Building Resilience and Overcoming Addiction

>> H.R. McMaster: America and other free and open societies face crucial challenges and opportunities abroad that affect security and prosperity at home. This is a series of conversations with guests who bring deep understanding of today's battlegrounds and creative ideas about how to compete, overcome challenges, capitalize on opportunities, and secure a better future.

I am H.R McMaster, this is Battlegrounds.

>> Presenter: On today's episode of Battlegrounds, our focus is on substance use disorder as a national security issue. Our guests are Doctors Alta DeRoo and Donald Elverd the Hazelden Betty Ford foundation, the United States leading nonprofit provider of addiction and mental health care.

Dr. Alta DeRoo is a medical director of the Betty Ford Center's three California facilities. She served 24 years in the U.S navy as a naval flight officer and naval physician and was among the first cohort of women to fly in combat. Dr. DeRoo is board certified in OB, GYN and addiction medicine and is a leading expert on maternal and fetal health implications of substance use disorder treatment.

She currently serves on the American Society of Addiction Medicine's board. Dr. Donald Elverd served as an army infantry soldier in the Vietnam War, where he received three Purple Hearts, a Bronze Star for Valor, and the Combat Infantryman's Badge. He then earned his doctorate in clinical psychology. Dr. Elverd is an expert on multicultural approaches to healing and speaks on healing and recovery from psychological trauma.

Dr. Elverd's clinical focus is on supporting active duty and veteran service members. He has worked with the Hazelden and Betty ford foundation for 33 years. Substance use disorder SUD is a treatable mental disorder that leads to a person's inability to control their use of substances, including drugs, alcohol or medications.

In 2023, 48.5 million Americans 12 years and older had an SUD according to the National Survey on Drug Use and Health, only one in four of those classified as needing treatment for their SUD received it. SUD is a risk to national security as well as personal well being.

US deaths from overdoses of synthetic opioids, primarily fentanyl, increased from less than 6,000 per year in 2015 to over 77,000 in 2023. Fentanyl kills an average of 200 Americans per day. Nearly all illicit fentanyl precursors are produced in China. In 2024, the United States saw its first yearly decrease in opioid overdose deaths since 2018.

Stigma around SUD and mental health issues has decreased in recent years as clinicians have come to understand addiction as a treatable medical condition. Nonprofit providers like the Hazelden Betty Ford foundation continue to expand access to treatment and help patients focus on resilience growth and emerging stronger from overcoming a substance use disorder.

We welcome doctors DeRoo and Elverd to Battlegrounds to discuss substance use disorder ways to prevent and treat addiction and its implications for national security.

>> H.R. McMaster: Doctors Alta DeRoo and Dr. Donald Elverd, welcome to Battlegrounds. I'm really excited to have you on today to talk about a topic that's really important to veterans, but really to all Americans.

Welcome and thank you for joining us.

>> Alta DeRoo: Thanks, H.R..

>> Donald Elverd: Thank you for inviting us.

>> H.R. McMaster: Hey, first I'd like to just jump right into the topic and talk about what lessons have we learned about addiction. In the intro, our viewers saw the statistics on addiction and substance use disorder.

What have you learned? I guess kind of an open ended question about addiction across your careers that you could share with our viewers?

>> Alta DeRoo: Yeah, thanks, H.R alcohol use disorder still remains the number one substance use disorder that active duty personnel are suffering from in the veteran community.

It's alcohol use disorder, but we see a lot of tobacco, I'm sorry, tobacco use disorder and cannabis use disorder creeping up. After we've started to accept addiction as a disease and allow treatment with it with medications. We've also lowered the stigma that folks are feeling when they have a substance use disorder.

And so I think we've improved in some areas where it's not as stigmatizing so much, but the stigma is still there. So that's a big, I would say that's a way to frame up a lot that I've learned through caring for active duty personnel and then veterans after their service is completed.

