The Impact of Stigma on Substance Abuse and Mental Health Care in Veterans

Key Takeaways

• Veterans face stigma related to mental health and substance use, which can deter them from seeking necessary treatment.
• Efforts to combat stigma include supportive military cultures, leadership training, and campaigns like Real Warriors and Military Pathways.
• Stigma can lead to internalization of negative beliefs, decreased self-esteem, isolation, and loneliness among veterans.
• Substance use is prevalent among veterans, often linked to co-occurring mental health disorders like PTSD.
• Stigma exacerbates substance use issues in veterans by fostering a sense of shame and discouraging help-seeking behavior.
• Significant policy changes and initiatives, such as the 2024 Agency Equity Action Plan, aim to improve veterans’ access to mental health care and reduce stigma.
• Public awareness and education campaigns are crucial in changing perceptions and reducing stigma associated with veterans’ mental health and substance use disorders.
• Legislative acts and proposed budgets reflect a commitment to investing in veterans’ mental health care and addressing the impact of toxic exposures.

The Stigma Surrounding Veterans and Its Implications

Stigma in the context of veterans is a multifaceted issue that encompasses societal attitudes, behaviors, and internalized perceptions negatively impacting individuals with a military background.

Impact on Veterans’ Well-being

It is a barrier that can demoralize veterans, making them feel devalued or discriminated against, and often hinders their willingness to seek necessary treatment.

Internalized Negative Beliefs

Studies show that stigma may lead veterans to internalize negative beliefs, contributing to decreased self-esteem, isolation, and loneliness.

Efforts to Combat Stigma

Efforts to combat stigma in the veteran community include developing supportive cultures within the military that encourage seeking help for mental health and substance use issues. The Army, for instance, has implemented leadership training and established psychological health care services available outside of duty hours. They have also integrated mental health and substance misuse treatment providers into unit services.

Promoting Help-Seeking Behavior

Initiatives like the Real Warriors Campaign and Military Pathways program aim to destigmatize seeking help by promoting the idea that mental health and substance use issues are not uncommon. These programs emphasize that asking for help is a sign of strength. Unfortunately, despite these efforts, significant challenges remain.

Stigma and Post-Traumatic Stress (PTS)

Research indicates that veterans with post-traumatic stress (PTS) may face stigma both within the military and from society at large, affecting their communication and willingness to seek care. Healthcare-related stigma includes concerns about privacy and personal beliefs about mental health disorders that deter veterans from utilizing available services.

Ensuring Access to Care

Addressing these issues is crucial to ensure that veterans receive the care they need without fear of judgment or discrimination.

Understanding Stigma and Its Types in Society

Stigma is a complex social phenomenon that manifests as a mark of disgrace associated with particular circumstances, qualities, or persons. It often leads to negative stereotypes and discrimination, impacting individuals and groups profoundly.

Types of Stigma

A comprehensive definition of stigma includes various types, such as public stigma and self-stigma.

• Public Stigma

Public stigma refers to the negative perceptions and attitudes held by others towards individuals with mental health disorders or other distinguishing characteristics.

• Self-Stigma

Self-stigma occurs when individuals internalize these negative beliefs and attitudes, leading to feelings of shame and reduced self-esteem.

Broader Associations

Stigma can also be associated with physical attributes, disabilities, deformities, ethnicity, sexual orientation, or health conditions like mental health disorders. The effects of stigma are far-reaching, often resulting in social exclusion, isolation, and barriers to accessing necessary care and support.

Systemic Discrimination

Research has shown that stigmatization is not only individual prejudice but also a cultural and societal construct that can lead to systemic discrimination and marginalization. The concept of stigma has evolved over time, with influential works like Goffman’s shedding light on its implications. It’s crucial to understand stigma’s various levels—social, self, and professional—to effectively address its impact.

Impact on Help-Seeking

Stigma can hinder individuals from seeking help for mental health issues or substance misuse, particularly in vulnerable populations such as veterans. Understanding and addressing stigma is crucial to reducing its detrimental consequences in communities.

Historical and Societal Roots of Stigma in Veterans

The stigma surrounding mental health and substance misuse in veterans has deep historical and societal roots. Research indicates that the origins of such stigma can be traced back to lay beliefs and societal perceptions of post-traumatic stress disorder (PTSD) and other forms of interpersonal trauma, including sexual assault and violence.

Impact of Military Experiences

These perceptions have often been shaped by military experiences and the transition to civilian life, creating a paradox between the warrior ethos and the obscurity of veteran experiences.

