The home front Robert Stebbings is policy and communications lead at Adfam Despite high levels of problematic substance use among ex-services personnel, the ingrained forces mentality can mean a reluctance to seek help – something that also extends to their families, says Robert Stebbings. Whilst the majority of serving personnel successfully transition out of the forces and back into civilian society, sadly it is also the case that many veterans encounter difficulties with substance use. Alcohol consumption plays a significant role in military culture, having done so for many years, and unsurprisingly this can translate to alcohol dependency amongst former members of the armed forces in subsequent years, whilst issues around drug dependency also exist. Such substance use problems rarely exist in isolation and the presence of a number of co-occurring problems, such as mental health, violence/abuse, criminal behaviour, and employment/financial difficulties, add further complexity. These problems – and their cumulative and longstanding nature – can also have a significant and sustained impact on veterans’ families. Over the past year we’ve been speaking with families of veterans with substance use problems (FVSUs) across the country, and through their testimonies have learnt how they can be profoundly affected by their loved ones’ drinking and drug problems, experiencing high levels of isolation and loneliness, yet rarely appearing to access support for themselves. ‘I became anxious and lost a lot of weight as I was stressed and worried. I was tearful and frustrated all of the time and worried what would happen to me and my children’ (FVSU research participant). Through our work at Adfam we know all about the challenges families affected by substance use face day-to-day – fear, abuse, stigma and mental health problems to name but a few. However, we now know there are a number of ways that the experiences of veterans’ families differ to those of civilian families, and certain characteristics of military culture play a particularly influential role in how this specific group of families are affected. In addition to heavy and frequent use of alcohol, there is also the ‘fighting mentality’ instilled into serving personnel from the start of their training. It was felt that not enough is done to address this mentality when individuals leave the armed forces and that this can cause problems for veterans and, therefore, their families. Furthermore, we were told about stoicism amongst military personnel and how they are expected to be strong and infallible, and should not expose, or ask for help with, vulnerabilities and problems. This mindset of not being open about problems, and hence being unwilling to come forward for help, extends to the families too. ‘There was just nobody I could go to; I just had to kind of live that life... I couldn’t tell people that that was the life I was living’ (FVSU research participant). Specific support for FVSUs is sparse, and of the support that is available, many aren’t aware of how or where they can access it. Opportunities to engage FVSUs when serving personnel and veterans access help are also often missed. Based on the findings from this research, we have developed a holistic, multi-component support model to address this and would encourage all support organisations to examine how it could fit within their work, to provide evidence-based targeted support to this important group of families. This article is based on Fighting their own battle, a new research report outlining the experiences of families of veterans with substance use problems (FVSUs), along with a support model designed specifically for FVSUs. This work was funded by the Forces in Mind Trust and delivered by Adfam and the University of York. Thank you to the many FVSUs across the country who took the time to share their experiences so openly and honestly, particularly those on our project advisory group, and also to the Forces in Mind Trust for their vital support in helping us deliver this work and our project partners Bristol Drugs Project, HMP Parc, SSAFA and Tom Harrison House. You can find out more about this research and download the research report in full along with the support model on Adfam’s website. Force for change We need to better serve those who’ve served, says Ray Lock. Ray Lock CBE has been chief executive of Forces in Mind Trust since 2012 Back in the eighties, I was based near Düsseldorf as one of around a hundred thousand members of British Forces Germany. Friday night was happy hour – although it carried on until midnight. Saturday night was often a formal dinner, and Sunday a jazz lunch. Long before it became popular in the UK, Warsteiner lager had gained the nickname ‘wobbly’ for the effect it had the morning after. Alcohol was tax free, the only drugs taken were Brufen and life was good (if you discounted the threat of nuclear Armageddon). Life for members of the armed forces in the 2020s though has changed – most are based in the UK and increasingly they and their families are integrated into local communities. Alcohol use has certainly fallen, and the Ministry of Defence has been trying for some years to lower consumption among its people via health strategies. Sadly, a recent initiative to introduce an annual check has been suspended due to COVID-19, although the ministry’s intent is clear. But the steps taken so far fall well short of those recommended by the Commission on Alcohol Harm. When I ran a large base in Wiltshire, we had over a hundred separately licensed bars selling beer at half the commercial price – hardly what the commission wants. So the relationship members of the armed forces have with alcohol remains problematical, which is why we at Forces in Mind Trust funded Fighting their own battle, the University of York’s study, with Adfam, into the support needed by families of ex-service personnel with substance misuse. It’s useful to recognize that the armed forces aren’t anywhere near as homogenous as an observer might think. From day one, alcohol is used to overcome social inhibitions, provide an acceptable environment in which to let off steam, and to bond. Our research consistently shows that when it’s time to leave, most serving people successfully make the transition into civilian life. For some though, the absence of shared values, recognizable structure and comradeship, together with a less-rewarding professional life and diminished personal pride, can build a barrier to that successful transition. Those dangerous habits of alcohol misuse, developed during service and masked to an extent by institutional encouragement and a generally fit population, are not shed with the uniform. We know, again from the evidence, that the proportion of serving personnel with damaging levels of alcohol consumption is significantly greater than the civilian equivalent, and the same holds true for the veterans population. This mixture of ingrained habits, an avoidance of help seeking and an easy retreat (at least whilst under the influence) from daily reality, provides a fertile ground for a downward spiral. Families are likewise affected, where the barrier between relatives and the veteran built during service as a means of protection can remain in place during tough times. Where the veteran has comorbid conditions, for example mental ill health, or there are other issues such as domestic violence, then the barriers are higher, the stigma greater, the alcohol misuse more severe and the chances of successful transition reduced. A word on drugs. The armed forces operate what amounts to a zero-tolerance policy for illegal drug use, and habits or addictions are unlikely to form during service. A single transgression will almost always result in discharge, as between 600 and 770 serving personnel find out each year, but their treatment requires improvement. Our research project Fall out – the impact of a compulsory drugs discharge with Galahad SMS Ltd will report shortly. Evidence is clear that the successful transition of a veteran is a successful transition for their family too. We speak about ‘holistic’ transition a lot, and we apply the same to any support that’s offered – which is why the joined up and wraparound family force support model is so exciting. It needs modest additional resource, but much greater connectivity, such as between local services and the ‘veterans gateway’. Becoming veteran aware would be a great first step forward towards helping those who have served their country, and those they love.