Vietnam Veterans and Alcoholism
Article Reprint Date, August 1984
BY THOMAS BRINSON AND VINCE
For the past two-and-a-half years
we have had the opportunity to work with alcoholic Vietnam
veterans. This has enabled us to deal with two of the most
significant aspects of our past lives, our experiences as
Vietnam veterans and our involvement with the disease of
THE WORLD OF THE VIETNAM
To understand Vietnam veterans,
it is first necessary to acquire some understanding of the
Vietnam War. It was America’s longest war, spanning the
twelve-year period from 1963 to 1975. Of the estimated 2.5
million individuals who served in Vietnam, some 58,000 Americans
lost their lives. Another 300,000 were wounded, and some 2,500
today [August 1984] are unaccounted for.
The Vietnam War has been
characterized as having the following five basic differences
from other wars Americans have fought:
First, the inescapable fact is
that the Vietnam War is the first armed conflict which the
United States has lost. The Vietnam warrior returned to his
homeland not as a heroic victor, but as a disgraced scapegoat.
Secondly, it was a guerrilla war.
Violence knew no boundaries. Many civilians were killed or
wounded. There were few safe areas, no defined areas of front
and rear zones. The enemy was illusive, invisible and as likely
to be a twelve-year-old girl as a pajama-clad peasant. Armies
didn’t meet head-on where superior American firepower could best
be utilized. Rather, Vietnam combatants were sniped at,
rocketed, mortared, and booby-trapped by an unseen foe. Terrain,
the climate, and accidents also took their daily toll.
Thirdly, to a great extent due to
the brutality of the war which was nightly displayed on TV
screens across the nation, the Vietnam War resulted in divisive
controversy at home. For the first time in our history, large
numbers of people seriously challenged the legitimacy of a
national policy to wage war. The returning Vietnam vet was often
branded by his college-aged peers as a baby-killer, an
aggressor, an object of derision.
Fourthly, the individual rotation
pattern utilized during the Vietnam War prevented soldiers from
effectively working through their combat experiences before
being plunged back into American society. Veterans of World War
II fought together as whole units for the duration of the war.
Coming home in the close confines of troop ships, they had the
opportunity to process their mutually experienced combat
Most soldiers in Vietnam, on the
other hand, were individually assigned as green newcomers to
units in the field from Replacement Battalions. After surviving
their year’s tour of duty, they were sent home alone on a
commercial airliner, often wearing jungle fatigues freshly
covered with mud.
Literally, within a brief
24-36-hour period, a combat soldier could be plucked away from
his buddies in the middle of a firefight and deposited into the
chaos of an urban traffic jam with no accommodations for
jet-lag, much less for the culture-shock of readjustment to
Lastly, returning Vietnam
veterans had to integrate themselves into an economy suffering
from “stagflation.” Several years behind most of their peers,
Vietnam veterans were often the last to be hired and thereby the
first to be laid off in a shrinking economy. In addition, they
received a G.I. Bill that was inadequate to provide for
education and training.
ARE WE A HIGH-RISK POPULATION?
Demographically, Vietnam veterans
comprise only a small minority of America’s largest, most
influential generation (Baskir and Strauss, 1978). Of the 26
million men who were draft-eligible during the war, roughly a
third, some 9 million men, entered military service. Of these,
the Pentagon estimates some 2.5 million men served in-country
Vietnam, and of that number about 1.5 million were exposed
regularly to periods of combat.
In other words, about one in ten
men of the affluent, baby-boom generation have survived a life
experience significantly different from most of their
peers—exposure to combat in Vietnam. Large numbers of minorities
in American society were disproportionately called upon for
service in Vietnam (Baskir and Strauss, 1978). Pre-existing
cultural, political, and racial biases have made readjustment
for these veterans especially difficult.
In addition, the Vietnam veteran
was our nation’s youngest soldier. Whereas the average age of
the World War II combatant was 26 years, the average age of the
Vietnam veteran was 19. One can readily appreciate the
monumental impact the brutality resulting from combat in Vietnam
would have upon a 19-year-old, an adolescent with a barely
formed identity still searching for suitable roles in adult
At an age when most young men are typically forming lasting
ideas about intimacy and relationships, soldiers in Vietnam were
losing friends in painfully horrible ways, and perhaps learning
that closeness hurts too much.
