Ways to Combat Addiction in the Army

Overmedicating in the Military: A Case Study into How Holistic Care and Preventive Practices Can Address the Problem of Substance Abuse among Overmedicated Troops
Abstract
This case study examines the problem of overmedication in the military. It discusses why this is a problem, based on the statistics and increasing awareness among various stakeholders. The study itself examines the cases of three soldiers in the military who were interviewed to describe how they were overmedicated and what impact it had on their lives. They also described how they were able to beat their addictions and turn their lives around in a positive direction using some form of positive psychology as an intervention instead of relying on pharmacological interventions. The study concludes with recommendations for what the military can do to address this problem, namely, implementing resiliency training among soldiers to help empower them to overcome their issues instead of attempting to distract them with drugs.
Keywords: overmedication military, drugs military ptsd, positive psychology military
Introduction
All one need do is a simple Google search using the keywords “overmedication military” to see that overmedicating in the military is an issue that needs addressing. The headlines leap from the screen: one from CNN, 2011—“After Decade of War, Concerns About Over-Medicated Military” (Keyes, 2011); one from MilitaryTimes (2013)—“Medicating the Military—Use of Psychiatric Drugs Has Spiked”; another from 2013 and CBSNews—“Veterans Dying from Overmedication” (Axelrod, 2013); from 2014 and the U.S. Department of Health and Human Services—“Overmedication: Problems and Solutions: (Director’s Testimony to Senate Committee on Veterans’ Affairs, 4/30/14)” (Briggs, 2014); and finally from Congress itself—S.788, the Veteran Overmedication Prevention Act of 2017 (Billings, 2017), currently sitting in committee in the U.S. Senate. One can go back to 2007, when Veterans for America counselors and investigators charged that the military was overmedicating troops (Mehan & Schneider, 2007)—but no matter where one looks, the stories all appear to be the same: soldiers and veterans are not getting the help they need; instead they are just getting prescription drugs which exacerbate their problems.
What sparked our interest in this topic were headlines just like these and stories that have been growing over the years. We have all heard the tales of soldiers and veterans becoming addicted to pain killers or opioids. We have seen the opioid epidemic washing over America and noted how it has coincided with the American military’s presence in the Middle East (Schoomaker & Buckenmaier, 2018; Snow & Wynn, 2018). As Schoomaker & Buckenmaier (2018) point out, “prescription opioid deaths are approaching 20,000 a year; in 2016, combined prescription and illicit drug deaths—many of which can be attributed to gateway use of prescription opioids—topped 64,000” (p. 9). This crisis is well-known in general terms (see Barglow (2013) and Huntley (2014) in the Appendix). What is required is a more detailed, in-depth understanding of it is real, specific terms—in academic terms that allow human faces and experiences to be understood from the standpoint of scholarly rigor.
This case study was designed to shed light on a problem that persists in the U.S. military—the problem of overmedicating soldiers as a quick-fix solution to mental health problems that run much deeper. Unfortunately there has been little scholarly attention paid to this issue: it has all been done by investigative journalists, watchdog organizations, independent physicians and counselors, and Congressmen at the federal level. With the Veteran Overmedication Prevention Act in committee in the U.S. Senate, there is a need for scholarly attention on this issue to help frame the discourse in an academic light. This case study aims to provide that perspective by giving an in-depth perspective of the problem of overmedication in the military using the case study design.
Literature Review
Giordano et al. (2016), Hines et al. (2014), and Kang et al. (2015) show that military soldiers and veterans are suffering in increasing numbers from mental health issues, post-traumatic stress disorder (PTSD) and are at risk of suicide as a result of failing to receive adequate care. Studies have shown that holistic approaches to care are most effective in treating the whole person, from mental health to physical dependencies and so on (Newhouse & Spring, 2010).
