Substance Use Disorders in Military Veterans — Problems Associated with Access to Care

In 2019, I was afforded the opportunity to participate in a Veterans Affairs (VA) Medical Center 28-day inpatient treatment program for co-occurring Post-Traumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD). While this opportunity ultimately saved my life and opened the door to sustained recovery, it opened my eyes to the barriers many military veterans and active-duty servicemen and women have regarding access to behavioral health treatment.

Stigma and Disciplinary Measures Among Active-Duty Components

I served in the United States Army as an Infantrymen just shy of nine years and completed two combat deployments in support of Operation Iraqi Freedom. Comorbid Substance Use Disorder and mental illness were perpetually common within the soldiers redeploying from my unit, which often showed in high-risk behavior, resulting in multiple vehicular fatalities involving the consumption of alcohol. Heavy alcohol consumption has been customarily engrained as a military cultural norm, intended for recreation and socializing. The onset of Substance Use Disorders is highly prevalent in veterans, secondary to other mental health problems associated with stressors, such as combat exposure, deployment, and reintegration challenges. Some common challenges that present with reintegration consist of: lack of community, creating structure, adjusting to providing basic necessities, and not relating to people who do not know or understand what military personnel have experienced.

The military stigma associated with seeking treatment for substance misuse or mental illness begins during time on active-duty service. Zero-tolerance policies combined with mandatory random drug testing creates fear of negatively affecting an individual’s career and potentially facing retribution through being discharged under other than honorable conditions. Being discharged from the military on a drug-related offense continues to fuel stigma even after service, as this action follows the veteran on their military record. For some types of discharges, the veteran can even lose all access to VA healthcare, regardless of length of service, combat deployments, and severity of issues they’re facing.

My military career was presumptively based on hitting milestones, performing at a high level, and leading from the front with my soldiers. While serving as a squad leader with the Army’s prestigious ceremonial unit in Washing D.C., “The Old Guard,” I had several dental-related procedures done for issues with bruxism and temporomandibular joint dysfunction. During that timeframe, the Army would prescribe opioid pain relievers for just about anything. I had been experiencing mental health related issues for a few years at that point and never sought help due to pride and stigma. Within a month of being prescribed opioid pain relievers, I found myself doctor shopping within the civilian healthcare sector. Having virtually no prior knowledge on Substance Use Disorder, I felt as though this was a challenging period in my life, and I could stop using at any moment. That was simply not the case. Before I knew it, I was so deep into my addiction and had graduated from prescription pain killers to intravenously using heroin. What on earth was I to do now?

During active addiction, especially for individuals on active duty in the military, attempting to conceal signs of use is futile. I soon found myself in my Commander’s office to face retribution. While being ordered to take a mandatory drug test, I decided to come clean and absolve myself to the inevitable. That next day, I found myself in a 30-day inpatient treatment program. This was my first exposure to anything recovery-oriented, and I was by no means ready psychologically. During my stay, I experienced a diverse and multifaceted set of emotions with the realization my military career would soon be over. Luckily, I was on my third contract and would be discharged receiving all benefits. According to the National Institute on Drug Abuse (NIDA), once active-duty personnel leave the military and protective influences are gone, substance misuse and other mental health issues become of greater concern.

1. Transition from Military to Civilian Life

From the time I joined the Army at 17 years old, it was the only job I had ever known. Four weeks before my separation from the military, I experienced the tragic loss of my 4-month-old son due to sudden infant death syndrome (SIDS). This grief, combined with the loss of my career, would create the precedent for my life moving forward. The use of substances became the sole proprietor of my life, ultimately leading to an extended stay behind bars. Even after this supposed “wake up call,” I continued using drugs while on probation, which eventually led to a breaking point. My will to live dissipated and the idea of suicide plagued my mind daily. Speaking with my probation officer, I begged to be given the opportunity to seek treatment. The state I live in does not have a single inpatient treatment program at a VA Medical Center. Probation and supervision guidelines made leaving the state a barrier, and my fate lied with the presiding judge.

According to NIDA:

“Between 27% and 44% of veterans say that the transition from military to civilian life was difficult for them. Veterans face many physical and mental health impairments that lead to increased struggles when transitioning to life as a civilian.”

