In July 2022, the National Institutes of Health (NIH), in collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSA), published a report on the current state of substance use disorder (SUD) among veterans who served in one of the four branches of the United States Military and Coast Guard: Army, Air Force, Navy, Marines, and Coast Guard. The report, the 2020 National Survey on Drug Use and Health: Veteran Adults (2020 NSDUH – Veterans), offers an in-depth report and analysis on substance use disorder among U.S. veterans, with a focus on opioid use disorder (OUD) and the phenomenon of co-occurring SUD and mental health disorders among veterans.
In honor of Veteran’s Day, we’ll share the top-line takeaways and important facts from this report in order to shine a light on those among us who served our country and returned home to experience challenge and hardship that, in many cases, resulted from the physical, psychological, and emotional stressors and injuries related to their military service.
Our nation’s veterans deserve our undying gratitude, respect, and loyalty. Unfortunately, many veterans are now vulnerable to the negative consequences of substance use disorder and mental health disorders. These conditions disrupt their lives, their personal relationships, their ability to gain and hold employment, and make it difficult to live self-directed, fulfilling lives in the civilian world.
We think of our women and men in uniform – our soldiers – as strong, stoic, capable, resilient, and brave. That’s how they think of themselves, too. And that’s why many of them are reluctant to ask for help with anything, whether it’s a physical condition, a mental health condition, or an alcohol or drug use problem.
We’re here to deliver this message to our veterans:
Asking for help is a sign of strength. We’re here for you when you’re ready.
How Many Veterans are in the U.S. Today?
In 2019, the U.S. Department of Veterans Affairs (VA) released a report called “The Opioid Crisis: Treating Our Nations Veterans” that offered a comprehensive overview of the impact of the opioid crisis on our veterans.
To give context to our overall understanding of veterans in the U.S., they began with these figures on the total number of veterans in the U.S. today:
World War II:
- 16 million served
- ~500,000 living survivors
Korean War:
- 7 million served
- ~2.25 million living survivors
Vietnam War:
- 7 million served
- ~7.25 million living survivors
Gulf Wars and Afghanistan:
- ~5.703 million served
- 7 million living survivors
This data from the VA tells us there are around 15.5 million veterans alive in the U.S. today. Among those, the VA reports that:
- 70% of veterans do not use VA healthcare
- 30% use VA healthcare
That gives you an idea of how many veterans live in our communities today, and the number that access care through the VA. As you read that number, and those that follow, remind yourself that because of tradition and the soldier ethos, veterans are among the least likely demographic to ask for help with substance use or mental health disorders.
Experts on veteran mental health identify the following stressors associated with service in and outside of combat zones:
- Losing friends
- Using deadly force
- Being injured/wounded
- Full sensory immersion in the violence, death, and destruction associated with was zones
- Witnessing collateral damage, i.e. witnessing damage to civilian infrastructure and witnessing civilians casualties and death
- Persistent threat of IED, a.k.a. improvised explosive devices, a.k.a. homemade mines
Those stressors give veterans a common experience. That’s one reason veterans stick together, across lines of race, socioeconomic status, politics, and social issues: shared hardship bonds humans in a way nothing else can.
Now let’s look at how those hardships affected rates of substance use, alcohol use, and mental health disorders among veterans.
Alcohol, Substance Use, and Mental Health Disorders Among Veterans: Facts and Figures
We retrieved this data from the report we mention in the intro to this article, the 2020 NSDUH – Veterans. We include the data on mental health disorders because its relevant to veterans: self-medication related to mental health disorders often leads to substance use, then substance misuse, then the disordered use of substances or alcohol.
Alcohol, Substance Use, and Mental Health Disorders: U.S. Veterans
- Clinical SUD:
- 2.4 million, or 12%
- Co-Occurring Clinical SUD and Mental Health Disorder:
- 1.1 million, or 5.7%
- Clinical Mental Health Disorder:
- 3.9 million, or 19.7%.
- Among those, 1.3 million, or 34%, had serious mental illness
- Total Presence of SUD and/or Mental Health Disorder:
- 5.2 million, 26.2%
- Among Veterans with Clinical SUD:
- 1 million misused illicit drugs, or 41.9%
- 1.7 million misused alcohol and met criteria for AUD, or 70.1%
- 290,000 misused illicit drugs and alcohol, or 12%
Next, we’ll look at the data on veterans, prescription pain medication, and opioid use disorder. The opioid epidemic claimed over a hundred thousand lives in the U.S. last year. A primary driver of the opioid and overdose epidemic in the U.S. is what’s called the prescription to addiction pathway, in which people prescribed opioids for chronic pain – think veterans with combat injury – and develop opioid use disorder as a consequence of chronic use.