One way to provide holistic care to patients has been shown to be through positive psychology. Sheldon and King (2001) state that positive psychology is “nothing more than the scientific study of ordinary human strengths and virtues” (p. 216). In other words, it is the science how people can live well and be strong. For that reason, positive psychology serves as the core of Master Resiliency Training (MRT) in the U.S. Army. Just as positive psychology focuses on identifying the elements that enable individuals to flourish (Fredrickson, 2001), MRT enables leaders in the Army to demonstrate and teach the skills that soldiers need to overcome obstacles and face challenges with determination, commitment and the ability to succeed. As Casey (2011) puts it, “the Army is leveraging the science of psychology in order to improve our force’s resilience” (p. 1). Positive psychology focuses on what motivates people to succeed. It looks at the sources of inspiration that make individuals want to reach up toward the light and hold onto the good. Positive psychology is the essence of the concept of “chicken soup for the soul”—it is the idea that people need to surround themselves with positive inputs to resist the negative distractions and oppressive feedback that can stymie their potential. It is the approach of basic psychology, in so far as psychology focuses on how to help human beings be happy and at peace (Sheldon & King, 2001).
The way to achieve the happiness and peace afforded by positive psychology is through the cultivation of positive emotions (Fredrickson, 2001). And the way to cultivate positive emotions is through the development and cultivation of resources that people can use to ward off anxiety, stress, depression, anger—anything that can come along to hold one back. The resources most commonly utilized to assist in this process are mental toughness, which comes by way of conditioning; commitment to an ideal, which can be fostered through habit and virtue; and mindfulness, which can come by way of meditation (Fredrickson, Cohn, Coffey, Pek & Finkel, 2008). The military can thus help soldiers develop their mental toughness, commit to an ideal, and strengthen their mindfulness by implementing MRT.
Through MRT the military can teach the skills and methods needed to train their soldiers in how to be resilient. The life of an ordinary civilian is difficult enough; the life of a soldier is doubly demanding. The soldier is not only responsible for tending to himself and making sure his life is in order; he is also responsible for tending to his unit and making sure he is supporting his brothers in arms at all times. The soldier in the Army is the member of a family that is tasked with defending the homeland at great risk to one’s own personal safety. The soldier is expected to live up to the demands of this task and serve honorably in the capacity that is allotted to him.
Leaders in the military, however, are often confronted with the baggage that many soldiers bring with them into the military or that they collect along the way of their service. Leaders have to know how to help soldiers deal effectively with this baggage so that it does not weigh them down mentally and lead them into collapse. Too many soldiers suffer from PTSD because they lacked resilience. The military leaders who have gone through MRT are better equipped to help their soldiers obtain that resilience so that they can in turn deal with whatever issues are impacting them, whether it is depression, anxiety or fear (Reivitch, Seligman & McBride, 2011). MRT provides the framework for developing a successful and positive approach to life.
One of the biggest challenges that a leader in the military will face is a unit of soldiers who lack mental and emotional toughness. Grit and determination are some of the fundamental qualities that every soldier must possess. If soldiers do not already possess them coming into the unit, how can they acquire them? The leader has to know the answer to this question—otherwise his soldiers will be like sitting ducks waiting to be picked off by the least disruption to the moods, minds and emotions. The leader has to know how to inspire toughness. MRT teaches that the leader has to know what does not inspire resilience—and that is the first key lesson taught in MRT: misconceptions about resilience are identified and true concepts of resilience are discussed by focusing on six key areas: Self-awareness, Self-regulation, Optimism, Mental agility, Character strengths, and Relationship connections. The first key area is crucial: unless one is aware of one’s own “thoughts, emotions, and behaviors, and patterns in each that are counterproductive,” one is going to be blocked at the gate (Reivich et al., 2011, p. 27). Awareness is necessary for the second key—self-regulation, which involves both monitoring and regulation emotions and thoughts but also being willing to express oneself in a healthy way. Third, one has to be able to see the good in things while being realistic about what one is able to actually control, and this is what is meant by optimism. Mental agility is also required, and it refers to the ability to be flexible and follows from one’s ability to be optimistic. One requires the character strength to overcome obstacles and one requires the ability to build relationships and make connections with people by putting himself in another’s shoes (Reivich et al., 2011).
