Veterans’ Mental Health: Exploring Co-Occurring Disorders

Key Takeaways

• Co-occurring disorders, or dual diagnosis, affect a significant portion of individuals with substance use disorders, with mood and anxiety disorders being common.
• Veterans face unique mental health challenges, including higher rates of PTSD, depression, anxiety, and SUDs, with the VA implementing measures to improve care.
• PTSD affects a notable percentage of veterans from various conflicts, necessitating early intervention and comprehensive treatment.
• The prevalence of co-occurring disorders in veterans is linked to combat exposure and traumatic events, with integrated treatment approaches being essential.
• Substance abuse and mental health disorders are interrelated in veterans, highlighting the need for integrated care models.
• TBI in veterans is associated with an increased risk of psychiatric conditions and substance abuse, requiring long-term care strategies.
• Barriers to mental health care for veterans include stigma, complexity of the healthcare system, and accessibility of services.
• Psychedelic drugs like MDMA and psilocybin are being explored as potential treatments for PTSD in veterans.
• Support systems, including family, peers, and community resources, are crucial for managing co-occurring disorders in veterans.

What Are Co-Occurring Disorders?

Co-occurring disorders, often referred to as dual diagnosis, are conditions where an individual simultaneously experiences a mental health disorder and a substance use disorder. This complex condition affects individuals across various socioeconomic, racial, and occupational backgrounds, leading to increased risks of suicide, adverse events, and challenges in treatment. 

What Is the Prevalence of Co-Occurring Disorders?

Prevalence studies indicate that co-occurring disorders are not uncommon. For instance, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) found that roughly 20% of individuals with a substance use disorder also have an independent mood disorder, and 18% have an anxiety disorder. 

The prevalence of co-occurring disorders can vary based on geographic and cultural contexts, as well as the population being studied. Empirical data suggests that both urban and rural areas are impacted, with a significant portion of adults experiencing these disorders.

Understanding the high prevalence and impact of co-occurring disorders is essential for clinicians, as it informs the need for comprehensive treatment approaches that address both mental health and substance abuse issues simultaneously. The complexity of symptoms and the interplay between disorders necessitate a nuanced approach to care, one that is often tailored to the individual’s unique circumstances.

Overview of Mental Health Challenges Faced by Veterans

Veterans often encounter unique mental health challenges as a result of their military service. Exposure to combat, separation from family, and the stress of transitioning to civilian life can contribute to various mental health issues. 

Studies have shown that veterans are at an increased risk for mental health conditions such as Post-Traumatic Stress Disorder (PTSD), depression, anxiety, and Substance Use Disorders (SUDs). The prevalence of these conditions is concerning, with research indicating that veterans experience higher rates of suicide compared to the general population.

Understanding PTSD in Veterans: Causes, Symptoms, and Impacts

Post-Traumatic Stress Disorder (PTSD) is a significant mental health condition affecting veterans, often triggered by experiences such as combat exposure, military sexual trauma, and witnessing death or serious injury. 

Symptoms of PTSD in veterans can include 

• intrusive memories, 
• avoidance of situations reminiscent of the trauma, 
• negative changes in thought and mood, and 
• heightened physical and emotional reactions. 

These symptoms can vary in intensity and may be triggered by reminders of the traumatic event, known as triggers.

PTSD prevalence among veterans is notable, with studies indicating that PTSD affects between 11-20% of Iraq and Afghanistan War veterans, about 12% of Gulf War veterans, and up to 15% of Vietnam veterans. The condition not only impacts the psychological state of veterans but also has broader implications, including an increased risk of suicide, accidental injury, and co-occurring conditions such as substance abuse and depression.

Effective treatments for PTSD include psychotherapy, medication, and support from family, peers, and specialized veteran services. Recognizing the symptoms and seeking appropriate care is crucial for veterans grappling with PTSD, as early intervention can lead to better outcomes and improved quality of life.

Understanding Depression and Anxiety Among Veterans

Depression and anxiety are significant mental health challenges that affect veterans at alarming rates. Studies indicate that approximately 14% of military members may experience depression after their service. Anxiety disorders are also prevalent, with an estimated 30% of veterans experiencing symptoms. These conditions can stem from various factors, including the strenuous demands of military service and the difficulties associated with reintegration into civilian life.

The acknowledgment of these mental health issues is crucial for developing targeted interventions. By understanding the unique challenges faced by veterans, healthcare providers can tailor treatments that address both the psychological and social aspects of depression and anxiety. The goal is to ensure that veterans receive comprehensive care that supports their transition back into civilian life while managing the symptoms of their mental health conditions.