Peter Marin (1981) in his
perceptive article about Vietnam veterans eloquently observes:
“What they know is this: the
world is real; the suffering of others is real; one’s actions
can irrevocably determine the destiny of others; the mistakes
one makes are often transmuted directly into others’ pain; there
is sometimes no way to undo that pain; the dead remain dead, the
maimed are forever maimed, and there is no way to deny one’s
responsibility or culpability for those mistakes; for those
mistakes are written, forever, and as if in fire, in others’
ALCOHOL-RELATED PROBLEMS AMONG VIETNAM VETERANS
Recent publicity and television
documentaries such as the PBS History of Vietnam last fall and
media coverage of the Vietnam Veterans Memorial in Washington,
D.C., have amply demonstrated the plight of Vietnam veterans,
which continues years after their return from active duty in
The Veterans Administration
estimates that between 500,000 and 700,000 Vietnam veterans
still experience severe readjustment problems related to their
duty in Vietnam. Significant numbers of these men are alcoholic.
The constellation of social,
political, demographic, and economic factors discussed above,
unique to Vietnam veterans, has resulted in a plethora of
negative attitudes and feelings—guilt, low self-esteem, rage,
alienation, bitterness, self-pity, grief, depression, etc. These
form fertile ground for the development of alcohol-related
The recent suicide in Peekskill,
New York, reported in a New York Times feature article (Winerip,
1984) of a one-time prominent Vietnam veteran leader with a long
history of alcoholism tragically illustrates the impact that
alcohol-related problems can have on the readjustment
difficulties of Vietnam veterans.
Several studies identify Vietnam
veterans as high-risk for alcohol-related problems. Greden,
Frenkel, and Morgan (1975) surveyed the alcohol use of 1,873
U.S. Army soldiers and reported that according to operational
definitions based on total alcohol consumption and behaviors
related to the drinking, 7 percent of the Vietnam veterans
studied were alcoholic, another 5 percent were border-line
alcoholic, and 24 percent were potentially alcoholic.
In other words, 36 percent of the
Vietnam veterans studied demonstrated alcoholism or significant
alcohol-related problems which could develop into alcoholism.
The Center for Policy Research, Inc. (1981) concludes that the
rate of alcohol problems among in-country veterans as a whole is
significantly greater than the rate for era veterans and
non-veterans. This study also found that exposure to combat had
a strong effect on drinking—both the frequency of drinking and
the reported amount of alcohol consumed increased significantly
with the amount of exposure to combat.
Boscarino (1981) asserts in his
analysis of data collected in 1977 that in-country veterans had
substantially higher levels of alcohol consumption and
binge-drinking episodes than comparable groups of era veterans
He reiterates the speculation of
President Carter’s Commission on Mental Health that alcohol
abuse may become a special health problem among Vietnam
veterans, suggesting that the drinking patterns among Vietnam
veterans may be related to post-traumatic stress.
The cumulative message of these
reports points to a significant incidence of alcohol-related
problems among Vietnam veterans. Add to this the fact that the
average age of the Vietnam veterans today is 36 years old, just
the age when physical tolerance to alcohol generally begins to
break down and the overt symptoms of progressive alcoholism most
insidiously begin to manifest themselves, and it is reasonable
to predict that Vietnam veterans will experience increasing
numbers of alcohol-related problems during the remainder of the
THE CORRELATION OF ALCOHOLISM
WITH POST-TRAUMATIC STRESS DISORDER
Vietnam veterans are susceptible
to Post-traumatic Stress Disorder. Those veterans who
experienced prolonged exposure to heavy combat are especially
vulnerable. Discussed in DSM III (1980) as a delayed stress
reaction which may occur years after the initial
life-threatening trauma, such as combat, is experienced, PTSD is
described as manifesting a variety of disruptive symptoms which
impact upon the emotional responses, cognitive functioning, and
interpersonal relationships of affected individuals.
For Vietnam veterans, hallmark symptoms of PTSD include the
following: 1) guilt, especially survivor guilt; 2) chronic
anxiety and nervousness; 3) depression or deep sadness; 4)
flashbacks; 5) startle reactions, jumpiness, hyper-alertness; 6)
difficulty being intimate; 7) sleep disturbances and nightmares;
8) trouble concentrating; 9) intrusive, obsessional memories;
10) psychic numbing; 11) self-medication, especially with
alcohol; 12) anger, rage, hostility; 13) distrust and
alienation; 14) low self-esteem, negative self-image; 15)
difficulty with authority; and 16) self-punishing and
Initially, the unbearable
intensity of these distressing symptoms may be somewhat
alleviated by drinking (La Coursiere, Godfrey, and Ruby, 1980).
