Veterans and Co-Occurring Mental Health Disorders

Key Takeaways

• Co-occurring disorders, prevalent among veterans, involve the simultaneous presence of mental health and substance use disorders.
• Approximately 80% of individuals with PTSD have at least one additional mental health diagnosis, with veterans facing unique stressors such as combat exposure and military sexual trauma.
• Integrated treatment approaches that address both substance use and mental health conditions are essential for effective management of co-occurring disorders in veterans.
• Combat exposure, military culture, and post-deployment challenges significantly contribute to the development of co-occurring disorders among veterans.
• Psychotherapy, particularly cognitive-behavioral therapy (CBT), and medication-assisted treatment (MAT) are key components of comprehensive treatment for veterans.
• Support groups and peer support play a vital role in the recovery process, offering shared experiences and mutual understanding.
• Stigma and access to care are significant barriers preventing many veterans from receiving treatment for co-occurring disorders.
• Advancements in treatment strategies, such as integrated, evidence-based approaches and trauma-focused therapies, are crucial for improving outcomes for veterans with co-occurring disorders.

Veterans and Mental Health: A Deep Dive into Co-Occurring Disorders

What Are Co-Occurring Disorders?

Veterans often face a complex array of mental health challenges compounded by substance use disorders, known collectively as co-occurring disorders or dual diagnosis. These conditions arise from a combination of factors unique to military service, including combat exposure, military sexual trauma, and traumatic brain injuries. Such experiences can lead to conditions like PTSD, depression, anxiety, and substance abuse, which frequently coexist and mutually exacerbate one another. Research indicates that the psychiatric scales from the Addiction Severity Index (ASI) can effectively identify individuals with a co-occurring mental health condition (MHC), though further assessment is required to pinpoint specific disorders.

• Definition: Co-occurring disorders refer to the simultaneous presence of a mental health disorder and a substance use disorder.
• Prevalence: Approximately 80% of individuals with PTSD have at least one additional mental health diagnosis.
• Impact on Veterans: Veterans often use substances to cope with symptoms of PTSD and other mental health issues.
• Treatment Challenges: The complexity of co-occurring disorders necessitates integrated treatment approaches that address both mental health and substance use simultaneously.
• VA Approach: The Veterans Affairs Administration emphasizes the importance of comprehensive care models combining psychotherapy and medication to manage these interconnected conditions effectively.
• The National Institute of Mental Health (NIMH) outlines that substance use disorder (SUD) is a treatable mental disorder characterized by an inability to control the use of substances such as drugs, alcohol, or medications.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) emphasizes the importance of integrated treatment for co-occurring disorders, which is considered the standard of care for both SUD and mental health settings.

Prevalence of Co-Occurring Disorders Among Veterans

Understanding the prevalence of co-occurring disorders among veterans is crucial for developing targeted interventions and improving healthcare outcomes.

• Statistics: Co-occurring disorders are significantly prevalent among veterans, with PTSD and substance use disorders being particularly common.
• Impact on Healthcare: Integration of mental health services within primary care settings has enhanced detection and treatment outcomes.
• Specific Challenges: PTSD prevalence among veterans is higher than in the general population, highlighting the need for specialized care approaches.
• Healthcare Strategies: Programs like Patient Aligned Care Teams (PACT) aim to provide comprehensive, coordinated care for veterans with co-occurring disorders.

Research Findings

• According to the 2021 National Survey on Drug Use and Health by SAMHSA, statistical testing across various demographics has highlighted the significance of co-occurring disorders in veterans’ lives. 
• Research from the Veterans Health Administration (VHA) notes that the integration of mental health services within primary care, through programs like the Primary Care–Mental Health Integration (PCMHI), has improved the detection and treatment of mental illnesses among veterans. 
• A report on PTSD in the US veteran population revealed that the estimated prevalence of probable lifetime PTSD among veterans was 8.0%, with higher rates observed in female veterans and younger age groups. 

Key Factors: Leading to Co-Occurring Disorders Among Veterans

The prevalence of co-occurring disorders among veterans is influenced by a multitude of factors stemming from their military service experiences and post-deployment challenges. Combat exposure, military culture, and the stressors of reintegrating into civilian life all contribute significantly to the development of mental health and substance use disorders.

• Military Service Factors: Combat exposure and military culture significantly increase the incidence of mental health disorders like PTSD and substance use disorders compared to civilian experiences.
• Impact of Trauma: Military sexual trauma and exposure to combat-related events contribute to higher rates of PTSD and substance misuse. Studies show that demographic shifts such as increased diversity and a growing proportion of female veterans necessitate tailored prevention and treatment strategies to address evolving healthcare needs.
• Barriers to Care: Stigma associated with mental health, limited access to evidence-based treatment, and the need for integrated, patient-centered care are critical barriers to improving outcomes. RAND Corporation research emphasizes the importance of expanding treatment availability and adopting integrated treatment models to better serve this population.
• Research Insights: Insights underscore the importance of expanding treatment options and adopting integrated care models to effectively address co-occurring disorders in veterans.

