By Joseph Troncale, M.D.
As one of the highest-rated shows on television, “This Is Us” has become a must-see primetime drama in many American homes. While viewers enjoy the family dynamics and some of the unfolding mysteries, as an addiction treatment physician and a veteran, I appreciate how the show has been handling both substance abuse and the recovery process.
This season, we’ve seen a fairly realistic portrayal of how war trauma and flashbacks can play a role in addiction for veterans, as well as how alcohol abuse impacts families. We see flashbacks to Jack, the beloved family patriarch who struggles with alcoholism, serving time in Vietnam. While the show doesn’t directly correlate Jack’s time in the service with his current struggles—since he also grew up with a father who abused alcohol—this connection is something I see on a regular basis in treatment.
Combat veterans have high rates of subsequent substance use disorders and mental health issues. Trauma is psychologically incorporated as guilt and shame. Veterans may experience survivor’s guilt, post-traumatic stress disorder (PTSD), or grief and loss from battle buddies being injured or killed. PTSD, depression, and traumatic brain injuries are also known as “co-occurring disorders.” One study of Iraq and Afghanistan veterans shows that 39 percent of them were likely suffering from alcohol abuse. In order to fully treat the addiction, these mental health issues need to be addressed at the same time.
Family plays a huge role in addiction—both for an individual’s treatment and their risk. We see Jack’s father suffering from alcoholism, which likely impacted Jack. We also see Jack’s son, Kevin, as a grown man working through his own substance abuse problems. Kevin enters a treatment program, goes through the steps, and makes amends to those he’s hurt. It’s a bumpy road, but his family supports him. And having family support is one of the biggest indicators that an individual’s recovery will be successful. Having witnessed his dad’s struggle, Kevin also adopts one of his dad’s hobbies, and uses handyman work as a way to help maintain his sobriety.
While not much screen time is given to Jack’s experience in Vietnam, it’s still a critical facet of his character. But it’s also a very real issue for veterans today. My colleagues and I have been working with the VA over the last year or two to make sure veterans have access to the care they need. We have met with numerous VA facilities to determine how we can work with individual VA hospitals and with the veterans themselves to get them into treatment. Not all VA hospitals operate with identical practices, so we have gone to great lengths to smooth out ways to get the veterans the transportation, medications, and follow up that they need in cooperation with the VA.
While veterans are in treatment, we try to integrate them into the larger treatment community, while at the same time recognizing them as respected men and women who have served this country and deserve special respect. I’m glad our veterans—as well as individuals in recovery—can turn on the TV and see their struggles reflected in a genuine way. This is us.