Prescription and Substance Use/Prescription and Substance Use Disorder Among Veterans
- Any Prescription Pain Medication Misuse:
- 2019: 555,000, or 2.7%
- 2020: 490,000, or 2.4%
- Prescription Pain Medication Use Disorder
- 2020: 91,000, or 0.5%
- Heroin Use:
- 2019: 57,000, or 0.3%
- 2020: 57,000, or 0.3%
- Heroin Use Disorder:
- 2020: 0.1%
- Opiate Misuse:
- 2019: 595,000, or 2.9%
- 2020: 494,000, or 2.5%
- Opiate/Opioid Medication Misuse, by Medication:
- Hydrocodone: 224,000
- Oxycodone: 232,000
- Codeine: 95,000
- Other: n/a
- Opioid Use Disorder:
- 2020: 91,000, or 0.5%
- Marijuana Use:
- 2020: 2.1 million, or 10.4%
- Marijuana Use Disorder:
- 2020: 707,000, or 3.5%
That’s the most recent data we have on substance use among veterans. As we can see, rates of SUD, rates of AUD, and rates of illicit drug misuse are high, and the most common substances of misuse are alcohol and marijuana. In data not reported above, rates of methamphetamine misuse among veterans age 18-25 is very high: in that age group, 7,000 (2.5%) of veterans misuse methamphetamine, which is twice the rate of veterans age 26 and older.
Next, we’ll look at the number of veterans who needed and received SUD treatment.
Alcohol, Substance Use, and Mental Health Disorder Treatment Among Veterans: Facts and Figures
We retrieved this data from the same report we used for the previous section: the 2020 NSDUH – Veterans. This next set of figures reveals what we call the treatment gap among veterans. The treatment gap is the difference between the number of people who need treatment for a specific disorder – in this case SUD – and the number of people who receive treatment for that disorder.
Treatment for SUD and Mental Health Disorders Among Veterans
- Among Veterans with SUD: 2.4 million
- Received treatment for SUD: 199,200
- Did not receive treatment: 2,200,800
- 91.7% did not receive treatment
- Veterans with Any Mental Illness: 3.9 million
- Received treatment: 1,907,1000
- Did not receive treatment: 1,992,900
- 51.1% did not receive treatment
- Among Veterans with Serious Mental Illness: 1.3 million
- Treatment figures unknown
- Veterans with Co-Occurring SUD and Mental Illness: 1.1 million
- Treatment figures unknown
Those figures show us an unacceptable gap in treatment: 9 out of 10 veterans who needed SUD treatment did not receive the treatment they needed, and almost half of veterans who needed mental health treatment did not get the treatment they needed.
How We Can Help Veterans: Awareness, Funding, and Treatment Engagement
Over the past twenty years, the federal government passes several laws that included significant funding for both treatment for substance use disorder and mental health disorders. In 2000, legislators passed the Drug Addiction Treatment Act (DATA). Then, in 2016, legislators passed the Comprehensive Addiction and Recovery Act (CARA). In 2018, legislators passed the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act.
While all three of these legislative actions contained funding for veterans with SUD and mental health disorders, the VA Maintaining Internal Systems and Strengthening Integrated Outside Network (MISSION) Act focused on supporting veterans only.
The Mission Act contained funding for the following initiatives:
- Revising opioid prescribing practices for veterans
- Increasing education and training regarding opioid prescribing for physicians working in the VA system
- Enhance access and integration with prescription drug monitoring programs
- Expand peer specialists program for veterans who need support for substance use or mental health issues
- Increasing SUD treatment for veterans
- Increasing mental health treatment for veterans
- Enhancing outreach efforts to encourage veterans to seek SUD and mental health treatment
- Enhancing outreach efforts to reduce stigma around SUD and mental health treatment
If we use the funding as directed and apply it to all of the targeted programs and initiatives, we can work to reduce the rates of SUD and mental health disorder among veterans. It’s vital to reduce the SUD treatment gap: the funding is there, the will among policy makers is there, and the skill and commitment among treatment professionals is also there.
Honor Our Veterans by Offering Support
What we need is for our citizens – all of them – to engage with our veterans and urge them to seek help and support if they need help and support. We understand: the veteran community is tight-knit. Veterans may not want help from people who don’t share their experiences. That’s okay: those of us who aren’t veterans can direct veterans to support by and for veterans, and those of us who are veterans can encourage their peers to engage in peer support groups by and for veterans.
If we all work together, we can help this vulnerable population – who it may be our bravest, strongest, and most capable citizens – get the lifesaving help they need.
Therefore, we owe it to them. We owe it every last veteran – even if they never deployed to a combat zone – volunteered to put their life on the line to protect us here at home.
The very least we can do is help them find evidence-based treatment and support for mental health and substance use disorders, which are, in many cases, a direct result of the sacrifices they made to serve their country.