The history of addiction treatment at VA: Part 3

Borne in battle: VA addiction treatment after Vietnam

In the post-Vietnam era, VHA hospitals introduced a variety of treatments for Veterans grappling with addiction issues, including specialized units, self-help programs and various drug dependency interventions. The rise in recreational drug use in the 1960’s, coupled with the greater availability of drugs in Southeast Asia—a prime region for opium and heroin production—fueled an epidemic among military personnel in Vietnam. This signaled a new era in the VHA’s approach to addressing addiction among Veterans.

The rise of drug use during the Vietnam War

Service members in combat zones frequently turned to substances like heroin, amphetamines and marijuana, among others. For the nearly three and a half million U.S. service members involved in the Vietnam War, drug use was notably high, surpassing levels seen in previous wars.  

Widespread use of drugs in Vietnam drew national attention from the media and those in the federal government. A 1973 Department of Defense (DoD) study titled “The Vietnam Drug User Returns” highlighted the extent of the problem in detail. Between 1966 and 1969, the study found that American military forces used 225 million tablets of amphetamines and 43% of servicemen reported using heroin, with more than half becoming addicted. Egil Krogh, liaison to the Bureau of Narcotics and Dangerous Drugs, told President Richard Nixon, “You don’t have a drug problem in Vietnam; you have a condition.” To control the crisis, the White House launched Operation Golden Flow in 1971, mandating urinalysis for all servicemen before returning to the United States. Those who failed were required to undergo detoxification in-country. The military went on to implement a clearer ban on illegal drug use after the war and pioneered the practice of regular drug testing.

Challenges in post-war addiction treatment

Despite initial fears, high substance abuse rates during the war did not entirely translate to enduring addiction issues post-war. A year after returning home, only 10% of service members initially detected as drug positive reported using opiates after detoxification, and just 7% reported re-addiction. Initially, service members identified as drug-dependent who refused in-service treatment were discharged from the military and advised to seek help from VA facilities. However, in late 1971, a new policy mandated transferring these service members to VA facilities prior to discharge when possible.

VA initially found itself unprepared for the sudden increase in drug cases. Existing treatment was primarily geared toward alcoholism among World War II and Korean War Veterans, not those who required treatment for drug addiction. The first VA drug clinic did not open until late 1970, compared to the 41 alcohol treatment centers already in operation at the time. Acknowledging the oversight, a VA official stated, “We admit the drug problem caught us by surprise.”

Initial unpreparedness and new initiatives

In addition, Vietnam Veterans often remained disillusioned and reluctant to seek treatment. Dr. Bernard Rappaport from the West Side VA Hospital in Chicago, Ill., observed that many patients, especially those with drug addictions, did not want to talk about their experiences, making treatment engagement challenging in a traditional hospital setting. According to the same 1973 DoD report, only 4% of Vietnam Veterans had undergone drug treatment at VA facilities.

To remedy this, VA began widening its approach to addiction treatment, focusing on dedicated settings and community-oriented care initiatives. In 1971, VA planned to open 30 specialized treatment centers—each with 500 beds—by mid-1973. VA programs from this period, including Vet Centers, focused on substance use reduction, abstinence and counseling. Above all, programs sought out Veterans who would normally be reluctant to seek help at regular VA medical facilities. 

Hospitality House and innovative care

In 1973, the Brentwood VA Hospital in Los Angeles, Calif., launched one of these new initiatives. The drug treatment center “Hospitality House” opened after extensive planning by both patients and hospital officials. This program emphasized total abstinence from drugs and provided living quarters separate from the main hospital to foster a sense of community and independence. An old building was repurposed to include everyday living facilities, such as a kitchen, dining hall, meeting space and offices. Hospitality House staff served as therapists, role models and supervisors for the Veterans; their own histories with substance abuse allowed the staff to connect and relate with the residents on a more personal level than in earlier treatment initiatives.

Personal independence was a core element of the program, and residents were responsible for their own cooking, laundry and housekeeping. There was no fixed duration for a Veteran’s stay, and treatment approaches were tailored to meet individual needs, with the overarching goal of teaching residents to cope with everyday life without resorting to drug use. 

Expanding and refining treatment approaches

Throughout the 1970’s and into the 1980’s, VA continued to expand and refine its treatment approaches, and it provided training to more than 500 employees in the treatment of drug dependence. Annual reports from this period highlight the success of various treatments, including 12-Step programs, cognitive-behavioral therapy and combined treatment strategies. The Substance Abuse Rehabilitation Program involved patients in governance, mutual support, vocational counseling and recreation, including weekly Alcoholics Anonymous meetings.

By the early 1980’s, VA had expanded its focus to include the establishment of halfway houses and integration with community programs for broader geographic coverage, as well as methadone clinics.

With a variety of treatment approaches, new specialized units and increased community-oriented care, VA addressed addiction among Vietnam Veterans in new and innovative ways. After the Vietnam War, VA continued to improve its services to address the diverse needs of drug-addicted Veterans by establishing specialized and integrated programs that provided comprehensive support—including counseling, rehabilitation and long-term management—to help Veterans recover and reintegrate into society.