>> H.R. McMaster: Also thanks, I've seen that even across my career the degree to which we've had success. I think relative success anyway, in no longer stigmatizing addiction and ensuring people can get the assistance that they need. And Don, how about you? You've, of course you're a veteran of the Vietnam War.

You've gone through challenging circumstances yourself associated with addiction on the back end of that war. And as a treatment for the pain that you were suffering after having been wounded several times, can you maybe share a little bit maybe about your personal journey. What you've learned personally, but also what you think we've all learned about addiction across your career.

>> Donald Elverd: On a personal level, I'd like to start off by saying the military hospitals helped me heal from physical wounds. Hazel and Betty Ford helped me heal from spiritual wounds. Often time when a soldier comes back, they get isolated where normally they're used to being part of a group and a team, alcoholics and addicts tend to get isolated.

I found it very important to get back in community again with fellow sufferers, and particularly in working with veterans. Often I will work with one and they will say, well, I've never been in combat. And I'll say, wrong, you're in combat now. You're in the weirdest combat of all.

And some of the things you learned in the military can help you in terms of recovering from this combat.

>> H.R. McMaster: I think that's a really strong message, of resilience and encouragement, both, right? That they can overcome even the most difficult or dangerous circumstances. And I think the analogy to combat works.

>> Donald Elverd: Absolutely and I let them know just right off the bat that I respect them and I honor them. And that if we're gonna send them down to a unit, a recovery unit in a treatment center such as ours, I tell them, you guys, you can use much of your military training here.

You understand life and death, this is life and death. You're playing for all the marbles here. You understand that you have a better chance of survival if you're part of a group or a team. We're gonna send you down there a part of a group or team community.

You're used to being part of a group from all different kinds of backgrounds. You people know how to do that. You had to do that in the military. Same thing here, you understand that in order to survive as a group or a team, everybody has to. To do their part, you have to rely on each other.

You have to, quote, help your buddy hump his or her pack. They understand some of that jargon. The main thing veterans, men and women, truly understand is training, training, training, training. And I will tell them, in the military, you learn how to train up to survive in a dangerous situation.

It's the same thing here. We'd like to teach you some different survival skills in this weirdest combat of all. So my jargon shifts a little bit. And if one of them relapses and they feel horrible, I'll say, look, what we need here is an after-action report. What happened?

How can we do this better the next time? What can you hear from some of the others? But the main thing I try to convey is you are not broken. You are not broken, you are injured. And we need to get you in recovery to be part of the team again.

So that's my little shtick HR.

>> H.R. McMaster: Well done, I'll tell you, it really resonates with me. And I just remember visiting many of our wounded soldiers, and some of them had really grievous physical wounds, losses of limbs and so forth, or bad burns. And what they told me because we weren't doing a very good job I think, on preventing addiction at the time with the way that opioids were being prescribed and so forth.

But what so many told me is, hey, getting over the physical wounds wasn't the hardest part. It was getting off of the opioids that were prescribed to them.

>> Alta DeRoo: Yeah.

>> H.R. McMaster: And for both of you also, and Don, I'd like to ask you about prevention. What are the most effective means of preventing addiction?

Have you seen some progress since we had the experiences of those who are wounded in Operation Iraqi Freedom and Operation Enduring Freedom?

>> Alta DeRoo: Yeah, it's funny you mentioned that. I was just reading a really good study the other day about those folks returning from OIF and OEF had a lot of injuries and they were treated with opioids.

Which at the time, this was part of the movement for doctors to prescribe liberally because we were told that these things were not addictive. At the time, I was at Walter Reed, and then Lejeune and was also prescribing a lot of these opioids. We found later that these were habit forming and that there were addiction potential with the opioids used to treat somebody with pain coming in off the battlefield.

And unfortunately, during around that time, we are very generous with prescribing opioids. We've since now determined that the opioids are addictive. They're much more addictive than we thought they were. So now there's then been a big stepping back to reassess the BDA, the battle damage assessment that we've had, learning what happens when we prescribe so many opioids.

