1 of 12 GEN Barry R. McCaffrey, USA (Ret.) November N. Union Street, Suite 100 Alexandria, VA TAKING CARE OF AMERICA’S VETERANS TAKING CARE OF AMERICA’S VETERANS November 2013 BARRY R. McCAFFREY GENERAL, USA (RETIRED)

2 of 12 GEN Barry R. McCaffrey, USA (Ret.) November BIOGRAPHY OF GENERAL BARRY R. MCCAFFREY, USA (RET.) Barry McCaffrey served in the United States Army for 32 years and retired as a four-star General. At retirement, he was the most highly decorated serving General, having been awarded three Purple Heart medals (wounded in combat three times), two Distinguished Service Crosses (the nation’s second highest award for valor) and two Silver Stars for valor. For five years after leaving the military, General McCaffrey served as the Director of the White House Office of National Drug Control Policy (ONDCP). Upon leaving government service, he served as the Bradley Distinguished Professor of International Security Studies from ; and an Adjunct Professor of International Security Studies from at the United States Military Academy at West Point, NY. He served as an Associate Professor in the Department of Social Sciences from teaching American Government and Comparative Politics. General McCaffrey is a member of the Council on Foreign Relations and the Inter-American Dialogue. He has been elected to the Board of Directors of the National Association of Drug Court Professionals and the Atlantic Council of the United States. He is also Chairman of the Vietnam Veterans Memorial Education Center Advisory Board. He has served on the Board of Directors of several corporations in the engineering design, technology, and services sectors. He is on the Board of Directors of CRC Health Group – the nation’s largest behavioral health care company. General McCaffrey attended Phillips Academy, Andover, Mass.; and graduated from West Point with a Bachelor of Science degree. He earned a master's degree in American Government from American University and attended the Harvard University National Security Program as well as the Business School Executive Education Program. In 2007 he was inducted into the US Army Ranger Hall of Fame at the US Army Infantry Center, Ft. Benning, GA. In May 2010, he was honored as a Distinguished Graduate by the West Point Association of Graduates at the United States Military Academy. General McCaffrey is married to Jill Ann McCaffrey. They have three married adult children and six grandchildren. Their son, Colonel Sean McCaffrey, just retired from the Armed Forces after his third combat tour. Currently, General McCaffrey is President of his own consulting firm based in Alexandria, Virginia He also serves as a national security and terrorism analyst for NBC News.

3 of 12 GEN Barry R. McCaffrey, USA (Ret.) November OUR US MILITARY FORCES Department of Defense 1.4 million active duty. 1.1 million National Guard and Reserves. 718,000 civilian personnel. 5,000+ global locations. Budget 2011 $549.1 billion. 23 million veterans (7.5% of U.S. population). 1.6 million U.S. troops served in Iraq and Afghanistan. Since ,000 women have deployed to combat in Iraq or Afghanistan. Women are 14% of active duty military. 152 KIA; 951 WIA 2,153 killed and 18,071 wounded in Afghanistan. 56,932 total casualties in the War on Terror. THE MOST PROFESSIONAL AND COMBAT HARDENED BATTLE FORCE IN THE NATION’S HISTORY.

4 of 12 GEN Barry R. McCaffrey, USA (Ret.) November PTSD AND OUR VETERANS Affects 11-20% of veterans of Iraq and Afghanistan. 10% of Gulf War Desert Storm veterans. 30% of Vietnam Veterans. Factors include combat, the politics of the war, where its fought, and the type of enemy you face. 7-8% of the U.S. population will have PTSD at some point in their lives. Women (10%) more likely than men (5%) to develop PTSD at some point in their lives.

5 of 12 GEN Barry R. McCaffrey, USA (Ret.) November PTSD SYMPTOMS Upsetting memories. Increased jumpiness – hyper-arousal. Trouble sleeping. Scared, confused, angry. Feeling of helplessness. May also include alcohol or drug problems. Cognitive behavioral therapy (CBT) or anti-depression medication (SSRI) may provide relief.