For example, a combat veteran may consume large amounts of
alcohol before bed, which may appear to calm sleep disturbances
and eliminate terrifying nightmares.
The heavy drinking may also seem
to relieve anxiety and block out intrusive memories associated
with combat incidents, and may induce psychic numbing, making it
easier to withdraw emotionally.
Vietnam veterans may suffer from
survivor guilt which manifests itself in a variety of ways to
include: despair at surviving the war while buddies died
terribly; anguish at not being wounded, knowing others lost
limbs, sight, or mobility; feelings of failure—real or
imagined—for things that were done or should have been done;
feelings of incompetence or helplessness in combat situations
that resulted in needless death and destruction; feelings of
cowardice under fire; horror at acts performed under combat,
especially against women and children; shame at having
participated in or watched atrocities; or despair at having
knowingly or accidentally killed fellow soldiers. Alcoholism
literature has many references to the negative effect of guilt
on drinking patterns.
Many Vietnam veterans have not
been able to re-connect following their experiences of combat in
Vietnam. The ensuing isolation and alienation has kept them from
sharing their pain with friends and loved ones. The veteran who
uses alcohol in order not to feel, as one veteran put it, “to
experience oblivion,” compounds this isolation and alienation.
Continued heavy drinking can lead to alcoholism.
In addition to becoming a problem in and of itself, La Coursiere
et al. (1980) also observe that abusive use of alcohol
significantly exacerbates the symptoms of PTSD. For example, as
a depressant, alcohol may contribute to psychic or emotional
numbing and induce depression. While in a depressed stage, a
pattern of heavy drinking may lead to obsessive ruminations
about combat experiences intensifying survivor guilt.
Self-destructive actions may follow.
The authors have noted excessive
late-night, solitary drinking followed by reckless, high-speed
driving, or use of guns to provide self-destructive
confrontations with police among our Vietnam veterans clients.
It is significant to note the high number of apparent suicides
among Vietnam veterans since their return from Vietnam, many of
which can be presumed to be alcohol-related.
Peripheral nerve damage due to
heavy drinking may make some veterans more susceptible of
hyperactivity, restlessness, and startle reactions. Alcohol may
“trigger” flashback episodes, during which traumatic events
experienced in combat are violently and frighteningly relived.
Since heavy drinking disturbs the
natural sleep process, interrupting REM dream patterns, the
veteran may become more vulnerable to the symptoms of PTSD.
A chronically stressful situation, such as combat, leaves some
individuals with free-floating anxiety. Continual stress may
actually cause damage to the autonomic nervous system. Many
combat veterans may have nervous systems that are less capable
of handling stress than normal persons. Numerous veterans speak
about not feeling the same since Vietnam or of being “a nervous
wreck” and not being able to talk about it with anybody, loved
one or stranger.
Compounding this combat-related
stress, Vietnam veterans continue to face multiple problems in
their struggle to readjust to American life. As we noted above,
Vietnam veterans came home to a society at times hostile,
ambivalent, or indifferent. They sought and were denied a forum
for the discussion of the shattering, war-related events. They
watched the country they fought for strive to erase a war it
found uncomfortable and embarrassing. They struggled to obtain
an education playing catch-up to many of their non-veteran peers
while supporting their families on a highly inadequate G.I.
Bill. They scrambled to compete for jobs in a rapidly shrinking
Many veterans became increasingly
bitter—their pariah-like treatment by American society led one
of this paper’s authors to write a poem in the early seventies
about the isolated, invisible veterans recognized only by other
silent veterans, somewhat surreptiously—usually in a bar!
It is understandable why rage is
a key problem for Vietnam veterans with drinking problems.
Branded a killer, a sucker, a loser, how does one accept the
painful memory of listening helplessly under intense enemy fire
to a fellow soldier whose face has been half blown off screaming
through the night to some God in the jungle to please let him
For years, many vets have lived
trying to suppress such memories and the burning rage that
accompanies them. To be told by someone, even a loved one or a
well-meaning alcoholism counselor perhaps, “Why don’t you just
let go of the past and forget it?” only increases the rage.
