General Overview 

According to the U.S. Department of Veterans Affairs (2021), there are almost 19 million military veterans in the U.S. Unfortunately, upon their return home, some veterans may deal with an entirely new set of physical and mental health issues. And while the physical pain can be treated, the long-term mental effects can be even more detrimental to everyday life.

More than 1 in 4 active duty members are found to have at least one mental health condition every year (National Alliance on Mental Illness, 2021).

Common mental health conditions among veterans include:

  • PTSD
  • Anxiety disorders
  • Depression
  • Substance use disorder;
  • and thoughts of suicide

​Research suggests that 11-20% of veterans experience PTSD in any given year (U.S. Department of Veterans Affairs, 2018). This can lead to higher rates of substance use disorder which is found to be linked to PTSD and depression (U.S. Department of Veterans Affairs, 2018). In addition, suicide rates among veterans have increased in recent years (Defense Suicide Prevention Office, 2021). 

References:

Defense Suicide Prevention Office. (2021). Quarterly reports. Retrieved from https://www.dspo.mil/qsr/ 
National Alliance on Mental Illness. (2021). Veterans and Active Duty. Retrieved from https://www.nami.org/Your-Journey/Veterans-Active-Duty
U.S. Department of Veterans Affairs. (2018). Research on mental health. Retrieved from https://www.research.va.gov/topics/mental_health.cfm 
U.S. Department of Veterans Affairs. (2021). Veteran population. Retrieved from https://www.va.gov/vetdata/veteran_population.asp 
It’s important to know that you’re not alone. There are many resources to help manage mental health for veterans. These include:

Military-Related Family Issues

The military is one of the demanding and necessary institutions in America, with over 8% of the country having served in the military and a third of the country being directly related to someone in the military (Ormeno, 2020). Service members and their families are a distinct population with unique exposures and stressors that significantly impact their lives. These unique experiences often lead to major family problems and discord such as substance abuse, divorce, child maltreatment and neglect which ultimately leads to poor parental and child mental health. Due to the uniqueness of the experiences of military families, clinical treatment for military families experiencing such problems is often under-researched and overlooked (Gribble, 2020).

The various stressors that military families face have been shown to negatively impact parental and especially child mental health. First, the service member experiences stress from the traumas of war and lack of engagement with the family. Second, the remaining parent experiences stress due to the increased workload of keeping the family afloat and taking care of the kids. Lastly, the child experiences stress due to the consequent lack of parental engagement and care. Lipari’s (2015) study showed that 29% of military wives had some form of mental illness, primarily anxiety and depression (Mailey, 2018) and 16.7% of military children had at least one major depressive episode. Consequently, this high occurrence of mental illness was also linked to higher frequency of alcohol and substance use in parents and children. 

Mental health in children was significantly more affected when the family experienced long and repeated cycles of deployment. This effect was particularly more prominent when the service member was in an active combat zone or previously had combat exposure. For example, children whose family members were in an active combat zone had significantly higher occurrences of depression and attention disorders like ADHD, which led to poor academic performance and behavioral issues (Briggs, 2019). Additionally, having more or older children in the family increased risk of mental illness in children, as it made it harder for the remaining parent to care for the children (Briggs, 2019).

One reason for the diminishing mental health in military children is the lack of communication within the family. Often, this lack of communication is caused by the service member’s PTSD or emotional numbing that prevents them from emotionally engaging with or opening up to the family. This unwillingness to talk about their traumatic experiences leaves the remaining parent feeling alienated by the service member’s emotional withdrawal. Consequently, the child is on the receiving end of this parental distress caused by lack of communication, as children will often blame themselves for the family falling apart, leading to feelings of distrust and emotional separation from the family (Saltzman, 2011). Another reason for the poor mental health of military children is poor parenting, leading to lack of family organization and guiding belief systems. Gibbs (2007) have shown that due to the heightened distress experienced by parents, they are less likely to engage with the child, leading to neglect and/or mistreatment. The inability of the parent to maintain consistent child discipline and engagement leads to their children having difficulty with regulating emotions and behaviors. Consequently, the children will often exhibit disruptive behavior or withdrawal from society, which render them less capable of dealing with future stressors (Saltzman, 2011). 

