From tanks and fighter jets to grenades and cadence, the publics' perception of the military as an institution and the culture varies. Perceptions within the ranks also extend to service members who fear reprisal if asking for help, a stigma the staff at Fort Bliss' Addiction Medicine Intensive Outpatient Program (AMIOP) are working to end.
Since opening doors to Fort Bliss service members just over a year ago, over 150 service members have completed a six-week program at the AMIOP to sober up and break free from addiction. But, according to the experts, the AMIOP is only the beginning of recovery.
"Initially (service members) start at (Substance Use Disorder Clinic Care, or SUDCC) for most cases," said Gisela Carter, program director, AMIOP / Partial Hospitalization Program (PHP). "A lot of times they get sent fairly quickly to us if they have higher needs."
The AMIOP, the only one of its kind at Fort Bliss, offers intermediary rehabilitation for service members and provides a level 2.5 level of care based on the American Society of Addiction Medicine's (ASAM) continuum of care which describes treatment as a continuum marked by four broad levels of service and an early intervention level. The lowest level of care, according to ASAM, is at level 0.5, early intervention, with the highest being at level 4, medically managed intensive inpatient services. The six-week-long program differs from SUDCC by approaching addiction with a full schedule of therapy modalities designed to keep patients engaged and practicing methods toward rehabilitation.
"We provide the tools during that six-week program and collaborate with patients (after completing the program) to see how they are using the tools," said Maj. Marlene Arias-Reynoso, AMIOP medication provider/ SUDCC consultant and chief of 1st Brigade Combat Team, 1st Armored Division Embedded Behavioral Health. "The earliest they come and get help, the more effective the treatment will be. If they don't come until a DUI later, there's already things in place. Although the Soldier may want to recover, their career may likely be over."
For one Soldier, a self-referral helped set up the Soldier to continue in the Army before the addiction took over.
"I had personal issues that escalated and I started going to Embedded Behavioral Health to get help then I was introduced to the program," said the Soldier. "I was off-track very badly, everybody saw a change in me, even (senior leaders) before going through AMIOP."
The Soldier, who wishes to remain anonymous, initiated his recovery at SUDCC and eventually found himself at the AMIOP for elevated care.
"For the first two weeks, like most people, I thought this was a bunch of BS. We're going to come in here and sing Kumbaya, a lot of people are just going to say, 'this is what you should do...' but after we got past that particular phase, I had a few emotional days. They started to peel the layers off the onion to figure out what makes us turn to using substances," said the Soldier. "It provided an open forum, where you can actually speak to others going through the same thing, because back in the unit you can't speak to others freely. The group is where everybody opened up, in that forum, with a bunch of strangers and I put my business out there, but to this day we still have that group that we had."
The Soldier's perception of stigma surrounding Soldiers who ask for help is one the AMIOP staff is working to transform.
"There's still a huge stigma about people who are recovering. There are still negative connotations with it," said Carter. "Sometimes the value of the Soldier decreases and becomes negative because of the stigma, people refer to them as 'bad for the unit'."
In 2016, the Army Public Health Command's Health of the Force report, a force-wide annual report discussing factors impacting Soldier readiness, lists five percent of active-duty Soldiers across the Army as being diagnosed with substance use disorder. The report consolidates the misuse and abuse of alcohol with prescription medication and other drugs.
"The longer you keep struggling with whatever substance, the worst the outcome is going to be. Habits are hard to break, so addicts may go back to (abusive) behaviors," said Arias-Reynoso. "This is only six weeks, after that are the challenging times. The certificate (for completing the AMIOP program) is not the end, it's the beginning."
According to the Soldier, one activity at the AMIOP helped him realize the importance of scheduling and keeping him active to deter him from negative behaviors.
"I'm back to the (Soldier) who (other Soldiers) knew. I had stopped going to the gym, I loved being outdoors and I had gotten away from all of that because of depression, anxiety, and crazy thoughts going through my head," said the Soldier. "I needed to eliminate the drinking, because at first I just wanted to minimize. But, (at the AMIOP) you have breathalyzers, urinalysis, AA meetings, which are eye-openers, just to see the long-term effects of what alcohol was doing."
By starting treatment, the Soldier was also able to reconnect with a daughter who was beginning to notice the changes.
"I have no problem talking, but I wasn't reaching out to my family as much (when the Soldier started drinking heavily). Once I opened up to family, it became easier to speak more about (addiction). Now our conversations are back to normal," said the Soldier.
"When we have graduation in six weeks, I always tell (patients), this is genesis, this is the beginning, this is the initial start of the recovery," said Carter. "There's after-care at the SUDCC, in addition they come back to us on Fridays for several weeks to see how they are doing. It is like a recovery group for patients that have attended the AMIOP, and on the outside they continue that external support system like Alcoholic Anonymous or Narcotics Anonymous."
According to AMIOP staff, continuity of treatment is essential in recovery and staying sober, with many programs designed to continue care three to six months after completing the program, to include family counseling.
"The program definitely gave us different tools to deal with the triggers, I don't even go out to clubs anymore, I go do my activity and back to the house," said the Soldier. "It's helping me deal with everyday life and motivate me not to drink. As long as you have like-minded people and someone who has been through a similar experience, then you can relate. And that's one of the best things about the program."
Two cohorts of eight service members occupy the program year round, with each cohort's participants starting at the same level of recovery.
"Recovery is not just something that happens, it's a process and people have to continue to work on it," said Carter. "Sometimes we have patients here until the day they walk out the gate (are out of the military), if a patient is willing to stay and work with us then we're willing to admit them."
"The tools that they learn here, even as civilians they can potentially apply them to their lives," said Arias-Reynoso. "Being sober is not recovery. Have you changed your lifestyle? Not just stop your substance."
Each September is Recovery Month, a Substance Abuse and Mental Health Services Administration-sponsored observance to increase awareness and understanding of mental and substance use disorders and celebrate those who recover. This year's theme is: Join the Voices for Recovery: Invest in Health, Home, Purpose, and Community.
In efforts to increase awareness of addiction symptoms, the AMIOP recently provided training to primary care providers at Fort Bliss to help identify addictive behaviors, during regular exams to help service members before it becomes a habitual juggernaut.
"Anybody that actually needs help, no matter what your rank, don't be afraid to stand up and say something," said the Soldier. "Just speak up, don't try to handle all issues by yourself. I always thought I was one of those people where it won't happen to me and I had my stuff together but I didn't... and it all came crumbling down."
Today, the Soldier is back at his unit and working toward bettering himself while continuing counseling during recovery.
Multiple referral options exists for service members seeking treatment including self, physician and command referred. All patients are required to enroll in SUDCC prior to seeking higher levels of care.