The abusive use of alcohol can
tap into this rage and release it uncontrolled. In our practice
we have observed the following: a veteran gets drunk and like
anyone else when drunk, his judgment is impaired and his
inhibitions are released. He doesn’t care about being hurt; he
may even look for it as self-punishment. More often than not, he
gets into a fight.
In military training, soldiers
are taught to react when threatened with aggressive, even
violent behavior. In Vietnam there were no rules. Violence was
sanctioned, rewarded, and reinforced as crucial to survival.
A combat veteran recently related
his feelings of horror when on his first combat assault he
looked up at the lead chopper coming in to pick up his unit and
read, “Forty-seven killing days till Christmas” painted on the
fuselage. When a veteran is intoxicated, this learned behavior
of violent reaction may re-emerge whether or not the threat is
real. An alcohol-induced flashback may occur.
We’ve worked with veterans who
while intoxicated have seriously hurt another. This often occurs
as the result of a derogatory remark about Vietnam made by a
non-veteran. Later, in a sober state, the guilt concerning loss
of control and explosive, violent behavior sends the veteran
into a deep depression. At such times, he views himself as
worthless, and very often thoughts of suicide predominate.
The authors contend that there is
a much stronger correlation between alcohol abuse and the
symptoms of PTSD than has previously been acknowledged in
treatment programs for Vietnam veterans. Unless alcoholism among
Vietnam veterans is aggressively treated in a drug-free,
abstinence-model program, there will be little lasting change in
Continued drinking, or abuse of
prescribed medications such as valium, for an alcoholic veteran
experiencing PTSD results not only in the progression of active
alcoholism, but also in an exacerbation of the distressing and
disruptive symptoms of PTSD.
TREATMENT CONSIDERATIONS FOR
ALCOHOLIC VIETNAM VETERANS
Alcoholism professionals who treat alcoholic Vietnam
veterans must examine attitudes and beliefs about the war, its
warriors, and the impact of the war on American society,
becoming familiar with the history of the war and specific
resources relating to veterans’ issues readily available in most
For example, there are 135 Vet
Centers operated by the Veterans Administration throughout the
United States. These Vet Centers are staffed to a large extent
by Vietnam veterans professionally and personally familiar with
the problems of readjustment for Vietnam veterans.
Staff in the Vet Center program
regularly receive training related to intervention with and
treatment of Vietnam veterans. It is critical that alcoholism
treatment programs utilize such resources of their clients who
are combat veterans.
Both the alcoholism and issues
relating to PTSD must be treated aggressively and
simultaneously. Treatment plans which deal only with one to the
exclusion of the other are doomed to failure. Either the veteran
will use his abusive drinking to sabotage successful
readjustment, or he will use his PTSD symptoms as an excuse to
For alcoholic Vietnam veterans
abstinence must first be established before substantive
resolution of the symptoms of PTSD can be achieved. For
treatment to be successful, repressed and often explosive
feelings must be directly confronted and worked through. This is
often a long and painful process during which the veteran who
lacks a strong network of support and compassionate counseling
will be extremely vulnerable to relapse.
A major obstacle to treatment is
lack of trust by many Vietnam veterans. Vietnam veterans are
characterized as being mistrustful, not only of institutions and
authority figures, but of most individuals as well, including
family and friends.
Many veterans relate that it is only within the company of
fellow veterans that they can comfortably let down the defensive
barriers and ease up on the wariness with which they deal with
Group counseling in which
alcoholic veterans work with and relate to each other is
strongly recommended. The use of sober, recovering combat
veterans as peer counselors in the group will facilitate the
establishment of trust and credibility.
Such veterans can also act as strong role models for active AA
involvement. This can have a ripple effect in the community in
terms of recovering veterans doing 12 Step work with other
veterans, creating a community of recovery veterans. This in
itself gives veterans a growing sense of self-growth, purpose
and strength, and a renewed sense of pride.
It is imperative that at least
one of the group leaders be a combat veteran trained in
alcoholism counseling and familiar with PTSD.
Last summer we facilitated such a
group of sober, combat veterans. The group began as a
twelve-session closed group which focused on aspects of early
recovery as they related to unresolved issues concerning Vietnam
duty. The group was so productive that it has continued as an
open-ended group where readjustment difficulties are dealt with
in depth and actively worked on.