Factors Contributing to Stigma

Studies have shown that factors such as lower rank, being unmarried, and experiencing low morale contribute to the risk of PTSD and subsequent stigma. Additionally, historical policies and the language used in military and healthcare settings have perpetuated negative connotations associated with mental health issues.

Role of the Department of Defense

The RAND Corporation outlines that stigma in the military is influenced by the Department of Defense’s approach to mental health and the need for stigma-reduction efforts.

Barriers to Mental Health Care

Furthermore, veterans often face barriers to mental health care due to their experiences and meaning systems, which shape their perceptions and willingness to seek help, as discussed in a study on veterans’ barriers to mental healthcare services.

Underutilization of Mental Health Care

The interplay of these factors has led to a significant underuse of mental health care among veterans, with only a small percentage actively seeking and engaging in treatment despite the high prevalence of mental and substance use disorders. The challenge lies in bridging the gap between the need for care and actual care utilization, as highlighted by the National Health and Resilience in Veterans Study.

Stigma’s Impact on Substance Abuse in Veterans

Stigma plays a critical role in shaping the experience of veterans with substance use issues, often creating significant barriers to seeking and receiving help.

Low Engagement in Treatment

Despite the prevalence of psychiatric and substance use disorders among US military veterans, many do not engage in treatment due to stigma. Studies have shown that only a small percentage of veterans with probable mental or substance use disorders are currently engaged in mental health treatment. This underuse of mental health care among veterans is linked to stigma, which can manifest as a sense of shame or weakness, discouraging them from accessing necessary care.

Efforts to Reduce Stigma

Efforts to reduce stigma and promote mental health care in the military include developing a supportive culture around seeking mental health and substance use services. This includes incorporating mental health treatment into unit fitness and preventative services, and establishing programs like Military Pathways and the Real Warriors Campaign to improve mental health through education and self-assessment tools.

Challenges in Seeking Treatment

However, despite these resources, approximately 60% of veterans who would benefit from care do not seek treatment, with stigma being a potential contributing factor.

Military Values and Stigma

Military values such as self-sufficiency and prioritizing the unit’s needs over individual well-being often continue after service, further complicating veterans’ willingness to seek help. To address this, initiatives aimed at educating military leadership and changing the culture of mental health care are crucial.

Promoting Help-Seeking Behavior

By fostering an environment that views seeking help as a strength rather than a weakness, we can begin to dismantle the barriers to substance use treatment for veterans.

Substance Abuse Prevalence Among Veterans

Substance misuse among veterans is a significant concern, with various studies highlighting its prevalence and impact.

2021 National Survey on Drug Use and Health Findings

According to the 2021 National Survey on Drug Use and Health by SAMHSA, there is a notable occurrence of substance use among veterans, including prescription medication misuse. The report indicates that individuals could have used more than one type of substance in the past month, suggesting the complexity of substance use patterns in this population.

Data from the National Center for Veterans Analysis and Statistics

Statistics from the National Center for Veterans Analysis and Statistics provide a graphical representation of various topics related to veterans, including substance misuse. The VA’s data is crucial for understanding the scope of substance use disorders (SUDs) within the veteran community.

Link Between Mental Health and Substance Misuse

Research has shown that veterans with post-traumatic stress disorder (PTSD) or other mental health disorders are more likely to receive opioid prescriptions and may have a higher risk of developing opioid use disorders.

Co-Occurrence of Mental Health Disorders and SUDs

Substance misuse in veterans is often linked to co-occurring mental health disorders. A study published in PubMed Central found that among veterans with an SUD diagnosis, a large percentage also had a diagnosis of PTSD, depression, or anxiety.

Prevalence of Alcohol Misuse

Alcohol misuse, particularly binge drinking, is prevalent among veterans and poses a risk for additional health issues and negative social outcomes.

Tobacco Use Among Veterans

Veterans are also more likely to use tobacco products compared to their non-veteran counterparts, contributing to significant healthcare costs.

VA Services and Interventions

Addressing substance use in veterans requires an understanding of its prevalence and the interconnectedness of SUDs with mental health and other challenges faced by this population.

Comprehensive Care Approach

The VA provides a range of services and interventions to help reduce the impact of SUDs among veterans, emphasizing the need for specialized and comprehensive care.

How Stigma Can Worsen Substance Abuse in Veterans

Stigma plays a critical role in the lives of veterans dealing with substance misuse issues. It often originates from misconceptions that addiction is a moral failing or a sign of weakness rather than a medical condition.

