Department of Veterans Affairs (VA) pharmacist Norman Hooten isn’t a typical new practitioner of clinical pharmacy—he’s a retired Army Master Sergeant and combat veteran, perhaps best known for his service as a Delta Force team leader who fought in the 1993 Battle of Mogadishu, Somalia.
Eighteen U.S. soldiers fell during that urban battle, which inspired the 2001 movie Black Hawk Down.
Hooten said losing friends and colleagues in combat is always tragic and difficult, even though soldiers are “mentally prepared and trained to expect combat loss and, more important, to deal with the loss of human lives in combat.”
But he said he wasn’t prepared for the dangers that affected service members off the battlefield.
“What I saw, after I left the Army, was a significant number of my friends and former colleagues became addicted to substances—alcohol, opioids, stimulants,” Hooten said. “A lot of them died of overdoses, lived through substance use disorders, or . . . committed suicide.”
VA’s Office of Mental Health and Suicide Prevention in June reported an average daily suicide rate of 20.6 for veterans, active-duty service members, and nonactivated guard members and reservists. That figure is from 2015 and has been essentially unchanged since 2008.
Veterans accounted for 16.8 suicides per day in 2015, and suicides were highest among veterans with substance use disorder or bipolar disorder. The report also cited “substantial” increases in veterans diagnosed with substance use disorder from 2005 to 2015.
Hooten reasoned that by becoming a pharmacist, he could help troubled veterans, although he said he didn’t at first appreciate the complexity of substance use disorders.
“I . . . thought, from a simple standpoint, that if I learn to manage medications, that I may be able to help,” he said. “You don’t really consider all the other things that go into it like the social problems, maybe some things they saw when they were growing up, different factors that contribute to substance use disorders.”
Hooten began his pharmacy school studies in 2001, but he was recalled to active duty after the 9/11 terrorist attacks. He then worked for several years for the Federal Air Marshal Service and for a defense contractor, positions where he had the opportunity to supervise veterans.
During those years, he said, he witnessed the magnitude of the substance use and mental health challenges among veterans.
“That was really kind of the triggering event that pushed me to going back to pharmacy school,” Hooten said. He enrolled in the Palm Beach Atlantic University School of Pharmacy in West Palm Beach, Florida, as part of the class of 2016, then completed a postgraduate year 1 (PGY1) residency at the Orlando VA Medical Center and a postgraduate year 2 (PGY2) residency at the West Palm Beach VA Medical Center.
The residency training gave Hooten the opportunity to work directly with veterans affected by substance use problems and related issues. During that time, he said, he viewed a “siloed” system of care as a likely obstacle to helping these patients.
“As a resident, for instance, I’d be in the pain clinic for a month, I’d see a patient for a month. And then a month later, I’d rotate into the substance use clinic and I’d see the same guy,” Hooten said. He later encountered some of these same patients while on rotation at the posttraumatic stress disorder clinic.
During his PGY1 year, Hooten worked with the healthcare team at the Orlando VA Medical Center to establish an interprofessional clinic that brought together specialists in mental health, substance use, and chronic pain for the coordinated treatment of interrelated conditions.
“We saw great benefit from it,” Hooten said. “We saw a decrease in their pain scores, we saw better sleep. Almost every measurable category that we looked at, we saw improvement.”
He said the pilot project—dubbed the Comprehensive Addiction and Recovery Act Clinic—has since been expanded at the Orlando facility. Under this model of care, he said, a psychologist, psychiatrist, pharmacist, and physician who specialize in pain management and a substance use or addiction specialist all meet together with the patient to coordinate care.
Hooten said there’s “a big opportunity for pharmacists to take the lead” and help such patients.
When Hooten began his studies, he was initially worried about being the oldest student in pharmacy school. But he said neither that nor the fact that he knew “absolutely nothing” about clinical pharmacy held him back.
“When you’re going into something that may be uncharted to you, you can’t wait for a road map. Because if you wait for that perfect road map, the perfect plan, you’ll never get started. Sometimes you just have to step into it and figure it out as you go. And that’s kind of what I’ve been doing,” he said.
As he learned more about the profession of pharmacy, he first thought to specialize in pain management.
“And then as I got further into it, I realized that the things that interested me more were the mental health components of it,” he said. That led him to focus on neuropsychiatry as a PGY2 resident.
After completing his PGY2 residency program this summer, Hooten joined the staff at the Orlando VA Medical Center, where he works in the inpatient mental health area.
“A lot of what we see in inpatient mental health deals directly with substance use disorder. So I feel like I’m in a good place to learn more about what I started out learning so many years ago,” Hooten said.
Though he’s started a new career in healthcare, Hooten hasn’t left behind his military roots or his views of service.
“I started out in the Army,” he said. “I kind of considered myself a lifelong soldier and, really, still do.”
He’s also found that, as a combat veteran, he’s better able to forge a personal connection with his patients.
“A lot of times it’s a great icebreaker, and they tend to open up a little more than normal,” he said.
[This news story appears in the November 1, 2018, issue of AJHP.]