For military men and women, not all formidable enemies are fought in the combat zone. Just ask any U.S. veteran, young or old, struggling with an addiction to alcohol, drugs or both.

The younger veterans just returning home from Iraq and Afghanistan may be different in some ways from the war veterans of other eras like Vietnam, "but they have a lot of the same issues," observed Denise Plante, RN, a staff nurse in the substance abuse treatment program at the Providence VA Medical Center in Rhode Island.

"I have always had a healthy respect for our veterans; they protect me," Plante said. "I really don't know what war is like. Some of these guys have been through hell. I believe that. They deserve to be treated with respect."

Providing Hope & Care

At Providence VA, one of 126 veterans' medical facilities offering specialized substance abuse treatment, the success is perhaps as much in the hope as the care nurses like Plante, Lynne Deion, RN-BC, LCDP, and Patrice Charnley, RN-BC, CARN, bring to the program.

"We really work in an expanded role for RNs. I feel very fortunate to have the role we do," said Deion, a private sector nurse for 16 years before joining the U.S. Department of Veterans Administration family 4½ years ago. "People pick themselves up from holes they never expected to be in. Every day, I have the privilege to see people get better, and that's inspiring."

Statistically, one out of nine people in the general population will have a lifetime occurrence of substance abuse. No one has to look far to find someone who has been touched by addiction, either directly or indirectly.

"I think we all have at least an acquaintance," said Charnley, a chemical dependency nurse for all but 9 of her 35-year career.

In fiscal year 2008, there were 23,000 substance-involved visits at the Providence facility, be it for medication, or group or individual counseling.

"That covers us treating around 1,000 patients," Deion said.

At Providence, patients are as young as age 19. They've been as old as in their late 70s. Maintaining their privacy is all part of the VA commitment.

Haunting Effects

By far, alcohol is the most frequent drug of choice among patients, according to Maryann Gnys, PhD, associate chief of mental health and behavioral science services at Providence VA since 2005. Five years prior, she was director of the substance abuse treatment program at the facility.

Other problems affecting veteran patients include opiates, in the form of prescription medication like Percocet (oxycodone and acetaminophen) and OxyContin (oxycodone) or street-bought heroin, as well as marijuana and cocaine.

"We are still treating [vets] from all the eras," Gnys said, "but we do have a number of veterans come back today with a [substance abuse] problem."

Unlike some nurses who only get to treat veterans as they face the sometimes life-threatening consequences of alcohol withdrawal, Charnley said, nurses in the substance abuse program get to know the whole person.

"We see them get well, make incredible strides," Charnley said. "That is where the hope is."

Value in Every Stride

According to the VA, its facilities provide effective, scientifically proven services for all eligible veterans, no matter where they come for service. That includes effective medications - like methadone for chronic opiate addiction - that help manage withdrawal symptoms, reduce craving and promote abstinence.

In mid-July, there were 88 patients receiving daily doses of methadone at the Providence facility. Thirty were on Suboxone (buprenorphine and naloxone).

"Substance abuse is a relapsing disorder. It can take a number of rounds of treatment, which varies from person to person," Gnys stressed. "While the ultimate goal is abstinence, harm reduction is a big focus. If we can get somebody to abstinence, that's the ideal. But reducing abuse, we see that of great value."

According to Gnys, among the veteran patients are those who fall prey to dependence by using more medication than what a physician prescribed.

"When pain isn't controlled, it can often have something that looks like addiction, but is only a person seeking adequate [pain] control," she said. "Pain does complicate things. Once you get pain under control, the symptoms of drug seeking go away for some. Others do become dependent."