MILITARY VETERANS STRUGGLING WITH SUBSTANCE USE DISORDERS

Caitlin Fecteau, Kyle Kelly, & Sabrina Lanker

Welcome VHA Leadership!

Issue: Addressing Veterans with

Substance Use Disorder(s) (SUDs)

Impetus for the Research Activity

Challenges for Military Veterans:

• Difficulties in reintegrating into civilian life
• Impacts on mental, behavioral, and physical health from active duty experiences

Substance Use Disorders (SUDs):

• High prevalence among Veterans
• Significant impact on well-being and reintegration

Our Research Team:

• Social workers with diverse experiences
• Involvement with U.S. Department of Veterans Affairs and state/national opioid task forces

Research Focus:

• Exploring VHA approaches to support Veterans with SUD
• Assessing VHA’s mental, behavioral, and physical health resources

Research Goals:

• Highlight importance of effective support systems and treatment programs
• Improve health outcomes and quality of life for Veterans

The Programmatic Context:

Substance Use Disorders (SUD):

• 11% of Veterans presenting for first-time care with VHA diagnosed with SUD (NIDA, 2019)
• 65% of Veterans with SUD received treatment in VHA specialty programs (VA OIG, 2019)

Alcohol Misuse:

• 43% of Veterans report binge drinking in the past year
• 27% of Iraq and Afghanistan Veterans report alcohol misuse (Bohnert et al., 2016; Seal et al., 2011)

Pain Management and Opioid Use:

• Two-thirds of Veterans report experiencing pain; >9% severe pain (Nahin, 2017)
• Increase in opioid prescriptions: 17% (2001) to 24% (2009) (Teeters, 2017)
• Opioid overdose rates: 14% (2010) to 21% (2016), mainly due to heroin/synthetic opioids (Lewei et al., 2019)
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The Programmatic Context Cont:

Mental Health:

• 40-50% of Veterans with SUDs have co-occurring mental health disorders (Greenberg et al., 2010)
• 20% of Veterans with PTSD also have a SUD (VA, 2017)

Barriers to Care:

• 56% perceive logistical barriers: transportation, scheduling conflicts (Elbogen, 2013)
• 58% report attitudinal barriers: stigma, reluctance to seek help (Tanielian, 2008)

Stigma and Military Culture:

• Historical stigma discouraging treatment for behavioral issues and substance use
• Minority Veterans at a particualrly high risk for SUD and suicide

Penalizing: loss of rank, job, career opportunities, social ostracism

Current efforts: more empathic messaging, evidence-based treatment

Search Criteria to Find the Studies:

Databases Utilized:

• Google Scholar
• PubMed
• University of Michigan Library
• Government websites
• Specialized journals in behavioral health, substance use, Veteran population health, and social work

Literature Scope:

• Reviewed studies from the past 20 years

Search Terms:

• "Veteran substance use"
• "Veterans substance use stats"
• "Social determinants of health for Veterans with SUD"
• "VA services for SUD treatment"
• "Veterans mental behavioral health stigma"
• "Impact of substance use among Veterans"

Sources:

• Reviewed and selected high-quality sources with empirical data
• Providing multi-disciplinary perspectives

Top Five Studies:

• Selected based on their ability to provide wide-ranging insights
• Enhanced overall understanding of the issue

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Limitations of the studies:

Data Collection Biases

• Potential biases in methods
• Underreporting affects sample accuracy

Design Constraints

• Reliance on cross-sectional designs
• Limits causal inferences

Sample Representation

• Findings mainly reflect Veterans who:
• Seek treatment
• have or are at risk of substance use disorders
• Not fully representative of broader population

Recommendations for Future Research

• Larger, more diverse samples needed
• Utilize longitudinal approaches for comprehensive insights

The Plan

Improving access to cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) in rural areas.

• Expanding access to substance use treatment services is crucial, especially in rural areas where Veterans may have limited access.
• Cognitive behavioral therapy (CBT)
• Dialectical behavior therapy (DBT)

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• Veterans living in rural areas may have difficulty accessing health services for reasons similar to other rural residents.
• Poverty
• Homelessness
• Education

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• Actionable Items:
• Monthly Outreach Events
• Healthcare providers can form a partnership with the VHA
• Distribute Educational Materials Quarterly

Peer Support Programs & Employment and Housing Support

• Weekly community peer support programs to connect Veterans in recovery with peers who have lived experience with substance use disorders and recovery.

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• Hire 1 additional full-time employee to support Veterans through the Mental Health Intensive Case Management Program.

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• Increase funding by 10% for local programs that offer job training, placement services, and housing assistance can help Veterans achieve stability and reduce the risk of SUD.

Healthcare Providers & VHA Partnership

• Build Local Networks
• Complete a national survey with at least 100 rural healthcare providers willing to collaborate on treating Veterans with substance use disorders.

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• Training Programs for Providers
• By February 28, 2026, develop a comprehensive CBT and DBT training curriculum tailored for substance use disorder treatment for Veterans and pilot it with at least 2 rural providers.

Resource Sharing:

• By March 2026 that gives at sample of at least 30 rural providers (nationally) access to VHA’s training materials, toolkits, and best practice guidelines.

Creating strong partnerships between local healthcare providers and the VHA ensures that:

• Veterans receive consistent, high-quality care.
• Lleverage the strengths of each entity to enhance service delivery, especially in underserved rural areas

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(U.S. Department of Veterans Affairs, 2019).

https://linktr.ee/VetSUD