Understanding the Link Between Military Service and Co-Occurring Disorders in Veterans

Military service exposes veterans to unique stressors and traumatic events, which can significantly impact their mental health. The prevalence of co-occurring disorders, or dual diagnosis, among veterans is a pressing concern, as it encompasses the simultaneous presence of substance use disorders and mental health conditions. A substantial body of research, including findings from the 2019 National Survey on Drug Use and Health (NSDUH) by SAMHSA, highlights the intricate connection between military service and the development of these disorders.

The intersection of these conditions creates a complex challenge for healthcare providers. Effective treatment requires an integrated approach that addresses both mental health and substance use disorders.

Substance Abuse and Co-Occurring Mental Health Disorders in Veterans

Veterans often face unique challenges that can lead to the development of co-occurring disorders, such as substance abuse alongside mental health issues like PTSD, depression, and anxiety. The prevalence of substance use disorders (SUDs) among veterans is a significant concern especially when it comes to opioids and alcohol.

• Opioids and PTSD: Research indicates that those with PTSD or other mental health disorders are more likely to receive higher doses of opioid medications, and are at an increased risk for opioid use disorders and related adverse outcomes. Studies have shown that veterans with SUDs are frequently diagnosed with co-occurring mental health disorders, with a high percentage of those diagnosed with an SUD also receiving a diagnosis for another mental health condition.
• Alcohol abuse: Alcohol misuse is particularly problematic among veterans, with higher rates of binge and heavy drinking compared to other military personnel, which can exacerbate mental health issues and lead to a range of negative consequences. 

Traumatic Brain Injury and Co-Occurring Disorders in Veterans

The Department of Defense (DoD) and the Department of Veterans Affairs (VA) define Traumatic Brain Injury (TBI) as a disruption of brain function due to external force, with symptoms manifesting immediately after the event. Veterans who have suffered a TBI face an increased likelihood of developing co-occurring disorders. Research from the National Center for Biotechnology Information indicates that TBI is frequently accompanied by psychiatric conditions like PTSD, depression, and substance abuse. The prevalence of TBI among military veterans is notably higher than in the civilian population, which underscores the need for targeted research and treatment strategies.

Navigating the Complexities of Co-Occurring Disorders in Veterans

The diagnosis and treatment of co-occurring disorders in veterans present unique challenges due to the complex interplay between mental health issues and substance use disorders. Factors such as the prevalence of post-traumatic stress disorder (PTSD), depression, traumatic brain injuries (TBI), and substance abuse contribute to the intricacy of addressing these conditions among veterans. Research highlights that effective assessment and diagnosis are critical in managing the course of illness and treatment outcomes.

One of the primary obstacles in the treatment of co-occurring disorders in veterans is the accessibility and integration of services. The Veterans Affairs Administration emphasizes the importance of psychotherapy as the foundation of treatment, often in conjunction with medication-based treatments. 

Barriers to Mental Health Care for Veterans

Veterans face unique challenges when it comes to accessing mental health care, which can impede their ability to receive the treatment for they need for co-occurring disorders:

• Cognitive injuries and personal anxieties: Research indicates that psychological and cognitive injuries, as well as personal anxieties, can discourage veterans from seeking treatment.  Studies have shown that factors such as emotional difficulties, PTSD symptom severity, chronic pain, and even personal resilience (grit) can influence a veteran’s likelihood to engage in mental health care.
• Cultural prejudices and legal consequences: Barriers such as stigma, lack of awareness, and the dishonorable discharge of service members using illicit drugs like marijuana, limit veterans’ willingness or ability to seek help. 
• Complexities of the healthcare system: Barriers to treatment are compounded by the complexity of navigating the healthcare system, particularly within the Veterans Health Administration. The Substance Abuse and Mental Health Services Administration (SAMHSA) advocates for a “no wrong door” policy, ensuring that individuals receive appropriate treatment or referrals regardless of where they seek services. This approach is aimed at bridging the gap and improving outcomes for veterans with co-occurring disorders.

Efforts to Improve Mental Health Care Access for Veterans

The VA has acknowledged the need to improve outcomes and eliminate disparities in veteran benefits and health care. Efforts include updating the Transition Assistance Program, enhancing outreach to underserved veteran communities, and addressing the medical burden by integrating mental health services with primary care. Despite these efforts, data from the 2019–2020 National Health and Resilience in Veterans Study revealed that only a fraction of veterans with a probable mental or substance use disorder were engaged in treatment.

Additionally, the VA is taking steps to improve access to high-quality mental health care by exploring telehealth services and other innovative solutions to meet the mental health care needs of its population. The recent 2024 VA Disability Law Updates aim to have positive impacts on veterans’ lives, indicating a continued commitment to improving the lives of our nation’s veterans.

Evidence-Based Treatment Approaches for Veterans with Co-Occurring Disorders

Veterans facing co-occurring disorders, such as PTSD and substance abuse, require comprehensive and integrated treatment strategies. 