So what we've learned from that is that, yeah, they are addictive. And you're gonna see a much more conservative approach when it comes to surgeons like myself not prescribing so many opioids. And instead, we choose to prescribe with NSAIDs, with Motrin, Tylenol, Gabapentin, those type of things. Instead of going straight towards the Percocet, Oxycontin, because that leads to other drugs.

When the OxyContin and the Percocet is not doing it, people start going to other stronger forms of drugs to heal their pain like heroin, which we know now has progressed to a fentanyl crisis.

>> H.R. McMaster: Absolutely, and of course, this affects the veterans community, but of course, it's across our whole society.

There's been so much litigation about this, especially the findings against some of these drug companies that were pushing off label prescriptions and introducing the pain scale and try over treating pain so they could profit from it. It was terrible and Don, any thoughts you like to share on prevention and the progress that you've seen in recent years?

>> Donald Elverd: I think probably one of the biggest advances I've noticed is information. We have a lot more information now that we didn't have previously. And part of its education, part of it's hearing from others. And I don't hold any resentments against the attending physicians that treated me. I hurt, and if you've got to pick between pain and numb, I'm going with numb.

Now, if somebody can show me something else, I'm listening. But there's a lot of information now that wasn't available at that time.

>> H.R. McMaster: Right, and what I'd like to do is maybe shift to treatment now as well. Treatment for pain, but also treatment for addiction. Also, I've heard a lot about holistic sort of assessments of pain and how to treat it, but I'd like to maybe just hear both of your thoughts on treatment both for pain and how you've seen it evolve away from opioids.

And you mentioned other drugs, but maybe other treatment and then also the treatment of addiction itself. What's most effective and how is our thinking about treatment changed over time?

>> Alta DeRoo: Yeah, so with the treatment of pain, we started to go away from such stronger and liberal prescribing for opioids.

And like you said, not just the military anymore, but we've started going towards more of the NSAIDs, more the COX2 inhibitor type medications. So that's gonna be like your celecoxib, Celebrex type of things, the non-opioid pain stuff and then physical therapy. But another thing that we're doing to help veterans heal besides just medications, is also treatment for mental health.

So after we get the mental health on board, we can start looking mental health so that they can engage in counseling, so that they can engage in therapy. We also add in some type of anti-craving medications. So the medications outside pain that can use to treat a substance use disorder involve the cravings and withdrawal from those use disorders.

So for alcohol use disorder, we have anti craving medications like naltrexone that can be taken by mouth or an injection. And then for somebody who is withdrawing from an opioid use disorder, we have something called buprenorphine naloxone, which trade name is Suboxone, which decreases the withdrawal symptoms and decreases the cravings.

And this can be used for acute settings when somebody's withdrawing or it can be used for chronic settings where somebody can be on this medication for long term. And those are both being used in the military and in the veteran space right now with really good success.

>> H.R. McMaster: Thanks, Alta.

Don, how are you on treatment and how it's evolved since your experience in Vietnam? But also, how have you seen it evolve as a professional who's helped so many others?

>> Donald Elverd: I think we take a much more holistic approach than we did previously, and I think we get some advances in clinical skills as well.

I tend to do some things that are fairly nontraditional. Dr. Derue understands the physiology and the medications, and I shift a little bit over from my perspective and I'll try to teach them some things. I have prescribed, teach them some things about exercise and attitude. To my soldiers, men and women, I will sometimes tell them in the military suppression of pain is valued.

We want you to suck it up, put your head down, and go forward, we need to teach you some different things now. In my time, I learned that one of the only emotions actually. Prized and allowed in the military was anger. It was okay to be angry, just focus, focus, focus.

Don't whine, don't be a crybaby, we shift a little bit from that. I sometimes use hypnosis, I sometimes use some other types of things.

