Co-Occurring Disorders in Veterans and Military Service Members
In the United States, there are an estimated 23.4 million veterans and 2.2 million military service members including National Guard and Reserve. Approximately one in five veterans of the wars in Iraq and Afghanistan has major depression or PTSD. While the rate of co-occurring substance use disorders among veterans of Iraq and Afghanistan has not been established, approximately three of every four Vietnam combat veterans with lifetime PTSD had co-occurring substance use disorders.
Veterans with PTSD or depression experienced more serious legal problems, higher lifetime use of alcohol and other substances, more psychiatric symptoms, a wide variety of trauma experiences, and worse general health. A study found that veterans who received services for both mental and substance use disorders were at elevated risk of arrest. But only half of veterans with a mental disorder have accessed behavioral health services, and even fewer received adequate care.
A 2007 Department of Defense task force report noted that military service can result in "hidden wounds" such as combat stress and PTSD. Symptoms of these injuries can include behaviors such as:
- Difficulty controlling anger
- Self-medicating with alcohol and other drugs
- Reckless and high risk behaviors
PTSD among veterans increases after return from deployment. A major risk factor for chronic PTSD is high combat exposure. Long and multiple deployments also increase the risk for combat stress and PTSD.
Prevalence of behavioral health conditions
Veterans of Iraq and Afghanistan have been part of a new initiative to assess the health of all service members returning from deployment. The Post Deployment Health Assessment (PDHA) is administered upon return and again at three to six months. The PDHA has found that mental health problems are highest among Iraq veterans compared with other areas of deployment, with 19 percent of Marine Corps and Army service members screening positive for at least one mental health problem. This was higher among members of the National Guard and Reserves compared with active duty service members, and higher among women than men.
Results from the reassessment found that both mental health and social problems were more likely to be reported three to six months after deployment. As with the initial assessment, members of the National Guard and Reserves reported higher levels of troubles than did active duty service members. However, the prevalence increased for all groups from the initial to follow-up assessment. For example, among active duty and National Guard and Reserves service members concerns about interpersonal conflict and aggression increased from four percent to 14 percent at follow-up for active duty and 21 percent for the National Guard and Reserves. Active duty service members' mental health risk doubled to 36 percent of respondents between the two assessments.
Treating veterans and military service members with co-occurring disorders involves the following:
- Offering integrated screening and assessment for co-occurring disorders
- Improving access to treatment within Department of Defense, Veterans Affairs, and non-military healthcare systems
- Identifying the individualized needs of veterans and active service members
- Promoting wellness through evidence-based treatment models
Integrated Screening and Assessment
A comprehensive, biopsychosocial approach to screening and assessment procedures helps to ensure that veterans and service members who suffer from co-occurring disorders are diagnosed early and accurately. Disorders such as combat-related Post-Traumatic Stress Disorder (PTSD) tend to develop over time. Practitioners conducting the initial screening and assessment should be trained to identify early stages of mental and substance use disorders so that early intervention and treatment may prevent progression to full diagnoses.
Improved access to treatment within the Department of Defense, Veterans Affairs (VA), and non-military healthcare systems increases the likelihood that treatment plans will be followed and individuals with co-occurring disorders will have continuous care when transitioning from one system to another. Better education, coordination among service systems, and case management will contribute to better outcomes for the veterans and service members.
To promote wellness among veterans, service members, and their families, practitioners may rely on treatment models shown to be effective with these populations. Further, they are encouraged to collaborate with other organizations to develop a training plan in effective techniques and best practices, including those developed by the National Center for PTSD, the VA Medical Center, the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism.
Read more about Co-Occurring Disorders in the Military
Resources and Links
A guide to SAMHSA's Military Families Initiative, one of eight Strategic Initiatives focuses its resources on areas of urgency and opportunity, which aims to ensure access to needed behavioral health services and positive outcomes for U.S. service men and women—active duty, National Guard, Reserve, and veterans—together with their families and communities.
Invisible Wounds: Predicting the Immediate and Long-Term Consequences of Mental Health Problems in Veterans of Operation Enduring Freedom and Operation Iraqi Freedom
This report reviews the literature on the long-term impact of mental disorders on veterans of Iraq and Afghanistan. Directed toward behavioral health practitioners and policymakers, the reviews the impact of mental and substance use disorders on employment, homelessness, and families.