2. Navigating the VA Healthcare System

My day of reckoning had come, the nerves I felt were not focused on potentially being taken back into custody, but that I would not have the chance to seek treatment when it was all I had wanted at this point. By the grace of God, the judge asked, “If I were to authorize you to go to treatment out of state, where would you go, and what is the timeline?” At this point, I was overcome with emotion and replied I would go directly to a VA Medical Center and present for treatment. He authorized my request, which came with a grim warning that if I was not in treatment by that Sunday, a warrant for my arrest would be signed and I would service the remaining time of my suspended sentence in prison.

That Sunday morning, I presented to the Emergency Department of the VA Medical Center with acute withdrawal symptoms. After sitting in a hospital bed for over two hours, the doctor finally came to see me. The news was shocking to say the least. He informed me there were no open beds for detox, and that I would have to return tomorrow unless I was actively suicidal. Let’s just say being informed of this news led to a sudden onset of active suicidal ideations. I was then held in the Emergency Department for 12-hours until a bed opened on the detox floor.

Yes, you read that correctly, presenting with serious acute withdrawal symptoms was not enough to receive immediate treatment. Instead, at times a veteran must self-report actively thinking about dying by suicide to receive help. This is a redundant story for many veterans seeking access to care.

After the initial barrier to receiving care, I completed detox for 5 days and the follow-up 28-day co-occuring SUD and PTSD inpatient treatment program. I have been in recovery ever since and haven’t looked back. This change would ultimately lead me to the recovery field and working with veterans.

3. Problems Associated with Access to Care

For most veterans, the only form of healthcare they have access to is the VA. When seeking inpatient treatment for a Substance Use Disorder or mental illness, the process is far from streamlined and is met with many potential barriers. To even start the process of getting access to treatment, an assessment must be scheduled with a VA Substance Abuse Counselor. Depending on the geographic location, there could be potentially one counselor serving multiple counties, making scheduling an initial assessment untimely. Once this initial assessment is completed, and if the counselor identifies the veteran meets this level of care, a consult will then be sent to a residing VA Medical Center that offers the appropriate treatment. After the consult is submitted, the VA has 21 days to locate care for the veteran before even having to adjust to utilizing a community care in-network facility. Using VA community care to gain expediated care for veterans to access treatment should be the norm, not the exception. Some veterans wait over 30 days from first contact to the VA to receive treatment. One of the greatest challenges we face today is the ever-increasing overdose related death rates. With the emergence of fentanyl, some veterans simply don’t have 30 days to wait to gain access to treatment.

Combating veteran suicide has been a top priority in the VA for many years. In 2021, the White House called veteran and military suicides “a public health and national security crisis.” When analyzing data from the 2017 VHA report, it states 58.7% of all veteran suicides had previously been diagnosed with a mental health or Substance Use Disorder. Many private inpatient drug and alcohol treatment centers are jumping on board to help assist veterans, by even applying and establishing themselves as a VA in-community network provider. Making changes to the VA Healthcare System and how they utilize federal money to provide more attainable access to care will take advocacy and the recovery community as a unit pushing for change.

Moving Forward

Advocating for veterans and their families navigating the VA Healthcare System to gain quality access to care has become a distinct passion for me. Walking side-by-side with a population that has given so much is at the very core of Youturn Health, and the support we offer to individuals in recovery. Connecting veterans on a peer-to-peer level has shown promising and lasting effects in the overall health and well-being of those dealing with substance misuse, or other mental health concerns like PTSD. While we continue to push for change, affording more accessible care to veterans, Youturn Health’s veteran peer-to-peer coaching program can be the missing link, providing support to those who feel alone.

The Youturn Health platform was developed using evidence-based strategies to cover an array of behavioral health treatment modalities and resources to assist in any complex issue. Combining effective peer coaching from trained individuals with lived experience to meet the individual where they are in the path to recovery.

Zachary GoffZachary Goff is a Recovery Coach Manager at Youturn Health. Zachary leads a team of peer coaches working with individuals with substance misuse, veterans and military active-duty personnel, and re-entry services. He is a person in long-term recovery and is currently in school pursuing a degree in social work.