How Stigma Affects Substance Abuse and Mental Health Care for Veterans

Key Takeaways

• Stigma creates barriers for veterans seeking mental health and substance use care, manifesting as social, self, professional, and structural stigma.
• Public stigma affects veterans’ reintegration into civilian life and access to care, with perceptions of dangerousness and incompetence leading to social exclusion.
• Self-stigma, influenced by military culture and values, leads to internalized negative beliefs and hinders help-seeking behavior among veterans.
• Substance use is prevalent among veterans due to factors like combat exposure, with alcohol and tobacco use being particularly high.
• Mental health challenges, including PTSD and SUDs, are significantly prevalent among veterans, exacerbated by combat stress and the transition to civilian life.
• Approximately 21 veterans die by suicide daily, indicating a critical need for accessible mental health care and suicide prevention efforts.
• Despite available resources, many veterans do not engage in treatment due to stigma, highlighting the need for stigma reduction initiatives.
• Programs like the Real Warriors Campaign and Military Pathways aim to normalize mental health discussions and reduce stigma.
• The VA’s Equity Action Plan and anti-stigma campaigns like Make the Connection seek to improve access to care and change public attitudes.
• Education, leadership support, and personal endorsements are key to combating stigma and promoting mental health care among veterans.

Defining Stigma in the Context of Veteran Health

Stigma, a critical concept in understanding the challenges faced by veterans in seeking care, refers to the negative attitudes, prejudices, or stereotypes associated with certain traits, behaviors, or health conditions. This social phenomenon can manifest in various forms, each with its distinct impact on individuals, particularly veterans. Research identifies several levels of stigma, including social stigma, self-stigma, and professional stigma, which together contribute to a complex barrier to mental health and substance use care.

• Social Stigma: It encompasses society’s collective negative beliefs about certain groups, leading to discrimination and social exclusion.
• Self-Stigma: This occurs when individuals internalize societal prejudices, resulting in diminished self-esteem and self-efficacy, which can be particularly detrimental to veterans’ mental health.
• Professional Stigma: Healthcare professionals may harbor unconscious biases that affect the quality of care provided to individuals with mental health and substance use disorders.
• Structural Stigma: Reflected in systemic inequalities, structural stigma is evident in the healthcare system through lower quality of care and limited access to treatment for mental and substance use disorders, as noted by the Institute of Medicine.

Understanding these various types of stigma is essential in addressing the barriers veterans face in accessing care and developing strategies to mitigate stigma’s negative effects on mental health and substance use outcomes.

Public Stigma and Its Impact on Veterans

Public stigma refers to the negative evaluative and emotional reactions, including prejudice and discrimination, that arise from socially learned stereotypes. This form of stigma is particularly detrimental to veterans, as it can affect their reintegration into civilian life and act as a barrier to seeking mental health and substance use treatment. Despite efforts to reduce these stigmas within military populations, they persist and may prevent veterans from accessing the care they need after returning from combat.

Effects of Public Stigma

Studies have shown that public stigma can evoke perceptions of dangerousness and incompetence in veterans with PTSD, leading to social exclusion and affecting their ability to secure employment or engage socially. Such stigma is a societal issue and a communication challenge within the military and broader communities. Media campaigns and educational programs have been initiated to dispel stigmatizing beliefs and promote a supportive culture around mental health and substance use services for veterans.

However, the challenge remains significant, with many veterans still reluctant to seek treatment due to stigma. This reluctance is compounded by military values such as self-sufficiency, which can influence a veteran’s decision-making process regarding health care. It is crucial to continue developing and implementing strategies that address public stigma, foster positive attitudes, and encourage veterans to engage in care without fear of judgment or discrimination.

Self-Stigma and Its Impact on Veterans

Self-stigma occurs when individuals internalize negative stereotypes and prejudices about mental health and substance use, leading to feelings of shame and inadequacy. This internalization can significantly affect veterans’ self-perception and willingness to seek help. Studies such as those conducted by RAND Corporation have acknowledged that self-stigma is a dynamic process, potentially contributing to a decline in mental health and an increased risk of suicide among veterans. 

Efforts to Combat Self-Stigma

The US Department of Defense has aligned its stigma-reduction efforts with best practices, which may be helping to reduce self-reported stigma. VA psychologists and peer support specialists play a crucial role in helping veterans overcome self-stigma. Programs like the Ending Self Stigma manual and the Real Warriors Campaign provide resources to educate and encourage veterans to seek treatment. Additionally, research has shown that military self-stigma can mediate the relationship between aspects of military identity and suicide risk, underscoring the importance of addressing self-stigma in suicide prevention efforts.

