Jonathan S. Cohen, MMSc, MBA, PA, is a Baltimore-based physician assistant working closely with Pyramid Healthcare in Maryland to care for medically complex clients and clients with open wounds in addition to their substance use disorder treatment needs.

In addition to his background in emergency medicine, plastic and reconstructive surgery and addiction medicine, Jonathan has significant experience working with the military and veteran community, including overseas in Iraq and Afghanistan. Pyramid Healthcare is a proud member of the VA-CCN, offering specialized support to veterans struggling with substance abuse and addiction as part of our mission to provide underserved populations with behavioral healthcare.

In this blog, Jonathan shares how his experiences overseas shaped his perspective on addiction medicine and his approach as a provider. In addition, he draws parallels between war abroad and the war we’re waging against substance abuse here in the U.S.

What is your connection to the U.S. military?

I am not a veteran myself. I spent eight years in Iraq and Afghanistan as a Department of Defense contractor. In my role, I cared for 100-200 American contractors (veterans from all branches) supporting an Air Force program. Before that experience, I worked on humanitarian projects in Latin America, Africa and Asia. I served as a member of the Maryland Disaster Medical Assistance Team and Johns Hopkins Go Team.

During my time in Iraq and Afghanistan, rotations were two to three months on and two months off. As the sole healthcare provider, I maintained 12-hour clinics seven days per week and had 24/7 on-call duties. During my R&R periods, I worked in a busy emergency department in Baltimore, MD.

My experience overseas very much informs my views on addiction medicine. That was the first time I had ever lived with and developed friendships with my patients. To this day, I remain in contact with a few, two of which I consider lifelong friends.

While living near my patients, I realized very quickly that many of them, particularly those who were deployed from 2001-2011, had endured substantial trauma. Following military separation, continued work in the deployed setting was, quite frankly, the “safest” place for them, as they needed solid social connections, routine, and employment in a setting amongst a group of people with shared experiences. Many of my patients’ military skills were not easily transferable to civilian life.

While I fortunately did not experience any patient deaths overseas, sadly, we lost eight to addiction and behavioral health issues while home on rest and recuperation leave.

Can you share comparisons between war/deployment and the battle we are fighting here against substance use disorders?

Politics and moral judgment aside, there are striking similarities between the battle spaces of veterans of foreign wars and veterans of “local wars.” In both cases, veterans may face many of the same challenges, including:

· Interpersonal violence

· Hypervigilance

· Housing, food and water insecurity

· Separation from family

· Loss of their “battle buddies”

· Generational impact on families

· Behavioral health needs

· Wound care needs

Baltimore is an exciting place to do this work. We have more than 10 hospitals within our beltway, three trauma centers, two academic medical centers, and an adult burn center. The U.S. military has programs here for trauma training (Center for the Sustainment of Trauma and Readiness Skills [C-STARS]). We have a VA hospital and the University of Maryland Hospital / Shock Trauma Center on one block downtown.

Essentially, in one place, we treat veterans of foreign wars. In contrast, in the other, we treat veterans of local wars, both of which have sustained similar injuries and endured traumatic experiences. My work both at home and abroad has strongly influenced my understanding of the challenges faced by our patients struggling with unmet addiction and behavioral health needs.

What I find most unfortunate is the veteran of both wars. The bottom line is that struggling military veterans need better access to care that provides the wraparound services they deserve.

Get help today

If you or someone you know is a veteran struggling with drug or alcohol abuse, our admissions team is available to take your call today. With an evidence-based, trauma-informed approach to treating substance use disorders, Pyramid Healthcare offers a full continuum of treatment programs, free transportation, 24/7/365 admissions and specialized support for medically complex individuals and people with open wounds.