Once these key areas are understood, leaders can focus on identifying triggers—events or thoughts that trigger a particular negative reaction. When patterns appear, individuals can begin to see the trend in one’s thoughts or feelings that push one into negative moods or the desire to seek escape in an unhealthy manner. Other areas that leaders can focus on are simple breathing exercises, which can help one to regain composure in a stressful period (Reivich et al., 2011); problem-solving, and developing the ability to show gratitude. Leaders also learn how to recognize counterproductive thoughts by owning them and taking responsibility for them. The errors that people make in trying to stop negative thoughts is that they try to reduce the noise they make by ignoring them—or they might try to justify why they are having them—or they just might simply try to deny they are that at all. A leader knows that reality always has to be dealt with head-on; so if negative thoughts are creeping about, the key to overcoming them is to acknowledge them, own them and assume responsibility for them by addressing them directly. This all helps the soldier to focus on the main idea that drives soldiers in the military, which is known as the Warrior Creed. It is: “I will always place the mission first. I will never accept defeat. I will never quit. I will never leave a fallen comrade” (Reivich et al., 2010, p. 27). This Creed is helpful in giving the soldier a sense of mission, place and self. However, in order to remain committed to it, the soldier has to develop some level of happiness and peace with being where he is. If the soldier is not at peace with where he is, there will be problems with pursuing this Creed. That is where the aspect of positive psychology can come into play. Positive psychology helps to give the soldier a reason for why it is important to be happy and to have love for oneself and for others. The main principles of positive psychology include the following:
· Happiness—because when people are happy, they tend to succeed more, and most people have the ability to be happy.
· Resilience—because when people are able to bounce back from adversity, they can achieve more and overcome obstacles instead of giving up—and most people have the ability to be resilient.
· Religion—because when people have some guidance or teaching that gives them a strong moral framework, they tend to make right decisions more than wrong ones.
· Heart—because when people have heart they are able to believe in themselves and in others.
These principles have been incorporated into the Army’s MRT training in a variety of ways, so that is something that is important to consider before examining the cases in this case study. By focusing on these principles in their interactions with soldiers, care providers and military leaders can develop a positive culture that re-affirms life’s great purposes, provides soldiers with a ideals that can give them encouragement even in the face of great adversity or personal struggles, and lifts them out of the gloom of depression. Positive psychology shows that individuals who are overly-stressed, depressed or suffering from some trauma, whether sexual abuse or domestic violence, need a light that can help them realize life does not have to be defined by the negatives, the troubles, or the defeats.
Hypothesis
The main question that led to the development of this hypothesis was why care providers and physicians feel the need to overmedicate soldiers in the military? Why do they turn to pharmaceuticals as a solution when it has been shown that there are so many other possible alternatives to care (Sheldon & King, 2001)? The answer to these questions may have to do with the ease that comes with handing out prescriptions, pain killers and pills: they are quick-fix solutions that do not require much in the way of intervention for care providers—at least initially. They do, however, tend to only serve as band-aids on much deeper problems.
Lichtenfeld (2011) pointed out that too many physicians are seeking to treat patients unnecessarily using pharmaceuticals instead of seeking to prevent health issues or find more holistic approaches to care that do not lead to deterioration in the patient’s quality of life.
With this perspective in mind, the hypothesis for this study was that holistic care and preventive approaches to preserving mental health, such as Master Resiliency Training (MRT), could benefit soldiers more than reliance upon prescription medications.
The research questions that followed the formation of this hypothesis included: 1) How can holistic approaches to care help soldiers in the military overcome their pill-addictions? 2) What is the effect of MRT on helping soldiers in the military combat the problem of overmedication and the stress that comes with it? 3) What is the impact of overmedication on soldiers?
Methodology
The methodology used in this case study was to interview three soldiers who suffered from substance abuse issues in the U.S. Army following deployment to the Middle East. The soldiers were known in advance by the researchers and their anonymity has been preserved in this study. Their stories serve as the focus of this case study and analysis of their stories helps to provide a deeper understanding of how holistic care and preventive practices can be used to address the problem of overmedication in the military.