>> H.R. McMaster: And I think in the military too Donna, I mean, really mental, psychological preparation for combat is so important. And I think this area, it's hard to replicate that in training, right?

Because you don't have the danger associated with actual combat in training. So, I think it's important to educate leaders in our army and certainly I think among first responders, others who go into dangerous situations, how to prepare themselves mentally for that. Because I think it was Aristotle who said, if you prepare for the worst, the blow is softer when it comes.

And I think it's important to prepare soldiers and units for the difficult and sometimes harrowing experiences they're gonna have in combat. Hey, Don, I'd like to ask you one other question, and before we go back to Altar on this, you already mentioned kind of the importance of communities, right?

And you're making me think of a previous battleground's episode with Sebastian Younger, who wrote this great book, Tribe, about how important it is for us to be connected to one another. At a time these days, Don, I mean, we are better connected to each other ever electronically, but I think more distant from one another than ever psychologically and.

>> Donald Elverd: Yes.

>> H.R. McMaster: And emotionally, right? So, could you talk about maybe a little bit more about the importance of communities in treating and overcoming addiction, especially to opioids. And maybe also what signs we should look for in others, signs of addiction so that can identify people who need assistance.

>> Donald Elverd: Well I learned in my combat experiences that the most important thing I had wasn't necessarily the weapon, it was the other guys. It was the team that was the most important buffer to stress and danger and pain that I had, if I could rely on these people.

The last time I was wounded was August 21, 1968, yes, I am that old, I'll admit it. Every August 21, I'll get a phone call from three or four people that were in that battle with me and they'll say things like, thinking about you today, brother. We're just thinking about your brother, that that connection is still there.

And to know that you're appreciated by these people who are in situations where it was incredibly stressful, that I'm still connected to those people. I noticed the same thing in recovery, that connection, that connection, that connection. People when they're in pain, when they're in stress, when they're in danger, they have a tendency to pull away and isolate.

And then they spiral out of control, mood disorder, depression, anxiety, etc, etc, etc. One of the most important thing is to get them back in community again, those are my thoughts on the matter.

>> H.R. McMaster: Thanks, Don, and also, I'd like to ask you about this as well, and I'm thinking about how after World War I, right?

Returning veterans kind of had a sense of that, right? It's when the American Legion was formed, and we have the Veterans of Foreign Wars. And when I go to these organizations, a lot of times I see older veterans, a lot of not Vietnam War veterans. But not as many veterans from Operation Iraqi Freedom, Enduring Freedom, and I hope more will join because that sense of community is so important.

And also, would you mind commenting on that as well and maybe also talking about what are some of the signs people should look for in those who need assistance.

>> Alta DeRoo: Yeah, so I love that we're really bringing the idea of family and sober community into this discussion for support.

There's so much evidence to show that family is one of the protective factors when somebody leaves treatment, that family support. And family doesn't have to be the traditional mom, dad, brother, sister. When we're in the military, our battle buddies, our shipmates are, that's our family. And so, when we leave treatment or we're suffering with some types of substance use disorder, that isolation is gonna kill us.

We need the community of our new family that we have within the military, the American Legion or any other veteran support. And so, lots of evidence about there how a family program or that community, whether it's an AA community. I'm sorry, Alcoholics Anonymous community, Narcotics Anonymous community, or veterans in support for each other in a sober community, so that is a true success factor.

We have risk factors in the military, stressful environments, grief, seeing things that we can't unsee. And so, that contributes to our use of drugs or mind-numbing substances. But it's actually the community that we have amongst our battle buddies and shipmates that help us heal. Now, you asked what type of sign should we look for if somebody might be suffering. 

Don, really hit it, it's the isolation, when we find that the person that we're serving with has become quiet, is radio silent. And we have to reach out to them, sometimes that's tough for us, can be uncomfortable. But when we even just send something as simple as, like a text, like, how are you doing just checking in with this person.