As military families are distinct from non-military families, it is important to tailor treatment and prevention tactics to the unique experiences and family dynamics of military families. Military families are often overlooked in research on mental health due to the complexity of their family dynamics. The effects of military deployment on family mental health are more than significant and treatment and prevention methods should focus on the specific aspects and stressors of military families. The key is building resilience, or the ability to withstand hardship with emotional adaptation and positive characteristics such as creativity and competence (Gribble, 2020). Additionally, militaries are showing increasing diversity in their service members, as women make up more than 10% of military personnel and approximately 3% identify as gay, lesbian, or bisexual (Gribble, 2020). Future research should reflect the complexities of family dynamics that come with this diversity of service members. 

If you are/know a military family member that needs help, check out:
References:
  1. Briggs EC, Fairbank JA, Tunno AM, Lee RC, Corry NH, Pflieger JC, Stander VA, Murphy RA. Military Life Stressors, Family Communication and Satisfaction: Associations with Children's Psychosocial Outcomes. J Child Adolesc Trauma. 2019 May 21;13(1):75-87. doi: 10.1007/s40653-019-00259-z. PMID: 32318230; PMCID: PMC7163866.
  2. Gibbs, D. A., Martin, S. L., Kupper, L. L., & Johnson, R. E. (2007). Child maltreatment in enlisted soldiers' families during combat-related deployments. JAMA, 298(5), 528–535. https://doi.org/10.1001/jama.298.5.528
  3. Gribble, R., Mahar, A. L., Keeling, M., Sullivan, K., McKeown, S., Burchill, S., Fear, N. T., & Castro, C. A. (2020). Are we family? A scoping review of how military families are defined in mental health and Substance Use Research. Journal of Military, Veteran and Family Health, 6(2), 85–119. https://doi.org/10.3138/jmvfh-2019-0054 
  4. Lipari, R. N., Forsyth, B., Bose, J., Kroutil, L. A., & Lane, M. E. (2015). Spouses and children of U.S. military personnel: Substance Use and Mental Health Profile from the 2015 National Survey on Drug Use and health. SAMHSA. Retrieved June 23, 2022, from https://www.samhsa.gov/data/sites/default/files/NSDUH-MilitaryFamily-2015/NSDUH-MilitaryFamily-2015.htm#:~:text=In%20the%20past%20year%2C%20an,combination%20of%20counseling%2C%20treatment%2C%20and 
  5. Mailey, E. L., Mershon, C., Joyce, J., & Irwin, B. C. (2018). “Everything else comes first”: A mixed-methods analysis of barriers to health behaviors among military spouses. BMC Public Health, 18(1). https://doi.org/10.1186/s12889-018-5938-z 
  6. Ormeno, M. D., Roh, Y., Heller, M., Shields, E., Flores-Carrera, A., Greve, M., Hagan, J., Kostrubala, A., & Onasanya, N. (2020). Special concerns in military families. Current Psychiatry Reports, 22(12). https://doi.org/10.1007/s11920-020-01207-7 
  7. Saltzman, W. R., Lester, P., Beardslee, W. R., Layne, C. M., Woodward, K., & Nash, W. P. (2011). Mechanisms of risk and resilience in military families: theoretical and empirical basis of a family-focused resilience enhancement program. Clinical child and family psychology review, 14(3), 213–230. https://doi.org/10.1007/s10567-011-0096-1

Substance Abuse in Veterans

Substance abuse has become an increasingly concerning problem among US veterans. The traumatic experiences of extended combat exposure put veterans at increased risk of substance use disorders (SUD), with over one in ten veterans suffering from SUD (NIDA, 2019). Of the veterans suffering from SUDs, 80% use alcohol, 27% use illicit drugs and 7% use both (Miller, 2021). SUDs in veterans have been associated with medical problems, increased suicide attempts, problems with jobs and interpersonal relationships, and mental health disorders, like anxiety and depression (Teeters, 2017). Despite the negative impact of SUDs on veterans, treatment for SUDs has been relatively inaccessible or increasingly difficult for some veterans. 

The most common form of SUD was alcohol use, which is concerning as alcohol is one of the leading causes of death in the US. Among veterans and active duty members, alcohol was seen as a cultural norm for recreation and socializing, as well as a way to relieve stress. For example, veterans with more combat exposure were found to be more likely to abuse alcohol and engage in binge-drinking. Alcohol abuse has been specifically linked in veterans to increased risk of violence, poor health and mortality (Teeters, 2017). The other common form of SUD is opioid use with opioids being increasingly prescribed to veterans to treat chronic pain and migraine headaches. For example, from 2001 to 2009, opioid prescription increased from 17% to 24%, with the majority of the prescriptions being oxycodone and hydrocodone (Teeters, 2017). Additionally, veterans with PTSD or mental illness diagnoses were more likely to get prescribed opioids and receive higher doses. Concerning was that veterans suffering from opioid abuse and mental illness were more likely to get admitted to the ER or have opioid-related accidents or overdoses (Teeters, 2017). Other substance use, like tobacco and marijuana, were also higher in veterans than civilians (PTSD and Substance Abuse) (Wagner, 2007). 