Through the group process of
sharing, support, and concentration, alcoholic veterans are
helped not only to accept their alcoholism and an abstinent
lifestyle, but also to come to terms with the residual moral
pain caused by their combat experiences.
Such a group experience can
generate a renewed sense of peer bonding, a feeling again of
camaraderie. Slowly, a sense of trust emerges, creating a
climate in which the strengths one had in Vietnam, long since
forgotten, can be found again.
Courage, pride, sacrifice,
high-level performance under extreme stress and brutal
conditions, a sense of community, service to country, endurance,
survival skills, caring for other men, strength of will—all
discarded in the years since, buried under isolation and
bitterness—are allowed to surface, take form to be used
As the negative aspects of PTSD
and alcoholism are discussed and worked on, so too are these
strengths developed. Group members evolve a sense of purpose, a
positive identity. They discover new meanings and directions in
There is a growing need to work
with families of Vietnam veterans, many of them blended
families, who have lived in an environment of constant stress
for years. A concurrently run partners group is important.
Veterans can too easily begin to relate as a re-creation of
their old platoon and become a self-enclosed world. A place
where partners can work on themselves can help break the
isolation. Partners can begin to communicate and view themselves
as human beings who have been terribly hurt.
Many children of Vietnam vets are
now teenagers with the double stressors of alcoholism and the
effects of PTSD in the family system. They are ripe to develop
drug and/or alcohol problems themselves. Some alcoholic veterans
are adult children of alcoholics who had no intervention or
knowledge of alcoholism before they went to Vietnam. They were
already emotionally damaged before being exposed to the
brutality of combat situations.
Family members need to be
educated about PTSD, so they can understand what’s been
happening and can let go of the guilt, deal constructively with
the anger, and begin to work on themselves.
It’s been a long road for many
Vietnam veterans, and a lot of them have not been able to hang
on. For many, help was too late in coming. One of the authors
recalls a particular morning in Vietnam:
“We’d been up all night through a horrendous firefight. It was a
situation which all of us felt could have been avoided. We’d
felt like we’d been used as bait. One of my badly wounded men,
who’d stayed up the night so others could leave by medevac, came
up to me screaming, ‘When are they going to learn; when the hell
are they going to listen?’”
It’s time to listen, time to
learn. People are not expendable. What we’ve been talking about
is healing. Throughout the ages, warriors have been given rites
of passage back into society.
A lot of men who fought in
Vietnam have felt that what they did in Vietnam made them
permanent exiles from society. When they came home, the country
confirmed this feeling. There were not rites of passage for
For many veterans, feeling like
outcasts living on the edge of society, not finding places to
fit in, even with a bottle, life has been a living hell. There
is so much more healing to be done. Who can understand this more
than the people working in the field of alcoholism?
American Psychiatric Association (1980), Diagnostic and
Statistical Manual of Mental Disorders. (3rd ed.) Washington,
Baskir, L.M., and Strauss, W.A. (1978), Chance and Circumstance:
The Draft, The War, and The Vietnam Generation. New York:
Boscarino, J. (1981). “Current excessive drinking among Vietnam
veterans: A comparison with other veterans and non-veterans,”
International Journal of Social Psychiatry, 27(3), 204-212.
Center for Policy Research, Inc. (1981), Legacies of Vietnam.
Greden, J.F., Frenkel, S.I., and Morgan, D.W. (1975), “Alcohol
use in the Army: Patterns and associated behaviors,” American
Journal of Psychiatry, 132 (1), 11-16.
La Coursiere, R.B., Godfrey, K.E., and Ruby, L.M. (1980),
“Traumatic neurosis in the etiology of alcoholism: Vietnam
combat and other trauma,” American Journal of Psychiatry, 137
Marin, P. (1981, November), “Living in Moral Pain, Psychology
Today, pp. 68-80.
Winerip, M. (1984, January 31), “Story of a V.A. Patient: A Long
Road to Suicide,” New York Times, pp. B1, B4.
The authors presented their findings at the 40th NCA Forum in
Detroit on April 13, 1984. Both served as Army officers in
Vietnam, are members of Chapter 8, and are associates at the
Breakthrough Center, 648 Franklin Ave., Garden City, NY 11530.