Or inviting them to a meeting with you if you know that person is suffering from a substance use disorder. And when I mean a meeting, I'm talking about something very specific, like an Alcoholics Anonymous meeting, some type of Narcotics Anonymous meeting. So, that person who is suffering often in silence is doing it in isolation.

And we often say in the recovery community that isolation kills and secrets keep us sick. So, we wanna invite that person back into the circle of our family. So, that's one of the things I would look out for, is one of these folks who are not joining activities anymore.

Or not coming to the meetings we would normally have or may not be part of our social circle anymore.

>> H.R. McMaster: What is interesting that's one of the signs that we would look for, for combat stress as well, this kind of disconnectedness. And then you know that's a soldier you have to help in some way, and sometimes even removed from that situation for a while.

I also, I'd like to ask both of you, you know what? When I had the opportunity to serve in the White House, I had the opportunity to meet Elizabeth Dole, who's fantastic person. And her big initiative was to help the caregivers, to create support for caregivers. I wonder what your advice would be for family members who wanna help a loved one.

How can they educate themselves about addiction? How can they help that loved one? And what do you think are some of the best practices, Don? And also, what do you think those who care about somebody who's battling addiction, what should they try to avoid in terms of things to say or do?

>> Donald Elverd: In my alcoholic people that are in programs of recovery, Hazel and Betty Ford has a family program. And I think that is so important, it's an integral part of recovery. I tell my folks the best thing in terms of prognosis for positive outcomes is social support. Unfortunately, in addiction, the family also struggles and has pain and issues, etc.

And I sometimes say to them if you come into a program like AA that puts out the fire, but it doesn't put out the smoke. Organizations like Al-Anon do as well, where they're dealing with their own self-care, understanding what they're responsible for, what they're not responsible for.

>> Alta DeRoo: Yeah, Don, I'm really glad you brought up the Al-Anon part, so that's crucial.

And that's available to active duty personnel and veterans, so Al-Anon helps the people who are helping, they're the healers in the family. So those are gonna be the significant others, the children of the alcoholics that also need the help, Al-Anon will help them understand the disease. Many recovery programs, not just Hazel and Betty Ford, but others also have family programs.

And that's your indicator of a good recovery program, is that they have a family program. One thing that would also help the caregivers is to know that addiction is a chronic, relapsing, but treatable disease. So if you're treating a loved one, or you're involved with supporting a loved one that's suffering from addiction, there will be slips from time to time because this is a chronic thing.

And do not abandon that person when they do have a slip, but seek support within the rooms of Al-Anon or others who have walked in these footsteps as well. Another thing I would say is give yourself some grace as the caregiver of somebody who is suffering from addiction.

This is a hard road, keep that family unit intact, do as much as you can to talk to maybe your children. So I'm thinking maybe a significant other has somebody who's suffering from an alcohol use disorder or opioid use disorder. If you get the children and the surrounding folks to understand that this person does not want to be engaged in this activity.

They don't want to be sick and missing work and having to suffer like this. So getting the surrounding family to support this person understand that this is not a choice that the active duty or the veteran person is suffering from. Get that support for yourself, get the support of your Al-Anon groups and any online groups that can support you because your job is also difficult carrying that family union.

>> Donald Elverd: Absolutely, Ditto.

>> H.R. McMaster: So, the last question I want to ask you guys, what else you'd want to share with our viewers and our listeners. One of the things I've been concerned about in recent years is this idea that veterans are universally traumatized or fragile human beings. And I think what we want to make sure as well though is that we don't ever stigmatize post-traumatic stress.

>> Donald Elverd: Totally.

>> H.R. McMaster: Addiction or any of these challenges that many veterans face and of course we know exist across our whole society. Don, I think you actually personify the resilience of our soldiers and the ability to overcome even the most harrowing experiences in combat. But then even after combat and go on to do like what you're doing now which is helping so many others.

