I'll take a couple of quick angles.
It was ironic they had Sue Ray come in on PTSD, and it wasn't what we found. That's one of the reasons we went to 50, because we kept looking for it and thinking we had some kind of sampling error we weren't finding.
I started my career working in addictions and alcoholism. One of the best things about addiction and alcoholism is it often takes a decade of heavy drinking to get to the point of physical withdrawal from addiction. There's a huge trajectory, a huge opportunity for intervention and prevention.
One thing we suggested in the report that Sue Ray and I did when we found this is as people are being released, a lot of 10-item screeners can be done on substance use. There's a lot of assessment around looking for PTSD. I think we need to be assessing at the point of a person leaving the service because you have a really long intervention period to prevent a problem and to deal with it. I think we'll probably hear a lot more from the others around other specific transition supports.
Some addiction counselling does occur through our OSI clinics, and we did partner with them. That's often where people would receive service. But in a lot of our discussions in the focus groups that we had throughout, which were phenomenal, part of that disconnect of cultures...is that one of the best practices around addressing addiction is harm reduction because you go at your own pace. You aren't required to have sobriety. They felt internally as well within organizations, it was a real conflict with military culture, the idea that if you're given an order not to drink, you should just be able to stop drinking, end of story. I heard this over and over again. Although they wanted something specific for veterans, it was one of the reasons they felt there might be more conflict if it was totally run by those organizations. The idea of harm reduction strategies, which came up over and over again as the main way they needed to get out of addiction, ran so counterintuitively to military culture. You're given an order, you should just stop drinking.
I'll give you two brief examples, both involving vodka.
One of the veterans in one of the sites had been on the street for 20 years only drinking non-palatable alcohol. I don't know how the person was alive. When I first met him at one of the first focus groups, his goal was to only drink vodka. I asked why vodka after all this? He said it's expensive, it will limit how much he can drink, and that's his goal. A year later he'd only drunk vodka, now he was ready to quit.
In a different city we had another situation with vodka, which is ironic, but it illustrates what we're talking about with harm reduction. So for him, imagine 20 years on the street and to just tell him to give up alcohol. That would be ridiculous. Twenty years on the street with non-palatable alcohol, he can't just suddenly stop. The other example was—