Barriers to Seeking Help

Research shows that veterans who perceive substance use as a weakness may avoid seeking help due to fear of judgment or repercussions within their community or the military culture itself. This avoidance can exacerbate substance misuse problems as veterans may attempt to self-medicate or hide their struggles.

Self-Stigma and Internalization

Self-stigma, where veterans internalize negative societal beliefs, can be particularly damaging. It may lead to feelings of shame and isolation, creating barriers to accessing treatment and support. Moreover, the military environment, which often values strength and self-sufficiency, can intensify these stigmas, making it challenging for veterans to acknowledge their need for help.

Role of Stigma Reduction Programs

Programs aimed at reducing stigma within the military and veteran communities are essential for encouraging treatment-seeking behavior. Stigmatization within the military not only affects veterans’ willingness to seek help for substance misuse but also impacts their mental health care.

Vulnerability of Veterans with Co-Occurring Disorders

Veterans with co-occurring mental health disorders, such as PTSD, are particularly vulnerable to the harmful effects of stigma, which can lead to a dangerous cycle of substance misuse and mental health decline.

Supportive Organizations

Organizations like The Recovery Village focus on providing fact-based content to improve the quality of life for those struggling with substance use and mental health disorders, emphasizing the importance of compassionate care and support.

Effects of Stigma on Veterans’ Mental Health Care Access and Quality

Stigma surrounding mental health in veterans presents significant barriers to accessing and utilizing care, often leading to under-treatment or avoidance of treatment altogether.

VA Initiatives to Combat Stigma

The Department of Veterans Affairs has acknowledged these challenges and is actively working to improve outcomes and eliminate disparities through initiatives like the 2024 Agency Equity Action Plan. 

This includes enhancing economic security for underserved Veteran communities and increasing access to VA services, as well as fostering a culture that supports mental health and substance use services.

Initiatives to Normalize Help-Seeking

Programs like the Brandon Act and the Military Health System’s efforts to reduce stigma through leadership training, Combat Operational Stress Control programs, and the Real Warriors Campaign are vital steps toward changing the perception of mental health care among veterans.

Shift in Perceptions

These initiatives aim to normalize seeking help and emphasize that mental health is a continuum of preparedness, not a binary state of being ‘fit’ or ‘unfit’ for service.

Challenges Despite Progress

Despite these efforts, significant work remains. Studies indicate that many veterans with mental health needs still do not engage in treatment, with stigma playing a potential role. To address this, integrated care models and confidential referral processes have been established, and educational materials are distributed to combat misconceptions and encourage help-seeking behavior.

Continued Advocacy

The VA and other organizations continue to push for equitable mental health care and the reduction of stigma, ensuring that veterans receive the quality care they deserve without fear of discrimination or prejudice.

Prevalence and Severity of Mental Health Issues in Veterans

Veterans are uniquely affected by mental health issues due to the stressors of military service, combat exposure, and the challenges of reintegration into civilian life.

Prevalence of Mental Health Disorders

According to the VA, a significant number of veterans are diagnosed with mental illnesses such as depression, PTSD, substance use disorder, anxiety, schizophrenia, or bipolar disorder. The 2016 study reveals that over 1.1 million veterans treated in VA Patient Aligned Care Teams (PACT) were diagnosed with at least one of these mental illnesses.

Treatment Disparities

The prevalence of mental health disorders among veterans is concerning, with studies indicating that many do not receive the necessary treatment. The 2021 National Veteran Suicide Prevention Annual Report highlights that approximately 17 veterans died by suicide each day in 2019. Additionally, a study found that only 27% of veterans with a probable mental or substance use disorder were engaged in mental health treatment.

Link to Homelessness

Homelessness is another critical issue linked to mental health in veterans, with a study from the VA New England MIRECC and the Yale School of Medicine finding that 5.6 percent of veterans referred to anxiety or PTSD clinics experienced homelessness within a year.

Focus on Suicide Prevention

Furthermore, the Department of Defense and VA have emphasized suicide prevention due to a rise in suicide attempts during the wars in Iraq and Afghanistan, as reported by PubMed. Addressing these mental health issues is a priority for the VA, which is committed to advancing research and providing personalized treatment.

Interagency Efforts

The Interagency Task Force on Military and Veterans Mental Health works to enhance access to mental health care, promote research, and develop more effective treatment methodologies for veterans and their families.

Barriers to Mental Health Care for Veterans

Veterans face a unique set of challenges when seeking mental health care, with stigma being a significant barrier.