But I'd like to ask you if you could maybe share your thoughts, both of you, on the resilience of our veterans and how that relates to also not ever again stigmatizing post-traumatic stress or addiction. And the other challenges that some veterans have after they return from experiences in combat or in the military broadly.

>> Donald Elverd: Well, One incident that comes to my mind is 25 years ago I was invited to international conference on traumatic stress in South Africa. It was the first South African, Pan African conference on trauma, Bessel van der Kolk, he's a well known trauma psychologist, was leading, and I went with him.

There were therapists from different countries, one of the places we went was a torture recovery center in South Africa. It was a chapel that Desmond Tutu had donated for that purpose, and at that time I was meeting with a Zulu psychologist. She had Western training, but she had traditional healing training.

She had a little sign on her desk, it was a quote from one of her patients. There had been some intertribal warfare, north in Rhodesia, Zimbabwe and fighting. And a woman who was suckling an infant had been shot in the face, lost her eye. Her husband had been killed, this is a little too graphic, I'll try to soften it.

She escaped through the jungle, she crossed the border into South Africa and a big huge wild game preserve, it's called the Kruger. And in the Kruger, there's crocodiles and lions and tigers and impalas, and here she is bleeding. One eye gone suckling an infant and a ranger going overhead spotted her, came down, rescued her, took them to get care.

Well, she got trauma treatment from my Zulu provider and she had a quote on her desk from this woman. She said, I do not believe these memories were meant to destroy me, I believe they were meant to strengthen me. For the same boiling water that softens the carrot also hardens the egg.

The first time I ever heard the phrase post-traumatic growth was out of the military. And that doesn't mean a person isn't injured, doesn't have symptoms, but sometimes they can carry on in productive lives. And we've learned some things about these people, and much of it from studies on prisoners of war who came home.

But I don't want to get too out in the weeds on this thing, but that's been my experience.

>> Alta DeRoo: I love that you're asking about that, HR, just because a person has PTSD or some types of substance use disorder doesn't necessarily mean that they're fragile for life. In early recovery, they can have these time frames of vulnerability, in acute recovery when somebody stops using this drug to help them cope and they're learning these new coping mechanisms.

Sure, we're a little vulnerable in those areas, but after that, when we get our coping skills and we don't rely on drugs or alcohol to numb these memories. The resilience and the teamwork and the strength that we've accumulated through our military service really is a protective factor. So I love the fact that you're pointing out that PTSD is not something that's going to make somebody fragile for a life where they can't live a very productive life.

If anything, that would contribute to the stigma, and I'm really glad that we're getting out of the idea that PTSD is also stigmatizing, so thanks for mentioning that.

>> Donald Elverd: When they first came out with a diagnosis of post-traumatic stress disorder, they described it as a normal response to an abnormal set of circumstances.

And I thought, look, if it's a normal response, how is it the disorder, I mean, come on. And you'd hear phrases like exaggerated startle response. And I thought, as an infantryman, there's nothing exaggerated about it. Or they'd say hyper vigilance. I thought, of course you're hyper vigilant, that's not always a bad thing.

>> H.R. McMaster: Right, I think, almost what we. The way I think about it is that you need a mild form of stoicism, not kinda dream stoicism where you wring out, emotions, right? You have to embrace your emotions, understand emotions and emotions in others and the responses to post traumatic stress and so forth.

But I think, that mild dose of stoicism comes in handy in combat. And I think after combat and our veterans exhibit it. Gosh, Don, and also, I'm here at the Hoover Institution, which one of our distinguished fellows here, years ago was Admiral James Stockdale.

>> Donald Elverd: Yeah.

>> H.R. McMaster: Who endured so much hardship and kinda fell back on the writings of Epictetus.

>> Donald Elverd: Yes, yes.