Military culture often emphasizes self-sufficiency, which can conflict with seeking help for mental health or substance use issues. Efforts to combat this include training leadership to foster a supportive culture, establishing psychological health care services during non-duty hours, and promoting positive attitudes toward seeking help. The Real Warriors Campaign and Military Pathways are examples of initiatives designed to improve mental health through education and self-directed activities.

Despite these efforts, many veterans still do not seek the treatment they need due to self-stigma. Addressing this issue requires a multifaceted approach that includes education, supportive leadership, and accessible mental health care services.

Prevalence and Contributing Factors of Substance Abuse in Veterans

The prevalence of substance use among veterans is influenced by a range of factors, including the unique challenges associated with military life. 

Substance Abuse Prevalence Among Veterans

Substance misuse remains a significant concern within the veteran population, with a variety of factors contributing to its prevalence. According to the 2022 National Survey on Drug Use and Health, approximately 11% of veterans visiting a Department of Veterans Affairs (VA) medical facility for the first time have a substance use disorder (SUD). 

• Alcohol: The Health Services Research & Development highlights that alcohol is the most commonly misused substance, with binge drinking being a particular issue. 56.6% reported alcohol use in a one-month period, and 7.5% reported heavy use. Veterans may turn to substance use as a coping mechanism for mental health disorders, the challenges of readjusting to civilian life, or managing pain.
• Tobacco: In addition to alcohol, tobacco use is notably high among veterans. Data from the National Institute on Drug Abuse indicates that veterans are more likely to use tobacco products than non-veterans across nearly all age groups, with close to 30% reporting use. The financial implications of this are substantial, with smoking-related healthcare costs estimated at $2.7 billion for the Veterans Health Administration.
• Prescription Drugs: Prescription drug misuse is also a concern, particularly opioids and sedatives, with a marked increase in prescriptions for pain medication among military personnel over the past two decades. The intersection of SUDs with other mental health disorders, such as PTSD, depression, and anxiety, is common, necessitating integrated treatment approaches that address both substance use and co-occurring mental health conditions.

Contributing Factors to Substance Abuse Among Veterans

Substance misuse in veterans is a multifaceted issue influenced by various factors that can be interrelated, including mental health disorders, trauma, and the unique challenges of transitioning from military to civilian life. 

Mental Health Disorders and Substance Use

Research indicates that veterans with a diagnosis of PTSD or other mental health disorders are more likely to develop substance use disorders (SUDs) and experience adverse outcomes such as opioid-related accidents and overdoses. The prevalence of illicit drug use, particularly marijuana, is roughly equivalent to civilian counterparts. However, veterans are more likely to be smokers with higher age-adjusted prevalence compared to matched civilian groups.

Combat Exposure and Stress

High levels of combat exposure and the associated stress increase the risk of problematic alcohol use among veterans. Deployment, combat exposure, and post-deployment reintegration challenges are significant environmental stressors linked to increased risk of SUDs. 

Impact of the COVID-19 Pandemic

Moreover, studies during the COVID-19 pandemic have shown that veterans with pre-existing depression are more likely to use alcohol and cannabis, with loneliness and limited social support during the pandemic exacerbating substance use, particularly among those with pre-pandemic depression.

Prescription Drug Misuse

Prescription drug misuse, especially opioids prescribed for pain management, is on the rise among veterans. The number of opioid prescriptions written by military physicians has significantly increased, contributing to the prevalence of SUDs. 

Gender-Specific Needs

Female veterans may benefit from specialized SUD treatment and gender-tailored care, which can increase treatment utilization and comfort. 

Social Support

Social support is a crucial factor, with greater support potentially mitigating heavy substance use. Lastly, co-occurring mental health disorders are common among veterans with SUDs, necessitating integrated treatment approaches that address both substance use and mental health issues.

Mental Health Issues in Veterans

Mental health challenges among veterans are a growing concern, with data indicating a significant prevalence of mental health issues within this population. 

Prevalence of Mental Health Issues in Veterans

Mental health challenges are a significant concern among veterans, with various studies highlighting the prevalence and severity of these issues within the veteran population. According to recent research, veterans are at an increased risk for mental health disorders such as depression, posttraumatic stress disorder (PTSD), substance use disorders (SUDs), anxiety disorders, and suicide. The National Institutes of Health reported that approximately 1.15 million veterans were diagnosed with at least one of these mental illnesses following the rollout of the Patient Aligned Care Teams (PACT).