Treatment Disparities

Research indicates that only about half of veterans who need mental health care receive it, with stigma contributing to the reluctance to seek help. Stigma in the military context often stems from attitudes that perceive mental health issues as weaknesses, which can be demoralizing and discourage veterans from accessing care.

Identified Barriers

Studies have identified several dimensions of barriers, including concerns about others’ perceptions, financial and personal obstacles, doubts about the VA healthcare system’s efficacy, complexities in navigating VA benefits, and concerns about privacy and service abuse.

Efforts to Combat Stigma

Efforts to combat stigma include training military leadership to foster a supportive culture, incorporating mental health providers into unit services, and creating programs like Military Pathways and the Real Warriors Campaign. These initiatives aim to normalize seeking help and emphasize that mental health and substance use issues are common and treatable.

Persistent Treatment Gaps

Despite these efforts, many veterans still do not seek the treatment they need, highlighting the importance of continued efforts to address stigma and improve access to mental health care for veterans.

Strategies to Combat Stigma in Veterans for Improved Care

Stigma surrounding mental health and substance use is a significant barrier preventing veterans from seeking the care they need. A multi-faceted approach is essential to combat this issue, involving individual providers, public figures, policy work, and military leadership training. 

Enhancing Public Awareness and Education to Combat Stigma in Veterans

Public awareness and education are pivotal in reducing the stigma associated with mental health and substance use disorders, particularly in veterans.

Role of Educational Initiatives

Educational initiatives and awareness campaigns are instrumental in changing public perceptions and encouraging positive attitudes towards those facing these challenges.

Impact of Interventions

Research has shown that interventions combining education with face-to-face contact can significantly improve attitudes towards mental health and reduce the desire for social distancing, thereby facilitating better help-seeking behaviors.

Campaigns and Initiatives

Large-scale campaigns, such as those conducted by the National Alliance on Mental Illness (NAMI) through their StigmaFree initiative, harness the power of storytelling and advocacy to foster a more inclusive society.

Comprehensive Stigma Interventions

Similarly, multi-level stigma interventions targeting individual, interpersonal, community, and structural levels have been recognized as necessary to address stigma comprehensively.

Elements of Effective Campaigns

Effective anti-stigma campaigns often incorporate various elements, including sharing personal success stories, involvement of credible speakers, and adapting messages to resonate with local audiences.

Role of Educational Policies

Educational policies also play a crucial role by integrating mental health literacy into curricula and training for educators and school staff.

Creating Supportive Environments

This comprehensive approach ensures that the next generation is better equipped to understand and support individuals with mental health conditions, including veterans.

Sustained Efforts

Ultimately, sustained public education and awareness efforts are essential in creating an environment where veterans feel supported and empowered to seek the care they need without the fear of stigma.

Policy Changes and Initiatives to Support Veterans

The fiscal year 2024 has seen significant policy changes and initiatives aimed at supporting veterans, particularly in addressing the challenges related to substance use and mental health care.

Equity Action Plan by the VA

The Equity Action Plan introduced by the Department of Veterans Affairs (VA) outlines strategies to address systemic barriers veterans face when applying for disability compensation and achieving equitable health care outcomes. This includes direct outreach to encourage Black Veterans to file for disability compensation benefits within the first year of discharge.

Expansion of VA Health Care and Benefits

Furthermore, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) expands VA health care and benefits for veterans exposed to burn pits, Agent Orange, and other toxic substances. This reflects a commitment to the comprehensive well-being of veterans.

Screening and Early Detection

Additionally, the VA has screened 5 million veterans for toxic exposures, facilitating early detection and treatment of health conditions.

President Biden’s Budget Proposal

In alignment with President Biden’s budget for 2024, there are proposals for historic investments in veterans. These include efforts to end veteran homelessness and prevent veteran suicide, as well as delivering care and benefits to toxic-exposed veterans. These initiatives represent a holistic approach to veteran care, acknowledging the multifaceted nature of their health and well-being.

Trauma-Informed Addiction Care for Veterans at The Recovery Village Columbus

If you or a loved one are looking for veteran-specific help for opioid addictions, we can help. The Recovery Village Columbus offers comprehensive trauma-informed substance use treatment. As a proud partner of the VA Community Network, we provide a veteran-specific treatment track and work with VA benefits. We also offer EMDR, a revolutionary new therapy to treat post-traumatic stress. Contact a Recovery Advocate today. They’ll guide you through the admissions process and help you navigate your VA benefits or insurance.