One seemingly inextricable correlate of SUD in veterans was mental illness, whether it was mental health causing substance abuse, or the other way around. The most commonly linked mental illness to SUD in veterans is PTSD, or Post-Traumatic Stress Disorder. PTSD is especially prevalent in veterans, with approximately 30% of Vietnam veterans and 11-20% of Operation Iraqi Freedom and Operation Enduring Freedom (OIF, OEF) veterans having experienced PTSD in their lifetime. In a 2020 survey, nearly 83% of veterans and active duty members reported experiencing PTSD since the 9/11 attack (PTSD Statistics). 

Veterans are not only at higher risk for PTSD but are at higher risk for PTSD-related SUD. Studies have shown that one in five veterans with PTSD suffered from SUD  (PTSD and Substance Abuse) and 63% of veterans suffering from alcohol use disorders also had co-occurring PTSD (Reisman, 2016). In addition, the number of veterans who smoke tobacco is almost double for those that have been diagnosed with PTSD compared to those with no PTSD diagnosis (PTSD and Substance Abuse). Other major depressive disorders have also been higher in veterans, which may be linked to their increased risk of substance use (Vazan, 2013). For example, veterans with SUD were 3-4 times more likely to be diagnosed with PTSD or depression. The relationship between mental health disorders and substance use is a chicken or the egg debate, as it is unclear which causes which and is probably a bit of both. However, what is clear is that there is a clear correlation between the two.

Although treatment of SUD is available in the form of Narcotics Anonymous/Alcoholics Anonymous meetings, and Veterans Affairs (VA) medical centers, it is not readily accessible for some veterans. Treatment is often more difficult for veterans because dual diagnosis of SUD and mental health disorders results in more severe symptoms and poorer treatment outcomes. This is especially true for veterans living in rural areas (over 40% of veterans), where access to mental health care is limited. Additionally, the social stigma around mental illness and SUD in a hypermasculine military culture makes it more difficult for veterans to seek help or even acknowledge mental illness or SUD as a problem. The hypermasculine culture of military communities makes it especially difficult for female veterans to seek appropriate treatment, which may explain the apparent increase in SUD in female veterans (Teeters, 2017). Moving forward, it is important to tailor treatment of SUD and mental illness to a wider variety of veterans across the US. 

Helpful Resources:
Substance Use Treatment for Veterans
References
  1. Miller, L. (2021, August 19). Statistics on veterans and substance abuse. veteranaddiction.org. Retrieved July 26, 2022, from https://veteranaddiction.org/rehab-guide/veteran-statistics/
  2. NIDA. 2019, October 23. Substance Use and Military Life DrugFacts. https://nida.nih.gov/publications/drugfacts/substance-use-military-life on 2022, July 26
  3. PTSD and Substance Abuse in Veterans. Substance Abuse in Veterans. (2011, December 22). https://www.ptsd.va.gov/understand/related/substance_abuse_vet.asp
  4. PTSD statistics: How many veterans have PTSD? Cumberland Heights. (2021, November 9). https://www.cumberlandheights.org/blogs/ptsd-statistics-veterans/
  5. Reisman M. (2016). PTSD Treatment for Veterans: What's Working, What's New, and What's Next. P & T : a peer-reviewed journal for formulary management, 41(10), 623–634.
  6. Teeters, J. B., Lancaster, C. L., Brown, D. G., & Back, S. E. (2017). Substance use disorders in military veterans: prevalence and treatment challenges. Substance abuse and rehabilitation, 8, 69–77. https://doi.org/10.2147/SAR.S116720
  7. Vazan, P., Golub, A., & Bennett, A. S. (2013). Substance use and other mental health disorders among veterans returning to the inner city: prevalence, correlates, and rates of unmet treatment need. Substance use & misuse, 48(10), 880–893. https://doi.org/10.3109/10826084.2013.796989
  8. Wagner, T. H., Harris, K. M., Federman, B., Dai, L., Luna, Y., & Humphreys, K. (2007). Prevalence of substance use disorders among veterans and comparable nonveterans from the National Survey on Drug Use and health. Psychological Services, 4(3), 149–157. https://doi.org/10.1037/1541-1559.4.3.149​

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