The Influence of Military Service

Military service, characterized by combat exposure, military culture, and post-deployment stressors, significantly influences the development of co-occurring disorders among veterans.

• Combat Exposure: Higher prevalence of PTSD and substance use disorders among veterans exposed to combat compared to non-combat roles. Research indicates that PTSD prevalence among post-deployed service members can be as high as 13%, with a substantial number also reporting high-risk drinking behaviors.
• Military Culture: Values of stoicism and self-reliance may hinder veterans from seeking mental health support.
• Transition Challenges: Difficulties in reintegration, loss of identity, and challenges finding civilian purpose contribute to mental health issues and substance misuse post-deployment.
• Gender-specific Challenges: Higher rates of military sexual trauma among women veterans contribute to gender disparities in PTSD rates.

Navigating Post-Deployment Challenges 

The transition involves navigating multiple domains such as psychological health, social relationships, employment, housing, and financial stability, all of which can influence a veteran’s mental health and likelihood of developing co-occurring disorders, as studies suggest. Many veterans report chronic physical or mental health conditions post-deployment, underscoring the need for comprehensive support systems and integrated healthcare approaches.

• Reintegration Domains: Psychological adjustment, social support, employment, and financial stability all impact post-deployment mental health outcomes.
• Challenges: Issues such as identity adjustment, isolation, and financial difficulties can exacerbate mental health issues and substance use.
• Support Systems: Effective support networks and comprehensive healthcare services are crucial in mitigating the impact of post-deployment challenges on veterans’ well-being.
• Long-term Outlook: Veterans with traumatic experiences may face ongoing challenges, necessitating sustained support and targeted interventions to prevent and manage co-occurring disorders effectively.

The Pew Research Center notes that veterans who struggle to understand their roles during service or lack support systems may encounter additional difficulties during reintegration. Thus, addressing the multifaceted needs of veterans is critical in preventing and treating co-occurring disorders.

Comprehensive Treatment Approaches: Veterans with Co-Occurring Disorders

Veterans with co-occurring disorders face the dual challenge of managing mental health issues alongside substance use disorders (SUDs). Effective treatment requires integrated approaches that address both aspects simultaneously. The RAND Corporation highlights the necessity for evidence-based, patient-centered treatments that do not enforce substance abstinence as a prerequisite for mental health care, as this can be a barrier to treatment. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that in 2020, 26.2% of veterans struggled with co-occurring disorders, underscoring the need for widespread, accessible treatment options.

Psychotherapeutic Approaches

Research has demonstrated CBT’s efficacy in managing a variety of mental health concerns, including depression, anxiety, and post-traumatic stress disorder (PTSD), all of which are prevalent among veterans.

• Cognitive-Behavioral Therapy (CBT):
  • Foundational in identifying and altering maladaptive thoughts and behaviors.
  • Effective in managing PTSD symptoms and substance-related problems.
• Dialectical Behavior Therapy (DBT):
  • Focuses on emotional regulation and relationship skills, beneficial for trauma survivors.

Medication Management

• Medication-Assisted Treatment (MAT):
  • Highly effective for opioid use disorders, improving substance use reduction and housing stability.
  • Requires personalized treatment plans tailored to individual mental health conditions and substance use histories.

For more information on medication management for co-occurring disorders, resources such as the National Center for Biotechnology Information and the American Society of Addiction Medicine can provide valuable insights.

Role of Support Groups

• Peer Support:
  • Provides mutual understanding and empowerment.
  • Enhances engagement and retention in treatment programs.
• Veterans Affairs Peer Support Specialists:
  • Assist in developing personalized recovery plans and connecting veterans to essential resources.

Research indicates that peer support activities are gaining attention, with an emergent literature base highlighting their positive impact on veterans’ well-being. Various programs, like the Military Veteran Peer Network and the Wounded Warrior Project’s Peer Support Groups, exemplify the implementation of peer support across the nation, providing veterans with opportunities to connect with others who have had similar experiences and challenges. 

Addressing the Challenges in Treatment: Veterans with Co-Occurring Disorders

Providing effective treatment for veterans with co-occurring disorders presents unique challenges. One significant hurdle is the requirement for veterans to abstain from substance use before receiving mental health care, which can create a barrier to treatment. This cycle often prevents veterans from receiving the comprehensive care they need for both mental health issues, such as PTSD or depression, and substance use disorders.  Research suggests that integrated, evidence-based treatments can lead to better outcomes for veterans, but the adoption of such approaches across treatment facilities is inconsistent.