The soldiers were interviewed using a semi-structured approach, which can help to obtain meaningful information from interviewees in an organic manner without the risk of too much steering from the interviewer (De Massis & Kotlar, 2014). Each participant was interviewed using Skype and the interviews were recorded and then transcribed.
Analysis of the interviews was conducted to identify common themes and elements that could explain the impact of overmedication on soldiers as well as the effect of holistic care approaches like MRT. The themes were identified and used as guides in explaining the outcomes that these participants experienced in relation to the interventions that they received, beginning with pharmacological interventions, which led to addiction, and then proceeding to holistic-centered approaches, which led to the soldiers coping with their issues and overcoming their addictions.
The interviews lasted no more than two hours per individual and a total of 5.5 hours of interview content was obtained. These interviews covered a wide range of ground, with each of the three participants describing their lives up to the time they joined the military, what issues or events prompted them to seek medical care, what the effects of overmedication were on their bodies and minds, and how they ended up overcoming their problems. The interviewees were also asked to describe what they would recommend for soldiers in the future who were suffering from their same issues, and the soldiers all gave their input on what would increase positive health outcomes and all pointed to the use of positive psychology as an intervention.
The participants in this study were emailed with follow-up questions both to clarify points in the transcripts and to obtain verification from the participants regarding what was stated in the interviews as well as to obtain validation for the way in which the responses were interpreted by the researcher. This method of using the sources of information as a means of verifying and validating information is recommended in qualitative studies to ensure trustworthiness and credibility (Golafshani, 2003; Patton, 2002).
It has been shown that by conducting semi-structured interviews in a setting that is natural for the participants will enable them to feel comfortable and contribute to a willingness to talk and discuss their situations more freely (Hämäläinen & Rautio, 2015); however, in the case of this study it was more convenient for all—both participants and researcher—to conduct the interviews using Skype. The researcher made sure that the participants were still comfortable with this method and each one assured that this way of interviewing would be the best because it would allow the participant to remain in his home and not have to go anywhere, and it would allow the researcher to record the interview for later transcription purposes. Each of the participants gave his informed consent for the interview to be recorded and used for the purposes of the study with the condition being that anonymity would be preserved.
The method of using open-ended questioning via the semi-structured interview process was deemed to be an effective method of obtaining natural and deep responses from the participants in the study, as it allowed for the researchers to pause and think about their stories and talk at length until they felt they had said all they had to say. By using open-ended questions in this manner, the participant is given the opportunity to share ideas that come to him without being directed in too intrusive a manner by the interviewer (Kallio, Pietilä, Johnson & Kangasniemi, 2016). This helps to guarantee that there will be a minimal amount of bias or over-steering on the part of the researcher and that in a study where the aim is to explore, understand and detail the issues and experiences that are being studied, minimal interference from the researcher should be the goal.
With these methods used to collect data, the analysis of the data now needs to be described. The data was transcribed and then read and re-read to identify the major themes that emerged in the stories of the three participants. These themes were then explained in the participants’ own words, with the use of eidetic reduction and imaginative variation being implemented to help block out the noise of miscommunications and wordiness to uncover the true meaning of what was being expressed, in accordance with the recommendations of Lin (2013). The interpretation of the content by the researcher was then verified and validated by the participants themselves through email to ensure that the study was credibly attributing meaning to the words of the participants that was in fact there.
The results of this method are described in the next section.
Results
Mike
Participant 1, who will be identified as Mike for the purposes of anonymity, told his story after returning to civilian life following a 4-year tour of duty in Iraq. Mike experienced PTSD during his tour of duty and sought medical attention. He was given a bag of pills by his physician without any explanation or description of what was inside. He trusted the doctor and began taking the pills to calm his nerves, sleep at night and function throughout the day. He began to feel terrible without them and realized that he was now dependent on these pills. He did not want to be a drug-addict and never had taken drugs before, but the stress of the situation had done something to him where he felt like he needed to get out of the situation by any means possible.
