Substance Use Disorders and Mental Health Illnesses Among U.S. Veterans: A Multi-Method Study Using Quantitative and Qualitative Research Methods

Abstract

This manuscript-style dissertation presents three studies highlighting some of the biggest challenges that U.S. veterans face after leaving the military, and explores trends related to their challenges. The most pervasive types of veteran’s health care treatment needs are for substance use disorders (SUD), suicidal behaviors (ideation, plan, attempt), and depression. Research evidence shows that among veterans who used the Veterans Health Administration (VHA) health care system, nearly half were diagnosed with at least one SUD. A study on military personnel found that approximately 30% of suicide attempts that resulted in death were preceded by substance use. Veterans who have experienced SUDs and homelessness also have a greater likelihood of struggling with depression and suicidal behaviors. The purpose of the first two studies were (1) to examine risk factors that contribute to SUD relapse upon completion of SUD treatment, (2) to estimate the prevalence of suicidal behaviors and prescription opioid misuse among veterans, and (3) to identify associations between suicidal behaviors and misuse of prescription opioids as well as other sociodemographic and behavioral determinants of health using data from large nationally representative datasets that are not affiliated with the VHA system. The third study used semi-structured interviews to conduct a phenomenological study in exploring the perspectives of homeless veterans living with SUDs and assess how social ecological factors impact their recovery. This multi-method study provides a robust analysis of the veteran population using nationally representative data and veterans’lived experiences through collection of data from semi-structured interviews. All three studies used non-VHA data, thus, producing an alternate assessment of all veterans, not just those who receive care from the VHA. The first study found that approximately 94% of veterans relapsed upon discharge from outpatient or residential SUD treatment. It also showed that veterans with homelessness, unemployment, or arrests upon discharge had a higher likelihood of relapse after SUD treatment completion. The second study revealed that approximately 3.7% of veterans experienced suicidal behaviors and nearly 3.0% reported prescription opioid misuse. This study also determined that 16.3% of veterans who misused prescription opioids also demonstrated suicidal behaviors; these results showed a much higher prevalence of suicidal behaviors than those with prescription opioid use without misuse (4.8%) and those with no prescription opioid use (2.5%) in the last year. The third study established that veteran homelessness and substance use are strongly associated with trauma suffered while on active duty and personal adverse life events. These experiences varied from grieving the death of a family member to being the victims of physical and sexual assault. Our findings suggest that a more focused approach to address substance use and mental health illness, along with permanent housing must be placed on veterans who recently separate from the military.