Substance Abuse and Mental Health Treatment Barriers: Military Life vs. Civilian Life

Hundreds of thousands of United States veterans are not able to leave the horrors of war on the battlefield (“Forever at War: Veterans Everyday Battles with PTSD” 1). Post-traumatic stress disorder (PTSD) is the reason why these courageous military service members cannot live a normal life when they are discharged. One out of every five military service members on combat tours—about 300,000 so far—return home with symptoms of PTSD or major depression. According to the Rand Study, almost half of these cases go untreated because of the disgrace that the military and civil society attach to mental disorders (McGirk 1). The general population of the world has to admit that they have had a nightmare before. Imagine not being able to sleep one

Over the last decade, the wars in Afghanistan and Iraq have drastically increased the need for effective mental health services and treatment for U.S. veterans and service members, especially those suffering from Posttraumatic Stress Disorder (PTSD). Nearly 1.5 million American service members have been deployed in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) since the attack on the Twin Towers in September 2001 (Price, Gros, Strachan, Ruggiero, & Acierno, 2013). Approximately 25% of soldiers and wounded warriors returning home from OEF/OIF present with mental illness due to combat-related violence and other trauma exposure (Steinberg & Eisner, 2015). According to Price and colleagues (2013), OEF/OIF soldiers and veterans are at greater risk for developing mental illness compared to others who served in past military operations.

This paper explores post-traumatic stress and how it is seen as a disorder. Post-traumatic stress can manifest into post-traumatic stress disorder. The evaluation and review books and articles seem to reveal a relation to these symptoms and military member, either active or non-active veterans. These symptoms do not manifest strictly into the full-extent of the disorder in all cases of military, however, things such as depression and other physical symptoms are discussed through the readings. The end result is that we discovered that through the readings PTSD will in fact lead to suicide if left untreated.

There is concern about military service members receiving stigma about getting or needing treatment in the area of mental health. Stigma occurs when individuals view others negatively because they have been labeled or identified as having a deviant behavior against societal norms; deviant behaviors such as mental illnesses or diagnoses uncommon or harmful to others. How does that impact the military? Military men and women alike are termed heroes, warriors, and survivors; this is quite the reputation to keep up. Military members go to war or deploy to hostile combat environments, which many come back with severe mental illnesses and diagnosis that need immediate care. At this point they may not feel like a hero. The terms psychological, mentally ill, PTSD, and behavioral health has gained a reputation as having or being a problem. Being labeled a problem is not what service members want. Many studies are trying to pinpoint the problem and resolve the stereotypes associated with getting treatment. Consequently, an individual’s attitude toward mental health treatment is thought to be affected by other people’s views on mental health care (Held & Owens, 2012).

The VA runs the largest substance use disorder treatment program in the world. Treatment of veterans with SUDs and co-occurring psychiatric disorders is one of the following three paradigms; parallel, sequential, and integrated. Most VA programs are parallel, where the patient receives treatment for SUD in one program and treatment for PTSD in another. Many SUD-PTSD veterans may be unable to navigate the separate systems or make sense of the disparate messages about PTSD treatment and recovery. One challenge to dissemination and implementation of EBTs is that of dual disorders, particularly SUD and PTSD. These patients use costly inpatient services, tend to have frequent relapses, and are less likely to adhere to or complete treatment.

Bennett, PhD; Hilary J. Liberty, Ph 2013 107). Prior research has evaluated the prevalence of MH concerns and opportunities for treatment at various points in the military/veteran career including post deployment, among those being treated at Veterans Affairs (VA) facilities, and in the general population) (Andrew Golub, PhD; Peter Vazan, PhD; Alexander S. Bennett, PhD; Hilary J. Liberty, Ph 2013 107). The National Survey on Drug Use and Health (NSDUH) data indicate that a substantial portion of young veterans in the general population have substance use disorder (18%) or Serious Psychological Distress (SPD) (14%) (Andrew Golub, PhD; Peter Vazan, PhD; Alexander S. Bennett, PhD; Hilary J. Liberty, Ph 2013 111). All in all, the NSDUH proved to be an extremely valuable resource for this study, and indeed, the results of this analysis for unmet treatment needs have identified important directions for further research into reasons for not getting treatment, especially for SPD (Andrew Golub, PhD; Peter Vazan, PhD; Alexander S. Bennett, PhD; Hilary J. Liberty, Ph 2013 113). The Veterans Administration and National Survey on Drug Use and Health (NSDUH) are taking steps in the right direction to help our veterans with their unmet needs with substance abuse and PTSD. Some examples of improvements are, better mental health evaluations before leaving active duty, more information about military service, and tracking trends among veterans in the general population, who are not necessarily in contact with the

