot out the flashbacks, nightmares, insomnia, and mood swings associated with PTSD. Experts say such complex cases should ideally be treated in an in-patient detox unit capable of providing an integrated approach to tackling both their addiction and their underlying trauma—a service currently unavailable anywhere in Britain.

Meanwhile, Tom Harrison House does what it can but faces a constant fight for survival, partly because local authorities or regimental associations who might fund other forms of support tend to assume that NHS addictions care will suffice.

Bill Haniver, who served for 30 years in the Army, said he had been forced to take a £1,500 [$2,275] bank loan to fund his admission to Tom Harrison House after exhausting all other services, while Thomas's father paid £1,200 [$1,820] toward his son's care. For veterans such as Frank Hampson, 57, who sold his medals to buy alcohol, any price is worth paying.

"Only six weeks ago a doctor told me: 'You keep drinking, you're dead in six months.'" he said. "This place has saved my life."

This post has been updated and some names have been changed.

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Matthew Green's new book Aftershock: the untold story of surviving peace documents the private battles of soldiers and their families struggling to adapt to life after the war zone.