Question: I am an honorably discharged Navy veteran who served from 1974 to 1978, as well as a recovering alcoholic/addict who has worked as an alcohol and drug counselor for the past 18 years. How can I be of help in the southwestern region of Oregon? I am also bilingual/bicultural (English/Spanish) and know about post-traumatic stress disorder from personal childhood abuse.

Dr. Suchinsky: I suggest contacting the substance abuse program Chiefs at the VA facilities in White City, OR, and in Roseburg, OR, to see if they have a position available for someone with your qualifications.

Question: I am a graduate student in experimental psychology at the University of Tennessee, Knoxville. I also work with the Steps House program for homeless veterans in Knoxville. I have developed some new assessment techniques and seek feedback, support, and knowledge. I have worked with addictive and mental disorders for 7+ years.

Dr. Suchinsky: I suggest developing a research protocol to test your techniques, with the possibility of publication in mind.

Question: As a home care and public health nurse for 30 years, I wonder why no referrals are made to visiting nurses-either public health nurses or home care nurses-for followup care for persons with substance abuse problems. Since continuing care is one of the 12 active ingredients of effective treatment, I am wondering if VA substance abuse providers would like to make referrals for skilled nursing visits to assess/teach medication regime (effectiveness, side effects, precautions) in the home, along with providing care and education to build immune systems, teach about nutrition and exercise, and assess family dynamics. Nurses from a baccalaureate program of nursing are trained in family dynamics, so it would make sense that these nurses would provide followup the way they do for physical, occupational, speech, and nutrition therapy. Most health plans have 40 skilled nursing visits per year. I am not sure about the military's Champus/Tricare plans. Do VA health plans have home care visits included?

Dr. Suchinsky: VA is increasingly involved with telemedicine techniques, which are essentially related to your suggestion. I suggest contacting a VA medical facility near you to determine whether they might be interested in developing a project involving home care and possibly relating it to telemedicine initiatives.

Question: Judging from the severity and types of war injuries and subsequent addiction to narcotic pain medications, is methadone a feasible VA treatment option?

Dr. Suchinsky: Methadone has been used to treat pain. Whether it is superior to other opioids in a given patient would have to be determined for that patient. Since methadone is an opioid analog, patients are susceptible to becoming dependent on it.

Question: We're desperate. My son is a heroin addict who has been in several in/outpatient detox facilities, and he's now using a methadone clinic. He does fine for a couple of months and then goes off of the methadone, saying it's like "a cage rattling." I know it's a chemical issue, but isn't there an approved drug that can help regulate the brain chemical in place of methadone? We feel we're running out of options. Thank you for any help you can offer.

Dr. Suchinsky: Without knowing more about your son's situation, history, and treatment, I am reluctant to suggest a course of action other than to obtain an expert evaluation, with particular attention to the possibility of your son having an additional psychiatric problem besides the addiction.