>> H.R. McMaster: So I'm kind of a fan of the stoic philosophers. Not again to be in denial, about the challenges associated with post-traumatic stress and addiction and so forth. But also, to recognize that they can be overcome, and that so many of our veterans, like Admiral Stockdale and you don't, go on to make just tremendous contributions to our society.

>> Donald Elverd: I'm glad you mentioned that I was somewhat affair of him. I've read a great deal about him and I'm certainly not in the same category as Admiral Stockdale. His experience makes mine look minimal. But you're right, one of the things they said was he had internalized a set of principles and values that helped him in times of extreme distress.

And in his case, it was Epictetus. I don't know I'm pronouncing that correctly, but he hung onto that. He'd internalize that it was a core belief. And I think we need to sometimes introduce people to some core beliefs.

>> Alta DeRoo: Yeah, I definitely feel like I'm among like-minded folks here.

I'm love the idea of stoicism and a huge fan of Epictetus. Yeah, absolutely. It brings to me a sense of calm and peace and puts my world in order, when I have to face stressful circumstances. So, yeah.

>> H.R. McMaster: Right, kind of the Serenity Prayer as well

>> Alta DeRoo: You are 100%.

Yeah, locked on HR. Great, thank you.

>> Donald Elverd: Well, I'm honored to meet both of you, thank you.

>> H.R. McMaster: Hey, I'm honored to be with both of you, and what I'd like to do is just end with an open-ended question. Anything else you'd like to tell our viewers and listeners?

>> Alta DeRoo: Yeah, I would love to talk to those families you mentioned suffering earlier or any of the shipmates and battle buddies supporting somebody that you might be serving with. You don't have to wait till that person reaches rock bottom, to help them get treatment. Sometimes they don't even have to necessarily want to get treatment themselves.

If starting a conversation is a little uncomfortable for you, then invite somebody else to help you have that conversation. So many folks think that they have to hit rock bottom before coming into treatment. I would ask you as a physician who treats these folks, don't wait till your liver is failing.

Don't wait till you have to go into withdrawal to suffer from these things. Please consider treatment early.

>> H.R. McMaster: Great, thanks, Alta. Don, any last words?

>> Donald Elverd: I'll try to be brief. In the early 80s, I was hired as an outreach worker in the Veterans Administration for Vietnam veterans at Kemo who had readjustment problems.

And most of the people that I met, many of them had substance abuse problems, but they wouldn't go to AA or recovery. I said, why not? Well, they're crybabies. If I tell them what's going on in my head, I'm gonna scare the hell out of them and, and they're gonna think I'm nuts.

So I started a group for those guys, for the Vietnam veterans, for the combat veterans. It took away their last excuse to not go. That group still meets, 40 years later. I just had to get them back in the circle. And I don't know, we picked up the ball.

We got tired of waiting for the government to do it. We need to do something for ourselves, and we did. And I'm hopeful that these guys from Iraq and Afghanistan and all that business at some point can do something similar as well.

>> H.R. McMaster: Yeah, Don, I think that's just a great last message.

Any veterans out there who listen to this, contact your fellow veterans.

>> Donald Elverd: Yes.

>> H.R. McMaster: Create a virtual one on Zoom. But even better in your communities where you can get together physically. I think that, of course we all need mental care and healthcare professionals like you, Alta, and like you, Don.

But we also need that community, that understands one another's experiences. I think that's such a strong message, and I can't thank both of you enough. On behalf of the Hoover Institution, thank you for helping our viewers and me learn more about a battleground that's important to our communities, to our veterans, to our society.

Thank you so much for being with us.

>> Alta DeRoo: Thank you.

>> Donald Elverd: Thank you.

>> Alta DeRoo: This is absolutely so needed, thank you.

>> H.R. McMaster: Thanks, Alta, thanks, Don.

>> Donald Elverd: Thank you.

>> Presenter: Battlegrounds is a production of the Hoover Institution, where we generate and promote ideas advancing freedom. For more information about our work, to hear more of our podcasts or view our video content, please visit hoover.org.