After finishing his tour and getting back into civilian life he experienced withdrawal when he tried to quit his pain-killers. He broke up with his girlfriend and felt alienated from his friends. He was unable to maintain a job because he easily became frustrated with bosses and co-workers and would either be fired for causing fights in the workplace or would quit out of anger.
Eventually he sought the advice of a counselor and began engaging in positive psychology, with cognitive behavioral therapy being used as the intervention. Mike set goals for himself that allowed him to recognize whenever a troubling thought or impulse was about to give him trouble: his goals gave him something else to focus on that was positive and that would allow him to redirect his energy to something good instead of something negative. After 6 months of cognitive behavioral therapy he was able to kick his dependency on pain-killers completely. His family and friends noted a marked improvement in his character and mood: his overall disposition was friendlier and more upbeat. After two years, he had no relapses and was holding down a regular job and had even won Employee of the Month twice since working there. He had also entered into a stable relationship with a woman, to whom he was now engaged to be married. The two were considering starting a family and buying a house, which had always been a dream of Mike’s, he said. He attributed his ability to achieve this life dream thanks to the positive psychology and cognitive behavioral therapy that he had received from his counselor upon returning to the States. It saved him from a life of drug-addiction, he said, that he had developed from being overmedicated in the military.
One of Mike’s big challenges, he said, was that he kept thinking he was okay for so long. He had the medication and he kept taking it and taking more of it, and he assumed that he was fine so long as he was in control. He eventually realized that he was not in control and he owned up to this. He said that was the first important step he took: he was willing to admit that he needed more help than what drugs could give him. When he went in for counseling he said he felt like this was what he had been looking for and in need of the whole time.
Ross
Participant 2 will be named Ross for the purposes of anonymity. Ross told his story as a current member of the military—a sergeant major, in fact, in charge of training young soldiers in his unit. Ross described himself as a recovering substance abuser who had become addicted to pills like Xanax while serving in the Middle East. He had been given these pills by the Army physician but beyond that he had never acquired any physical or mental health check-up to assess why he was having suicidal ideation in the first place, as he described them. Ross said he often felt depressed, could not sleep, felt restless during the day, and had a hard time focusing on anything positive. He said that during his tour he would sometimes hope that an IED would kill him so that he would not have to be there anymore.
He nonetheless continued to climb the ranks and took over his own unit. It was at this time that he received education in Master Resiliency Training. He said that this 10-week program changed his life completely. He described it as one revelation after another: on each day of the course, Ross, in his own words said: “It was like another piece of my soul was being given some light, was being brought out into the sunshine for the first time. I felt like I was being disinfected and I could feel my spirit just jumping for joy at the end of every class. I never felt like that before. I finally understood what it meant to be happy, to want to live for the good life, to have something to live for. I quit taking those pills that really were just making me miserable anyway—and I have not looked back.” Ross went on to implement the techniques and tools he learned in MRT in his unit and said that he helped numerous soldiers to overcome their own difficulties, including pill-popping and drug addiction which they had developed in the military. Ross says that he remains an example of the power of MRT and why it should be used in place of pills to help soldiers cope with their issues.
Jim
Participant 3 will be called Jim for the purposes of anonymity. Jim was a soldier in Ross’s unit and suffered from anxiety and depression. He said he began taking medications from the Army physician, often switching them up as there was no real direction from the doctors about what to take. He said they only made him more irritated and he was getting into fights with his fellow soldiers in the unit. He said he was not well-liked and that most of the others felt that he was just drifting along and not contributing to the unit in a meaningful way.
Jim said that when Ross came back from his MRT training he saw a new leader—one had undergone “a kind of spiritual transformation,” as Jim puts it. Jim said that he himself used to be spiritual as a civilian but that he had lost that contact with religion upon entering the Army. He said he liked going to church in his youth because he felt it kept him grounded and gave him something to look up to. He missed that in the military, became depressed and anxious all the time and once he started taking drugs he lost all desire to be social and to contribute.
