Once a Warrior--Always a Warrior: Navigating the Transition from Combat to Home--Including Combat Stress, PTSD, and mTBI

Once a Warrior--Always a Warrior: Navigating the Transition from Combat to Home--Including Combat Stress, PTSD, and mTBI

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by Charles Hoge

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The essential handbook for anyone who has ever returned from a war zone, and their spouse, partner, or family members. Being back home can be as difficult, if not more so, than the time spent serving in a combat zone. It’s with this truth that Colonel Charles W. Hoge, MD, a leading advocate for eliminating the stigma of mental health care, presents Once a


The essential handbook for anyone who has ever returned from a war zone, and their spouse, partner, or family members. Being back home can be as difficult, if not more so, than the time spent serving in a combat zone. It’s with this truth that Colonel Charles W. Hoge, MD, a leading advocate for eliminating the stigma of mental health care, presents Once a Warrior—Always a Warrior, a groundbreaking resource with essential new insights for anyone who has ever returned home from a war zone. In clear practical language, Dr. Hoge explores the latest knowledge in combat stress, PTSD (post-traumatic stress disorder), mTBI (mild traumatic brain injury), other physiological reactions to war, and their treatment options. Recognizing that warriors and family members both change during deployment, he helps them better understand each other’s experience, especially living with enduring survival skills from the combat environment that are often viewed as “symptoms” back home. The heart of this book focuses on what’s necessary to successfully navigate the transition—“LANDNAV” for the home front. Once a Warrior—Always a Warrior shows how a warrior’s knowledge and skills are vital for living at peace in an insane world.

Editorial Reviews

“Returning veterans who are affected by PTSD, traumatic brain injury (TBI), combat stress, and other war-related reactions will find both compassion and the resources needed to understand and get needed help for these troubling, and often disabling, conditions.” —ForeWord Magazine

“There’s combat. Then, there’s the rest of your life. We need survival skills for each battle zone. This is the guide to surviving the war back here. We all need it. A hell of a book. The lucky get it.”

—Max Cleland, former United States Senator from Georgia, former Administrator of the Veterans Administration, decorated wounded combat veteran of the Vietnam War

"I've never met a mental health professional who 'gets it' as well as Colonel Charles Hoge. He's done the research, he's been shoulder-to-shoulder with warriors, and he's woven it together in language that is real and resonant. Once a Warrior—Always a Warrior is a vital handbook for every leader, and it is a survival book for warriors-come-home."   —Nate Self, former Army Ranger Captain, author of Two Wars: One Hero's Fight on Two Fronts—Abroad and Within

“John Denver’s lyrics about coming home to a place you’ve never been before sums up this book. A brilliant guide, and very much needed now.”   —Gordon R. Roberts, Medal of Honor recipient  

“Of all the victimizing crap out there regarding what real warriors experience in battle, Dr. Hoge’s deeply researched work stands a breed apart from anything in this genre. He has simply written the best, most comprehensive study of not only what those at the tip of spear have endured, but what they can expect to go through as they confront the realities of combat. Just as every warrior should drink water and clean their rifle in battle, every returning veteran should pack this book as they continue their journey home.”  —Staff Sergeant David Bellavia, author of “House to House: An Epic Memoir of War”

"Once a Warrior—Always a Warrior provides a uniquely valuable addition to the subject of Post Traumatic Stress in the military population because it comes from a Soldier and a mental health professional who has years of real world, hands-on experience helping our warriors deal with these issues. Dr. Hoge possesses the rare gift of being able to translate the science from published research into the language of the warrior.  As valuable as this book is for warriors coping with experiences that in many instances are normal responses to abnormal circumstances, it should also be required reading for mental health professionals to whom our warriors turn for assistance. It will help them strike the right chord with those they serve, even if they have not walked in their boots. Finally, it's a book for the warrior's family.  It will help them to understand, participate in, and facilitate the warrior's journey, and realize that it can be a journey of growth." 
—James B. Peake, M.D., Former Secretary of Veteran Affairs (2007-2009), 40th Surgeon General of the U.S. Army, decorated combat veteran


“Dr Hoge has served his nation well by compiling a user friendly guide to issues this generation faces in the long wars of Iraq and Afghanistan. Written in a language warriors can understand he takes complex issues and delivers practical advice, tips and strategies that are the antidote to suffering. Ultimately no matter the experience, the warrior must decide which path they will choose. They can go down a negative path that leads to dysfunction and suffering or they can chose to own their experience, rather than being owned by it. This book and the skills within it can serve as a first step in a journey toward resilience and positive growth.”  —Steve Robinson, SFC (Retired), Army Ranger, Veteran Advocate 