• Accessibility and Availability of Treatment:
  • Many veterans live within an hour’s drive of a facility that treats co-occurring disorders, yet most do not receive treatment.
  • Factors contributing to this disparity include stigma around mental health, geographical location, and availability of services.
  • Coordinated efforts across the treatment community are needed to expand and enhance treatment opportunities for veterans.
• Cost of Community Care:
  • Rising costs of community care within the Veterans Health Administration may impact access to services for veterans with co-occurring disorders.
  • Potential implementation of cost controls could limit veterans’ access to necessary treatment.
  • Testimony to the House Veterans’ Affairs Committee highlighted these financial considerations and their potential impact on veterans’ healthcare access.

Overcoming Stigma in Veterans’ Mental Health

Stigma surrounding mental health is a significant barrier that discourages veterans from seeking necessary treatment for co-occurring disorders. Research indicates that stigma can lead to underutilization of mental health services among veterans with probable mental or substance use disorders.

• Combat-related PTSD is particularly stigmatized, contributing to veterans’ reluctance to seek mental health services.
• Efforts to combat stigma include developing supportive cultures within the military, educating leadership, and integrating mental health care with other services.
• Supportive leadership has been linked to higher help-seeking intentions among service members and veterans.

Navigating Access to Care Challenges

Access to care for veterans with co-occurring disorders is complex, influenced by geographical and systemic barriers despite proximity to treatment facilities. For instance, the RAND Corporation highlights that despite proximity to care centers, many veterans do not receive the necessary treatment for co-occurring mental health and substance use disorders.

• Challenges include the need for specialized treatment approaches and persistent stigma around mental health services.
• The Department of Veterans Affairs acknowledges the need to improve outcomes and eliminate disparities in veteran care. The Department of Veterans Affairs’ 2024 Equity Action Plan aims to enhance access to services and eliminate disparities in veteran care, particularly in underserved communities.
• Telehealth services like Video to Home are implemented to improve access, but barriers remain in rural areas.

Advancements in Treatment: Veterans with Co-Occurring Disorders

The evolution of treatment strategies for veterans with co-occurring disorders is an area of significant importance and ongoing research. Future directions emphasize integrated, evidence-based approaches that address both mental health and substance use disorders concurrently.

• Trauma-Focused Cognitive Behavioral Therapies:
  • Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT):
    • Shown to reduce PTSD symptoms and substance use when integrated with substance use disorder (SUD) therapy.
    • Meta-analysis supports integrated treatment’s effectiveness over treating SUDs alone.
• Improving Access to Medications for Opioid Use Disorder (MOUD):
  • Expansion beyond specialized SUD treatment facilities to primary care, mental health, and pain management clinics.
  • Aims to increase access to care for veterans with co-occurring opioid use and other substance disorders.
• Policy Implications:
  • Remove treatment barriers, such as the requirement for abstinence from substance use before receiving mental health care.
  • Shift towards standardized, integrated treatments to improve outcomes for veterans.
• Enhancing Availability and Accessibility:
  • Coordinated efforts across the treatment community to expand integrated treatment options specifically for veterans with co-occurring disorders.
  • Improve care through accessible treatment centers tailored to veterans’ needs.

The Veterans Health Administration (VHA) clinicians are actively exploring ways to address barriers and facilitate access to MOUD for veterans with co-occurring substance use. Research and policy reforms continue to drive improvements in the care of veterans, focusing on patient-centered, evidence-based treatment modalities that are readily accessible to this vulnerable population.

Treatment Options: The Recovery Village Palmer Lake

There are quite a few different options for people who are seeking treatment for drug & alcohol addiction. Your individualized treatment plan at The Recovery Village Palmer Lake may include:

• Medical detox: Patients detox from substances in a clinical environment where doctors monitor health and provide medications to ease withdrawal symptoms.
• Inpatient treatment: Patients in inpatient treatment live at our facility and attend a full schedule of individual and group therapy, counseling and peer support sessions.
• Partial hospitalization program (PHP): PHPs provide patients with additional flexibility and independence than inpatient programs.
• Intensive outpatient program (IOP): IOPs help patients transition to life outside of rehab, with fewer hours of care and more time building skills and habits for recovery.
• Outpatient treatment: Outpatient care provides ongoing treatment after an inpatient stay and supports clients as they transition back into their daily lives.
• Aftercare: Aftercare programs help support long-term recovery through clinical and medical recommendations for follow-up care, relapse prevention plans and more.

If you or someone you love is struggling with drug or alcohol addiction, help is available. The Recovery Village Palmer Lake is here to support you throughout the entire recovery process. It’s time to get your life back. Call our Recovery Advocates today.