However, when his sergeant returned and starting teaching the unit in the ways of positive psychology, Jim began to react in a positive way. It reminded him of his lessons from church in his youth—of being committed to something higher than himself; of living one’s life in order to be good and to have a good life; of seeing the good in others and of not always focusing on the negative. Jim said that he was “inspired” by Ross and that he eventually stopped going to the doctors in the Army for more drugs because he felt that the training he received from Ross actually helped him to cope with his depression and anxiety better than the pills did. Jim began being recognized by his peers for his commitment to the unit and began demonstrating leadership characteristics. He is now being promote upwards in the ranks of the Army and is constantly teaching MRT to others because he believes passionately in it.
Analysis
The findings of the study by Ledford (2017) show that “resilience mechanisms, such as a large support network, adaptive behaviors, faith and perseverance have allowed [the patient] to cope with life as a survivor of trauma” (p. 105). This study confirms that resilience, support networks and positive psychology, which can include faith-based orientations, are a good way for soldiers to cope with the stresses they face in the military and the problems they require to be addressed. These approaches are much more holistic than the mere use of pharmacological interventions.
The need for resilience training showed in the cases of Mike, Ross and Jim. Mike received cognitive behavioral therapy, which helped him to overcome the obstacles he faced without having to rely on drugs. Drugs were only displacing the issue for a short time—they were not giving Mike a way to actively deal with the issue and put it behind him. For Ross, it was a similar story. He had no technique or training in how to deal with his issues so he was just using drugs as a way to numb himself. The problems were not getting solved though until he received actual training in MRT. Then he realized that there actually was a way to address the issues he was having. He did not need drug interventions to solve them but could address them by focusing on the tools given in resiliency training. He could focus on mindfulness and on being committed to the good. He was able to pass these tools on to others and thus benefited Jim who also found the training to be highly useful.
The major themes that emerged were these: the soldiers all required some form of stability in terms of having a sense of self-worth that drugs simply did not give them. The holistic approach, however, did remind them of their self-worth by allowing them to see that they had strengths and good qualities that they could use to overcome their individual issues. They stopped feeling powerless as though they had to take drugs to try to feel normal. They started feeling like they were in control.
Another area where a major theme appeared was in the idea of believing in something higher than themselves. For Mike, it was believing in family and the idea of attaining a life’s dream. That helped to drive him to success. For Jim, it was believing in God and re-igniting his faith to help increase his sense of resiliency. For Ross, it was believing in the ideals of the military and the Warrior Code.
In terms of the hypothesis, these findings confirmed my expectations that what would benefit soldiers would be positive psychology interventions. The soldiers benefited tremendously from cognitive behavioral therapy, as in the case of Mike, and from MRT as in the case of Ross and Jim. The methods used to obtain this understanding were appropriate because they provided in-depth stories of how these interventions were effective in actually helping the individuals to acknowledge their problems and face them instead of just drugging themselves and going through life like a zombie that no one wanted to be around. All three of the participants disliked the people they were when they were on drugs and they all noticed marked improvements in their characters and personalities once they started using positive psychology instead of drugs.
One way that leaders learn to address challenging instances soldiers may face is to remind soldiers that it is okay to ask for help. In the Army, there is sometimes a stigma that soldiers feel when it comes to asking for assistance: they fear coming across as incapable. Leaders have to show soldiers that challenging situations occur for everyone and it is better to seek advice, assistance, guidance, or support than to try to face one’s troubles alone. They must demonstrate this idea graciously so that soldiers themselves recognize the beauty and grace in asking for assistance instead of attempting to face their problems as though they were the only ones impacted by them. Because a unit is a team, a family, when one member is troubled, the whole unit is troubled.
As Reivich et al. (2011) show, sometimes soldiers simply do not know how to ask for help and it is up to leaders to step forward and summon their individual strengths to help their brother in need. The example of Jim as a soldier who was always frustrated and angry—to the point where no one wanted to be around him—shows how this is so. His presence was bringing a bad spirit to the unit, so one soldier who recognized that within himself he was capable of expressing love and showing wisdom approached the soldier and gave him support and friendliness—and that was Ross. The angry soldier gradually opened up and told the friendly soldier about his domestic situation, how his own issues were troubling him and how he felt depressed and so on. The friendly soldier listened without judging and then used his wisdom to try to share how he could focus on his faith and get back to living the noble life. In short, the leader helped to get the angry soldier back to a point where could show resilience.