“Dr. Hoge explains cutting edge medical discoveries in plain English, and describes the psychological and physiological mechanisms underlying post-deployment transition challenges.  In essence, he tells us two things: there are good reasons why it is hard to adjust to “normal” life after combat, and understanding those reasons empowers us and makes us more likely to succeed at adjusting and integrating combat experiences into a healthy psychological and emotional life.  This understanding is essential for our growing ranks of combat veterans and their loved ones, mental health professionals, policy makers, and concerned citizens, and this book is the way to get it.”   —Gabriel Ledeen, Former Captain, U.S. Marine Corps, 2-tour Iraq Combat Veteran, Senior Fellow, Vets For Freedom

“Dr. Charles Hoge has provided those who defend us a road map for treatment and support of their unseen wounds. The burden is heavy among those returning from deployment and the system they must navigate is complex. Barriers jump up at many points along the way. Our warriors are provided with the very best guidance on the battlefield so they may find their way to safety and victory; Dr. Hoge has provided our returning warriors guidance for gaining victory over the pain within.”  —Dan G. Blazer, MD, PhD, JP Gibbons Professor of Psychiatry and Behavioral Sciences, Duke University Medical Center

“Once a Warrior – Always a Warrior is the answer to the question “Where can I get great advice to help me adjust to returning home?”  Charles Hoge shares his experience as a soldier and his wealth of knowledge as a physician and mental health expert with the aim of easing the transition from the battleground to civilian life. The book is fact-filled, authoritative, and immensely practical. It is a must read for returning military personnel, their families and friends, and anyone who provides care to active duty personnel and veterans.”   — Murray B. Stein MD, MPH, Professor of Psychiatry and Family & Preventive Medicine, University of California San Diego; Staff Psychiatrist, VA San Diego Healthcare System; Volunteer Staff Psychiatrist, Naval Medical Center San Diego

“Finally, a respected military leader and mental health professional brings a no-bullshit, common-sense approach to the discussions on combat stress, resilience and warrior adaptations. Colonel Hoge’s integrity and deep commitment to supporting America’s service members are clearly expressed in this book. It is an excellent starting point for anyone who wants to understand and navigate their own adaptations to operational stress and adversity, or those of the people they care about. This is a great resource for warriors of all backgrounds and generations.”   —Dan Taslitz, former Reconnaissance Marine, Iraq combat veteran.

“This superb book should be required reading for all mental health clinicians working with new veterans, particularly those in Veterans Administration medical centers.  Dr. Hoge's combination of crystal clear prose, deep understanding of the warrior experience, and thoughtful, practical advice, makes Once a Warrior indispensible to any veteran (or anyone helping him) ease the transition to civilian life or recover from more serious illness.  Dr. Hoge's message is essential - everyone is changed by war, but even those with the most lasting effects can recover by embracing their warrior spirit.”   —Sally Satel, American Enterprise Institute, Washington DC

“True to his word, Charles Hoge "cuts to the chase", gets rid of as much jargon as possible, and provides warriors with a comprehensive, accessible and sophisticated no-nonsense survival manual regarding post-deployment transition and readjustment.  He provides a unique perspective that is rarely equaled through both his personal experiences as a soldier and his scientific mastery of the latest developments on the causes and treatment PTSD, TBI and related problems.”     —Matthew J. Friedman MD, PhD; Executive Director, National Center for PTSD, US Department of Veterans Affairs; Professor of Psychiatry and Pharmacology & Toxicology, Dartmouth Medical School 


“Colonel Hoge, MD, a well-known and respected psychiatric researcher and clinician, has written a smart, insightful, jargon-free book on reactions to trauma and the syndrome of Post Traumatic Stress Disorder. This book is a gift to anyone in the military or anyone who has relatives or loved-ones in the military. What was obvious to me is that Col. Hoge genuinely cares about the health and well-being of people serving in the military and of their relatives. His direct, clear language and thinking help clear up many misconceptions about reactions to combat, and provide useful tools to aid in recovery/readjustment.”  —Greer Richardson, MD, Assistant Clinical Professor of Psychiatry, Yale University; Veterans Affairs Staff Psychiatrist, West Haven, Connecticut

Library Journal
Retired army physician Hoge (research director, Division of Psychiatry and Neuroscience, Walter Reed Army Inst. of Research) addresses the psychological problems returning combat veterans face and the social stigma attached to seeking mental health care. As a remedy, he redefines their symptoms as a physiological condition including behaviors that had been necessary for combat survival but are less functional in a civilian setting. Beginning with a discussion of post-traumatic stress disorder (PTSD) and mild traumatic brain injury (MTBI), including incidence, checklists of symptoms, causes, and associated conditions, and the current professional debate over whether combat-related reactions are based on psychological (PTSD) or physical causes (MTBI), Hoge then presents his own system for managing transition problems. Skills for life survival, managing stress, monitoring feelings and emotions, and navigating the mental health-care system are outlined. Strategies for family members are offered, and the book concludes with a section on loss and coping. VERDICT More self-help and less policy-oriented than Victor Montgomery III's Healing Suicidal Veterans, this work addresses a similar audience by using the language of military camaraderie and acknowledging that war changes people in ways only other warriors may fully grasp. A workmanlike but user-friendly guide for returning combat vets experiencing a broad variety of adjustment problems.—Antoinette Brinkman, MLS, Evansville, IN
From the Publisher
"A workmanlike but user-friendly guide for returning combat vets experiencing a broad variety of adjustment problems." —Library Journal