• Depression is the most common condition, affecting 13.5% of veterans seen in PACT.
• PTSD follows, with a prevalence of 9.3%.
• SUDs are also a significant concern, with an 8.3% prevalence.
• Anxiety disorders and serious mental health disorders (SMI) affect 4.8% and 3.7% of veterans, respectively.

These issues are compounded by the unique stressors faced by veterans, such as combat exposure, separation from support systems, and the transition back to civilian life. The Department of Defense and the VA have emphasized suicide prevention due to the rise in suicide attempts among veterans. Alarmingly, approximately 21 veterans die by suicide daily, a rate 50% higher than the civilian population. This crisis is even more pronounced among female veterans, who have a 50% higher incidence of suicide compared to civilian women.

Efforts to address these mental health challenges include enhancing access to care, increasing the number of mental health providers, and promoting research. However, the stigma associated with mental health issues and the complexity of diagnosing conditions like SUDs presents ongoing barriers to effective treatment and support for our veterans.

Contributing Factors to Mental Health Challenges in Veterans

Veterans face unique mental health challenges influenced by a combination of factors. Exposure to combat, separation from support systems, and the stress of adapting to civilian life contribute significantly to the prevalence of mental health issues. 

A study highlighted by the National Center for Biotechnology Information (NCBI) identifies risk factors:

• Lower rank
• Being unmarried
• Lack of education
• Proximity to enemy combat
• Low morale
• Lack of awareness about common psychological reactions upon returning home. 

Additionally, pre-existing psychological problems, multiple deployments, and prior adverse life events further exacerbate the risk of post-traumatic stress disorder (PTSD) and other mental health conditions.

Substance Use Disorders and Mental Health

Substance use disorders (SUDs) are also prevalent among veterans, with depression and severe mental health disorders being associated with an increased risk of hospitalization and suicide. The interrelation between chronic pain and PTSD often leads to an increased risk of alcohol use disorder (AUD).

VA Efforts and Challenges

The VA’s efforts to improve mental health care access and the development of treatment methodologies are crucial, as indicated by the US Department of Veterans Affairs. 

VA Initiatives: Adoption of the Patient Aligned Care Team (PACT) model for primary care aims to improve outcomes for veterans with serious mental health disorderes.

Research Insights: Research from sources such as RAND Corporation emphasizes the emotional toll of traumatic experiences, which often manifest as depression, anxiety, PTSD, and other mental health disorders.

However, the challenge remains in adequately addressing the myriad of factors that contribute to mental health issues, including the stigma associated with seeking help.

Stigma as a Barrier to Mental Health and Substance Abuse Care

The stigma surrounding mental health and substance use issues poses a significant barrier to care for veterans. Despite efforts to improve accessibility, such as the Veterans Choice and VA MISSION Acts, which aimed to provide more flexibility in accessing care outside of VA facilities, stigma remains a formidable obstacle. 

Impact of Stigma on Veterans

Veterans may perceive a stigma about their conditions, feeling misunderstood, judged, or rejected, which can lead to internalizing negative views, decreased self-esteem, and reluctance to seek help. This internal battle often results in isolation and loneliness, exacerbating mental health struggles.

Underutilization of Treatment

Statistics indicate that a substantial portion of veterans with mental health or substance use disorders do not engage in treatment. Factors such as emotional and cognitive dysfunction, PTSD symptom severity, and chronic pain are significant in determining health care utilization among veterans. 

Perceived Barriers to Care

However, perceived barriers to care, including stigma, play a critical role in whether veterans seek and receive the necessary treatment. Research highlights that only a fraction of veterans with probable mental or substance use disorders are currently engaged in mental health treatment, pointing to an underuse of mental health care services within this population.

Strategies to Combat Stigma

Addressing this issue requires a multifaceted approach. Strategies to combat stigma and improve care access involve integrating mental health screenings and treatments with primary care and nonmental health clinics. Additionally, prospective research and innovative interventions are needed to normalize health and treatment-seeking within military and veteran communities.

Addiction Treatment for Military Veterans at The Recovery Village Cherry Hill at Cooper

If you’re a military veteran seeking addiction treatment, The Recovery Village Cherry Hill at Cooper is here to help. We are a part of the VA Community Care Network, and we offer a trauma-informed program designed for veterans and first responders. Contact a Veteran Advocate today to learn more or to get started with treatment.