This story gets to the heart of what it means to demonstrate MRT in action. The key is to recognize that all soldiers are part of the same family, and all are going to have times where they are afflicted by some trouble. Leaders have to be willing to step up and show empathy, because it is only through understanding and appreciation that true bridges can be built and true development of resiliency be obtained. Stress can come in so many different ways, and the military can use positive psychology and the techniques it teaches to give soldiers the guidance and support to cope with their stress. Learning to communicate, how to use body language, how to use develop and use social and emotional intelligence—all of this is part of building resilience among soldiers in a unit. This is what is meant by the holistic approach to care. Soldiers need that holistic approach to cope with their issues. Drugs only numb them. Praise, giving feedback, showing gratitude, offering assistance, being kind—each of these actions demonstrates a heart and mind that is in a positive place, which is where positive psychology wants them to be.
These findings show from a case study point of view that the military really should stop overmedicating soldiers and start focusing on providing soldiers with resiliency training and positive psychology. Soldiers need strong support networks and they need to be made aware of their internal strengths that they can use to cope with whatever negative issues are impacting them. They need to feel empowered and that they have the ability to overcome their issues on their own. Drug interventions do not help them to understand themselves, they only add to the problems that plague them. The soldier also has to maintain a sense of realism so that he is never left in the lurch so to speak. He has to be honest with himself about what he is going through. Each one of the soldiers in this study demonstrated honesty and a willingness to open up and be sincere. This is a pre-requisite for getting help. If one is going to overcome a medication addiction problem, one has to first acknowledge the problem—but this concept is taught in MRT and so this training can be very helpful in this respect.
It is also important to be honest and real because demoralization tends to set in when a person sets high expectations for himself that realistically cannot be attained. The best approach to developing toughness is to start off with small goals and build confidence. Gradually the goals can become larger and more difficult to attain, but with the confidence of the unit established and morale running high, these bigger challenges will appear as opportunities to prove themselves rather than as insurmountable obstacles that will only cause them to fail and fall back into whatever bad habits they possessed before. Mike showed this when he kept thinking he could solve his problems on his own by medication without actually acknowledging that something more as wrong and that he needed more help.
Military leaders can help soldiers identify thinking traps that keep them from reaching their true potential. Thinking traps are something that military leaders learn about in MRT and they occur when individuals jump to conclusions, over-generalize, or engage in other thinking styles that move them away from positive goals back towards their own problems. The leader can show the soldier that by succumbing to thinking traps, the soldier undermines his own strength and resilience as there are emotional, cognitive and behavioral consequences to falling into these traps (Reivich et al., 2011). Leaders themselves have to be careful to avoid these traps because as they learn in MRT it is easy to overestimate the value or strength of an individual soldier based on one action. Sometimes leaders can become beholden of a soldier because the soldier does something right—but this does not mean the soldier is going to successful in everything, so the leader has to be careful not to over-estimate a soldier’s abilities: doing so can lead to failure, discouragement and depression. Thinking traps can be seen in each of the three cases described in this study. Mike, Ross and Jim all engaged in assumptions about their mental health and their various issues—they believed they were in control or that there was simply no point trying to solve anything. They engaged in self-defeating thought processes that kept them going back to the drugs even though they did not like taking the medicine really in the first place.