Alcohol use and abuse is prevalent among members of the United States military as well as among the veteran population. Binge and heavy drinking is commonplace among the military and veterans. Veterans and members of the active duty military face a unique set of challenges when compared to the civilian population. There is a trend of combat exposure leading to a higher risk to abuse alcohol. For over a decade the United States military was involved in combat operations in support of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). This has lead to a generation of service men and women as well as veterans with a host of physical and mental injuries as a result multiple combat deployments. There are many veterans and active duty personnel suffering from post-traumatic stress disorder (PTSD) as well as traumatic brain injuries (TBI) as a result of their deployment in support of OIF and OEF. There is a link between post-traumatic stress disorder (PTSD) and traumatic brain injuries (TBI) and a higher potential for the abuse of alcohol. Veterans and members of the armed forces deal with a host of psychological injuries related to the stresses of combat which can lead to the abuse of alcohol as a coping mechanism.

Rates of trauma and mental illness are reported to be disproportionately higher among American veterans, especially those of the recent wars in Iraq and Afghanistan. The barriers to care after civilian reentry further disadvantage this already vulnerable population. The wars in Iraq and Afghanistan have been the longest sustained US military operations since the Vietnam era, sending more than 2.2 million troops into battle and resulting in more than 6,600 deaths and 48,000 injuries. Veterans are at risk mental health challenges, as well as family instability, elevated rates of homelessness, and joblessness. Veterans have disproportionate rates of mental illness, particularly posttraumatic stress disorder (PTSD), substance abuse disorders, depression, anxiety, and military sexual trauma.

Both articles identify the issue of providing mental health services for veterans with an extra emphasis on those that served in Afghanistan and Iraq (OEF/OIF veterans). It is no surprise that returning veterans suffer from both visible/invisible (physical and mental) wounds. Most veterans have this “high” expectation that they are going to receive quality care from both the DoD and VA. Unfortunately reality steps in where veterans are slapped in the face because they are receiving a lack of poor quality care all while jumping through Beuracractic hoops. The challenges faced to access these services include resistance, stigma, lack of professionalism, and geographic and/or regional disparities in the distribution of services resources and/or benefits, and the system simply refusing to change.

The heroes that make up our armed forces often suffer from terrible experiences in battle, some of which severely impact their mental and physical health, including suffering from post traumatic stress disorder or PSTD. Unfortunately, this has caused many of them to turn to drugs, whether prescription or illicit, to treat these problems. In fact, recent statistics estimate that one in 10 soldiers returning from Afghanistan and Iraq suffer from a substance abuse problem.

The mean age for the participants in the study was 45. The study also took in account the time of service from the veterans, 60% served in the 1970's, 18% in the 1960's, and 18% in the 1980's (Carlson, Gavert, Macia, Ruzek, & Burling, 2013). The study includes veterans that suffer from personality disorders as well as alcohol abuse. Participants within the study are a mixture of races and come from various backgrounds. Included in demographic questions is if the veteran is divorced or married, which may also be a factor in this study. Additionally military branch information and associated was

According to Connor, Jones, Watts, Shiner, and Stecker (2013), “[o]nly about one quarter of active duty troops with psychiatric disorders actually receive treatment services” (p. 280).These researchers conducted a study using a qualitative analysis method by means of an intensive cognitive-behavioral telephone interview lasting approximately forty-five to fifty minutes. The participants consisted of approximately 300 service members who were recruited within a three year time frame, beginning in November 2009 and ending in January 2012.  The makeup of the participants included: 84% percent male, 67% Caucasian, 13% African Americans, and 9% Latinos. The sample identified participants from forty-eight to fifty states including veterans from all branches of military service. Research findings revealed four primary reasons veterans do not seek treatment for PTSD symptoms: concerns about treatment (40%), emotional readiness for treatment (35%), stigma (16%), and logical issues (8%) (p. 282-283). Overall, the research concludes that if there is an increase in veterans seeking treatment for PTSD after serving military time then the primary care physician should emphasize to the veterans upfront certain expectations. These expectations include

Article Citation: Bernhardt, A. (2009). Rising to the challenge of treating OEF/OIF veterans with co‐occurring PTSD and substance abuse. Smith College Studies in Social Work, 79(3-4), 344-367.

According to a study constructed by JAMA Psychiatry, a medical journal published by the American Medical Association, explained that one out of five soldiers, who have enlisted into the military have suffered from a mental disorder (Hastings). With this statistic, there are doubts regarding the military’s assessments of the enlisted. Matthew Nock, a Harvard University psychologist, led a study on mental disorders in the military, and concluded that

Many challenges still remain as Iraq and Afghanistan veterans seek available access to mental health care. These challenges include the resistance and stigma to seek care, lack of