6 of 12 GEN Barry R. McCaffrey, USA (Ret.) November TRAUMATIC BRAIN INJURY Brain injury trauma caused by accident, blast, or fall. TBI basically a concussion. Damage may cause bleeding between the brain and the skull. Bruises may form on brain matter. Length of time person knocked out one way to measure severity. Less than 30 minutes minor or mild. Even patients with moderate or severe TBI can make remarkable recoveries. Symptoms – headache, vision problems, memory problems, trouble putting thoughts into words, depression, personality changes. 22% of all OEF/OIF wounds are brain injuries (12% for Vietnam wounds). Symptoms for combat wounded may last months after TBI. IED’s and landmines are the signature weapon of the war in Iraq and Afghanistan. (3,000+ per month – Iraq 2006) (1,600+ per month Afghanistan – June 2011).

7 of 12 GEN Barry R. McCaffrey, USA (Ret.) November SUICIDE AND VETERANS U.S. general population suffers 30,000 to 32,000 suicides per year. 20% are veterans (18 deaths per day). Suicide rate – U.S. Civilians 24 per 100,000. Suicide rate U.S. military veterans – 30 per 100,000. Highest risk among those veterans wounded multiple times and hospitalized. Not linked necessarily to overseas deployments. 2,600+ U.S. military suicides past decade. 323 total military suicides in 2012 (as of Nov. 11, 2012). Total per branch: Army: 168 Navy: 53 Air Force: 56 Marines: 46 Traditionally military service members have been less likely to die by suicide than civilians data Army and Marine suicide rates more than double general population. Rates higher for those with multiple deployments, younger, Caucasian, enlisted, previous psychiatric diagnosis, alcohol or drug use (30%), legal problems, history of self-injury or mutilation. U.S. military has invested more than $50 million in research efforts to produce evidence-based tools for preventing suicide.

8 of 12 GEN Barry R. McCaffrey, USA (Ret.) November VETERANS – THE NATURE OF ADDICTION History of adolescent drug behavior. Addictive Neuro-chemical changes in brain function. Co-morbidity (mental health). The influence of environment (parents, peers). The influence of genetics. U.S. military illegal drug use rates low but increasing. Alcohol abuse a major problem – 27% returning Iraq/Afghanistan troops. Prescription drug misuse up 11%.

9 of 12 GEN Barry R. McCaffrey, USA (Ret.) November HOMELESS VETERANS One-fifth of the homeless population veterans. 56% African American or Hispanic. 107,00 veterans homeless on any given night. 76% experience alcohol, drug, or mental health problems. 33% served in a war zone. 47% served Vietnam era.

10 of 12 GEN Barry R. McCaffrey, USA (Ret.) November INCARCERATED VETERANS 140,000 veterans held in state and federal prisons. Male veterans half as likely as other men to be held in prison. (630 vs. 1,390 per 100,000). Veterans less likely than non-veteran prisoners to have used drugs. Over half of veterans (57%) were serving time for violent offenses compared to 47% of non-veterans. Nearly one in four veterans in state prison were sex offenders to one in 10 non-veterans. More than a third of veterans in state prison had maximum sentence of at least 20 years, life, or death.

11 of 12 GEN Barry R. McCaffrey, USA (Ret.) November VETERANS TREATMENT COURTS January First Veterans Treatment Court launched in Buffalo, NY. December Operational Veterans Treatment Courts with 100 more being planned. Hybrid Drug Court and Mental Health Court. Provide veterans with intensive treatment and other services while holding them accountable to the court, society, their families and themselves. Change the way the criminal justice system targets, identifies and treats veterans. Keep Veterans out of jail and putting them back to work, back in school and back with their families where they belong.

12 of 12 GEN Barry R. McCaffrey, USA (Ret.) November CONCLUSIONS MILITARY VETERANS The most current combat forces characterized by enormous courage, dedication, competence. ALL VOLUNTEERS. The U.S. Armed Forces the most respected institution in American society (79%). U.S. combat forces smallest force any modern U.S. conflict. Multiple deployments. No end in sight. We must care for our veterans. They have stepped forward to defend us.