Veterans are at significantly higher risk of developing a substance use disorder (SUD) as compared to non-veterans.  Despite attempts to address this concern by the Veteran Affairs (VA) and other agencies over the last two decades, this risk continues to rise. Veterans with SUD are also more likely to suffer from a mental illness or experience homelessness. As such, there is an increasing need to tailor prevention programs for veterans, in addition to providing integrated support that addresses social determinants of health (e.g., housing and employment).

Challenges Accessing SUD Prevention & Treatment Services/Programs

• Veterans transitioning back to civilian life are at increased risk of developing a SUD, being diagnosed with a serious mental illness (e.g., PTSD), and becoming unhoused. The presence of any of these risk factors often increases the risk of the others.
• Although the VA provides mental health and SUD treatments and services, there is an increasingly long backlog of unanswered disability and related compensation claims. Preventing SUD among veterans could also decrease the number of new claims.
• The COVID-19 pandemic exacerbated national health care and mental health provider shortages, including those who serve veterans.
• Many veterans face transportation and geographic barriers to accessing care, often because they live in rural communities.

(figure derived from 2015 and 2020 SAMHSA reports, and a 2023 VA PIT count of unhoused veterans)

 Strategies to Support Veterans & Prevent or Treat SUDs

• Crisis and peer-support programs can provide effective trauma-informed, community-based support to those suffering from SUDs.
• Screening practices (e.g., Screening, Brief Intervention, & Referral to Treatment (SBIRT) model) at the state level have led to reductions in risky alcohol and drug use, as well as depression rates.
  • Although this model has not been expanded nationwide, national screening efforts have been effectively implemented to lower suicide risk, providing the infrastructure for expanding such programs.
• Low-barrier models of care addressing housing and medication have been shown to reduce the rate of harmful substance use, increase access to treatment, and improve recovery outcomes for individuals with SUD.
• The VA offers a wide range of SUD programs across all 50 states. However, younger veterans are less likely to seek traditional care from the VA and could benefit from novel methods of engagement and delivery.

Policy Considerations 

To prevent SUDs and reduce other negative health effects of substance use for the veteran population, policymakers can leverage a multifaceted approach to maximize impact. Strategies to support veterans can include:

• Evidence-based, trauma-informed treatments for SUD.
• Depression and suicide prevention
  • Example: Twin Cities Suicide Prevention Coalition’s Healthcare Informational Toolkit for preventing suicide in Service Members, Veterans, and their Families.
• Effective programs service delivery involves selecting and coordinating evidence-based programs designed to treat co-occurring mental health and SUDs. This is particularly important for veterans who experience multiple barriers to care (e.g., housing instability, unemployment, childcare responsibilities, justice system involvement, rural residency, among others).

Examples:

• Integrate housing services and mental health support, such as Housing First models with long-term support. Shelters and emergency care providers typically do not offer long-term support.
• Universal screening for behavioral health conditions across all VA sites, while lowering barriers to immediate access to care.
• Telehealth may be particularly beneficial for rural-residing veterans.

• Providing additional support for female veterans who have experienced sexual trauma.
• Leveraging existing networks of non-government and state-level programs, in addition to expanding accreditation systems to increase the number of eligible VA providers.