Veterans Mental Health - PTSD, Anxiety, Depression & Substance Abuse

Published Mar 23, 2020

Mental illness can arise due to both genetic factors and stressful life events.¹ Within this context, it would make sense that veterans, who are often exposed to combat and other dangerous and stress situations, would experience high rates of mental illness, including post-traumatic stress disorder (PTSD), anxiety, depression, and substance abuse.

In this article, you will learn more about:

PTSD and anxiety in military Veterans.
Retired service members’ struggle with depression.
Co-occurring substance abuse and other mental health disorders.
Substance abuse treatment and mental health assistance for Veterans.

Veteran Depression

Depression is one of the most common mental health disorders among Veterans.² According to National Alliance on Mental Illness, it also “carries the heaviest burden of disability.”¹ Symptoms of depression include:¹

Feelings of sadness or despair.
A loss of energy and interest in things you used to enjoy.
Withdrawal from activities and loved ones, which leads to a feeling of isolation and loneliness.
Feeling hopeless and/or helpless that things will change.
Thoughts of self-harm or suicide.

In 2008, the VA estimated that:¹

1 in 3 Veterans experienced some symptoms of depression.
1 in 5 Veterans had serious symptoms.
1 in 8 Veterans have been diagnosed with major depressive disorder (MDD) and required therapy and medication services.

A 2018 study conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) concluded that more than 14,000 Veterans experienced severe impairment in their daily functioning that was directly caused by an MDD.³

PTSD in Military Veterans

PTSD, also called “shell shock” during WWI and “combat fatigue” in WWII, is a mental health disorder that occurs when a person is exposed to a traumatic event and experiences distressing symptoms related to that exposure for longer than 1 month.⁴PTSD in military Veterans can be linked to traumatic events including but not limited to:

Exposure to combat including roadside bombs, IEDs, traumatic injuries sustained, and multiple tours of duty.⁵
Natural disasters.⁴
Molestation, rape, or violent assault.⁴
Serious accidents where life or physical integrity was threatened.⁴
Terrorist acts.⁴

Symptoms experienced by those who have PTSD include:⁴

Intrusive thoughts and feelings that relate to the experienced traumatic event and include flashbacks and nightmares.
Avoidance of people, places, and things that may remind the person about the traumatic event, including avoiding talking about the event.
Negative thoughts and feelings such as fear, guilt, shame, anger, detachment from loved ones, and cognitive distortions such as “it should have been me” or “I didn’t deserve to live.”
Emotional arousal or reactivity such as increased irritability, angry outbursts, self-destructive tendencies, increased startle response, and disrupted sleep and concentration.

PTSD is a common mental health diagnosis in Veterans. Studies estimate the prevalence of Veterans with a current diagnosis of PTSD is anywhere from 9-15%.^2,6 Most notable was that among Veterans who were diagnosed with depression, 33.2% of them also had a PTSD diagnosis.²

The purveyors of this same survey were surprised to find that the rate of mortality and emergency room visits among those diagnosed with PTSD was lower than those diagnosed with other mental health disorders. After a PTSD diagnosis, however, the number of visits a Veteran made to healthcare professionals increased, leading the researchers to conclude that great contact with the medical system may result in lower mortality.²

Anxiety After Military Service

Anxiety disorders are characterized by excessive worry or fear that causes distress.⁷ Symptoms of anxiety disorder include:⁷

Experiencing excessive fear of or anxiety that is out of proportion to the situation or is not typically considered age-appropriate, e.g., an adult experiencing a debilitating fear of the dark.
Feelings of muscle tension related to fear or anxiety.
Avoidance of people, places, or things that may trigger these feelings.
Impaired functioning related to fear and/or anxiety.

Anxiety disorders are the most commonly diagnosed disorders among the general population.⁷ Approximately 3% of adults experience symptoms of generalized anxiety disorder every year.⁸ Rates of anxiety are typically higher for military Veterans,⁸ with studies placing estimates around 5-12%.^{2, 9}

Unfortunately, there is a lack of research regarding anxiety disorders in Veterans, as it has historically been associated with PTSD.¹⁰ However, a study conducted in 2013 found that as many as 40% of Veterans who have been diagnosed with PTSD could also be diagnosed with generalized anxiety disorder.¹⁰

Veterans and Co-Occurring Disorders

Co-occurring disorders, also referred to as dual diagnoses, occur when someone has more than one mental health disorder, such as a substance abuse disorder and PTSD. In a large study of Veterans receiving primary VA care that screens for and detects mental illness, substance use disorder co-occurred for more than 20% of those with depression, PTSD, anxiety disorder, and serious mental illnesses (e.g., schizophrenia, bipolar disorder).²

The presence of a substance use disorder was also associated with increased odds (44%) of an emergency room visit as well as increased odds (77%) of 1-year mortality.²

Research from 2018 shows the following statistics regarding Veterans with substance use disorder and another co-occurring mental health disorder:³

In 2018, 3.7 million Veterans had a mental health disorder and/or SUD.
Alcohol (28-34%), marijuana (20-23%), and opiates (6-8%) were the most widely abused drugs in 2018.
1 in 4 used illicit drugs that year.
4 in 5 abused alcohol in 2018.
1 in 13 abused both illicit drugs and alcohol in 2018.

Veterans who have a co-occurring mental health disorder in addition to a substance use disorder are also at risk of increased suicide.³ Compared to their counterparts without a substance use disorder, these Veterans are:³

8 times more likely to consider suicide.
11 times more likely to formulate a plan to attempt suicide.
23 times more likely to attempt suicide.

The correlation between the increased risk of suicide and co-occurring disorders in Veterans highlights the urgent need for treatment for Veterans’ mental health issues.

Substance Abuse Treatment and Mental Health Assistance for Veterans

In 2018, SAMHSA found that:³

89.4% of Veterans with a SUD did not seek treatment.
53.5% of Veterans with any mental illness received no treatment.
28.8% of Veterans with serious mental illnesses did not seek treatment.

There is a strong correlation between Veterans and mental health, as well as a large percentage of Veterans dealing with mental health issues who aren’t seeking treatment. Veterans need to know that help is available at little to no cost.

Veterans seeking treatment have the following resources available to them through the VA system:

Make an appointment with your primary care provider, who can refer you to a mental health professional and may be able to initiate medication for the interim.
Find a local Vet Center where you can walk in with your DD214 and talk to a therapist without an appointment and regardless of your eligibility status. Find a Vet Center near you.
Go to your local VA and speak to a Local Recovery Coordinator. These LRC’s can connect you to local resources and they operate education and discussion groups with other Veterans.
Determine your eligibility with the VA and make an appointment to see a mental health professional for therapy and/or medication.
Look outside the military for a community care provider, like American Addiction Centers.

Veterans who don’t want to go through the VA can utilize the following free resources:

If you or a loved one are a Veteran and believe you may be dealing with one of these mental health disorders, contact one of these resources today to begin your journey toward health and wellness. While it may seem hopeless right now, all of these illnesses can be treated with therapy and/or medication. Help is available.

About American Addiction Centers

AAC’s Veteran services are available at all AAC facilities. Our dedicated, robust Veteran program, The Rally Point: AAC is offered at our 4 VA Centers of Excellence:

The Rally Point: AAC blends AAC’s medically informed, patient-centric approach to treatment with therapies that address co-occurring disorders that may affect military Veterans. Many of the staff involved in our programs for Veterans or come from military families. This helps them connect with the Veterans receiving treatment and help them move towards a life in recovery.

No Veteran should have to suffer in silence. There are several methods to help you find peace and start your life in recovery.

Veterans’ Mental Health Issues