Product Details

Rowman & Littlefield Publishers, Inc.
Publication date:
Edition description:
First Edition
Sales rank:
Product dimensions:
5.90(w) x 8.90(h) x 1.00(d)

What People are saying about this

From the Publisher
"A workmanlike but user-friendly guide for returning combat vets experiencing a broad variety of adjustment problems." —-Library Journal

Meet the Author

Col. Charles W. Hoge, M.D., Colonel U.S. Army (Retired), served as Director, Division of Psychiatry and Neuroscience at Walter Reed Army Institute of Research from November 2004 until his retirement in summer 2009. Since 2000, Colonel Hoge has directed a comprehensive research program at the Walter Reed Army Institute of Research (WRAIR) focused on mitigating the mental health impact of the current wars in Iraq and Afghanistan. His program has been responsible for the Mental Health Advisory Team (MHAT) assessments in Iraq and Afghanistan, research that led to the DoD Post-Deployment Health Reassessment Program, and the development of novel educational efforts to reduce stigma and promote psychological health after deployment, including Battlemind Training. In addition, he maintains a clinical practice caring for soldiers and family members with war-related mental health conditions. Col. Hoge is also a national spokesperson for the Department of Defense (DoD) on war-related mental health issues and traumatic brain injury. He has been interviewed on hundreds of occasions by major news organizations on camera, radio, or in print, including NBC, CBS, ABC, CNN, C-SPAN, NPR, Reuters, AP News, New York Times, Washington Post, USA Today, Newsweek, and numerous others, including the Diane Rehm Show, the Paula Zahn Show, and the Dr. Oz Show. He has published over 90 peer-reviewed articles, letters, and chapters. His most widely cited articles pertain to the mental health impact of the wars in Iraq and Afghanistan and to mild traumatic brain injury among U.S. troops returning from Iraq. He is the recipient of numerous awards in his field, including the U.S. Army Achievement Medal for Psychiatric Research; the U.S. Army Commendation Medal for selection as finalist for Bailey K. Ashford Research Award, Walter Reed Medical Center; the Iraq Campaign Medal, OIF-2, Mental Health Advisory Team Member; the U.S. Army Meritorious Service Medal for General Officer Mental Health Summit, and, in 2006, the U.S. Army Medical Research and Materiel Command Combat Casualty Care Program Award for Excellence in research to support the mental health of deployed forces.

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Once a Warrior, Always a Warrior 5 out of 5 based on 0 ratings. 7 reviews.
Gulf-War-1-Warrior More than 1 year ago
In reading the first three chapters, Hoge changed my thinking about PTSD dramatically. As a Gulf War veteran who returned with an array of medical conditions, I was initially told it was all stress related; however, I was a nonbeliever. Hoge addresses this in his book. I began to understand -- for the first time -- that PTSD is not only for combat veterans who actually fired a shot in anger, but also for those support troops that simply lived in "fear" of SCUDS, NBC attacks and the "mother of all ground action" -- but never really experienced. A large part of this fear was due to the inability to defeat it -- fire back at the enemy. Many ill Gulf War veterans may want to read this book and reflect back on their time in the "sandbox" only to return with unanswered health problems. I was particularly surprised by the symptoms that I shared with those with actual combat experiences. I also reflected on other "highly stressful" military occupations that place service members in dangerous situation right here in CONUS -- military law enforcement, firefighter, medics, missile launch officers -- many occupations that seeking mental health counseling could adversely impact security clearances or promotional potential. Good read and got me thinking difference about PTSD -- and seeking new answers to why am I sick? This book opened a new door for me.
Anonymous More than 1 year ago
This book has a tremendous amount of information in it. It helped understand many things that was explained to me before or told to me. Many of the things written in this book now makes since to me and the tools and suggestions really work.
toddstage More than 1 year ago
As a Vet from OIF, I appreciate the balance this book makes between breaking down PTSD academically and telling it from a grunt's perspective. I especially appreciated the "back home" accounts of the 1st Sgt.
Anonymous More than 1 year ago
Anonymous More than 1 year ago
Recommended by USMC veterans and this Marine spouse. Read it and then tell your friends and family to read it. Understand your warrior and love and respect them even more!
Anonymous More than 1 year ago
Anonymous More than 1 year ago