• Innovative treatments: Recent explorations by the Department of Veterans Affairs (VA) into the use of psychedelic drugs like MDMA and psilocybin indicate a progressive approach to treating PTSD among veterans. These substances are being studied for their potential to help patients process trauma and improve mental health outcomes. Research has shown that veterans who engaged in trauma-focused cognitive behavioral psychotherapies for PTSD, in combination with substance use disorder (SUD) therapies, reported a reduction in both PTSD symptoms and substance use.
• Integrated treatment: Barriers such as the requirement to abstain from substance use before receiving mental health care have been identified as counterproductive. Instead, integrated treatment models that address both substance use and mental health simultaneously are recommended. 
• Psychotherapy and medication management: VA guidelines emphasize the importance of making pharmacotherapy and psychosocial interventions available for co-occurring mental health conditions, alongside appropriate care coordination.

Evidence-based treatment, including psychotherapy and medication management, serves as the foundation for managing mental health and substance use disorders, but the inclusion of robust support systems can significantly enhance outcomes.

Support Systems in Managing Co-Occurring Disorders for Veterans

Support systems play a crucial role in managing co-occurring disorders among veterans, providing the necessary stability and resources to navigate the complexities of dual diagnoses.  Research indicates that while most veterans live within an hour’s drive of a treatment facility for co-occurring disorders, many do not receive the treatment they need. This gap highlights the importance of support systems in facilitating access to care and encouraging engagement with treatment services.

Support systems are not limited to formal structures; they also encompass the broader societal attitudes towards veterans and mental health. Stigma reduction and public awareness campaigns can encourage veterans to seek help and can improve overall treatment outcomes. Integrating these various layers of support ensures that veterans with co-occurring disorders receive comprehensive care tailored to their unique needs.

The Impact of Family and Peer Support on Veterans with Co-Occurring Disorders

Family and peer support play a crucial role in the recovery and management of co-occurring disorders among veterans. These support systems provide emotional backing, understanding of shared experiences, and a sense of community that can significantly enhance the well-being of veterans facing mental health challenges. 

• The importance of peer support is highlighted by its evidence-based approach, where veterans support each other through a variety of challenges, including substance use, transitioning to civilian life, and mental health disorders.
• Programs like the Growing Veterans’ Peer Support Training and the Military Veteran Peer Network (MVPN) are instrumental in creating a structured environment for veterans to give and receive support. These programs often include certified peer specialists who are intimately familiar with the unique challenges faced by veterans. 
• Family support is recognized as a cornerstone of mental health care for veterans, with policies like the VHA Directive 1163.04, which establishes the provision of services to family members in support of a veteran’s mental health care.
• Events such as the Veteran Family Virtual Summit also serve as platforms for empowering families through knowledge and resources, thereby fostering a supportive environment for veterans.

These initiatives underscore the collective effort required to address the complex needs of veterans with co-occurring disorders and highlight the positive impact of a supportive network on their recovery journey.

Community and Government Support Structures for Veterans with Co-Occurring Disorders

Veterans facing co-occurring disorders benefit from a robust network of community and government support structures designed to facilitate their transition to civilian life and manage their health challenges. 

• Community support groups, such as those facilitated by the National Veterans Homeless Support (NVHS), provide critical outreach through programs like Search and Rescue, offering supplies, connections to resources, and assistance in securing housing. These groups acknowledge veterans’ sacrifices and actively contribute to their post-service life quality.
• The U.S. Department of Veterans Affairs (VA) plays a pivotal role in delivering government support, offering a multitude of services, including the VA Child Care Subsidy Program and comprehensive healthcare appointments. The VA Community Playbook outlines best practices for veteran-serving organizations, ensuring coordinated, effective support for service members and their families.
• At a strategic level, the Veteran Community Partnership (VCP) initiative is expanding to every VA medical center, aiming for complete coverage by September 2024. This expansion is guided by experts from various VHA National Centers and Offices, along with non-VA organizations, ensuring that veterans receive well-rounded and accessible care. 
• The Government Accountability Office (GAO) has evaluated programs aiding servicemembers’ transition to civilian life, making recommendations to enhance their effectiveness.
• Nonprofit organizations also contribute significantly, offering no-cost support and services to the military and veteran community, addressing a spectrum of needs from healthcare to social integration. The VetResources Community Network (VRCN) exemplifies such efforts, establishing community goals and connecting veterans to resources, particularly in underserved areas.

 

For veterans grappling with addiction and co-occurring mental health disorders, the VA’s services stand ready to assist. The first step towards recovery is reaching out for help today.

 

Orlando Recovery Center is a proud member of the VA Community Care Network and are equipped to accept VA health benefits. Our Veteran Advocates are poised to assist you or a cherished veteran in navigating the VA approval process, ensuring you receive the vital help you deserve. Call us today and ask for a dedicated Veteran Advocate to assist you.