Soldiers also have to be able to identify icebergs, which are deeply held beliefs that can both “contribute to or undermine their effectiveness in the Army, as leaders, and in creating strong relationships” (Reivich et al., 2011, p. 28). It is important to do this so that no stone is left unturned as the soldier engages in strengthening his own ability to lead and also in developing the ability of others to identify their own core values and assess whether they are suitable for whatever situation they are in or not. One particular iceberg that has been shown to be problematic is the belief that asking for help is bad and shows weakness on the part of the soldier. Soldiers have to recognize that asking for help is not a sign of weakness but rather a sign of strength. The three soldiers in this case study all had problems asking for help and were not willing to do it right away. They did not mind asking their doctors for drugs and medication because this was viewed as normal behavior in the military—but by seeking counseling, this was a big step for Mike. Ross and Jim were both fortunate in that training found them—they did not have to seek it out or ask for help. They were lucky in the sense that help just came and got them. For a soldier who is dealing with stress or some trauma, asking for help can be the best way to actually begin to heal and overcome the challenges facing him. Leaders have to really focus on deconstructing the dangerous iceberg that is the fallacy of asking-for-help-shows-weakness. When help is genuinely needed, soldiers have to be willing to ask for it—because that is the only way they will improve. Asking for help, however, requires trust in the process—and that trust will only be there if the soldier knows that the Army and its leaders are going to be there to provide help and support. So the leader, above all, has to show that he cares for his soldiers and wants them all to attain the good life.
All three of the participants whole-heartedly recommended that some form of positive psychology be implemented among soldiers seeking treatment. Mike recommended cognitive behavioral therapy instead of drugs. Ross and Jim both recommended MRT. To help soldiers cope with stress, sergeant majors can utilize positive psychology and specifically MRT to develop the mental toughness and resilience of their soldiers. Positive psychology focuses on the principles that help one to attain the good life and stay motivated to succeed. This approach feeds into the promotion of the Warrior Ethos that soldiers need to have to keep from falling into bad mental, emotional and behavioral habits. The leader can help soldiers to deal with trauma, stress, depression, anxiety or any other negative factor by providing an example of the good life, showing that it is possible to attain through discipline and commitment to the ideals represented by the military.
Conclusions
The case study showed that the hypothesis was proven correct: holistic care and preventive approaches to preserving mental health, such as Master Resiliency Training (MRT), could benefit soldiers more than reliance upon prescription medications. Further work that could be recommended in this area would be to develop a mixed-methods study that combined qualitative data with quantitative data to deliver even more convincing evidence of the direction the military should take to promote mental health.
The mixed-methods design would be an improvement on the case study design in that it would allow for a triangulation of sources to be used. This would help to shore up the study even more and provide a variety of data sources to give it even more validity and reliability while simultaneously strengthening its credibility. I would recommend that a mixed-methods approach be taken on this subject next, especially as Congress is looking at the matter of overmedication in the military and could benefit from having more scholarly data to analyze to help it make its decision.
The lessons learned in this study include: case study design is a most helpful method of investigating in a deep manner the impact of overmedication on soldiers. Through the use of the interview process, participants were able to explain their lives and how medication in the military negatively impacted them. It helped to put a face and name to the facts that are coming out in the public. Interpreting the themes described above helped to locate the problems underlying these soldiers’ issues. In all, it was a positive design for this topic.



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Acknowledgments
First and foremost I would like to thank the soldiers who participated in this case study. Without their involvement this research could not have been conducted and the important findings that emerged from the sharing of their stories would not have had the opportunity to leave an impact on the world. This issue of overmedication is an important one, as many soldiers are suffering from it, and these participants took the time to open up and share their own stories—which is needed in today’s world to shed light on the problem of overmedication in the military. To them go all of our whole-hearted thanks and appreciation.
Secondly, I would like to thank my own support network that has given me the opportunity to pursue this research and that has enabled me to continue to keep going in spite of all the obstacles that came with it. I will not name them individually but they know who they are: they have been with me from the beginning and I count them among my closest friends and advisors.
Finally, I would like to thank God and my Lord and Savior Jesus Christ without whom nothing is possible. I have relied upon my faith like so many others to remain positive in this life and I am always thankful every day for the faith I have received. There is strength to be had in committing oneself to God and trusting in His mercy and guidance, and that shows in the fact that I have been able to see this study through to completion—never giving up hope that I would do so and never thinking that my Lord would stop giving me the light and grace to carry on.


Appendix

1. Unmet Need



(Huntley, 2014)

2. Growing Rates of PTSD

(Barglow, 2012)