Letters to the Editor

Care of the Military Veteran Should Include Screening for Substance Use Disorders


Am Fam Physician. 2020 May 15;101(10):580-582.

Original Article: Care of the Military Veteran: Selected Health Issues

Issue Date: November 1, 2019

See additional reader comments at: https://www.aafp.org/afp/2019/1101/p544.html

To the Editor: The article from Drs. Yedlinsky, Neff, and Jordan provides insight into the complexity of four areas of military veteran health care. However, the critically relevant topic of substance use was not discussed. Substance use disorders are pervasive within the veteran population, with rates from 11% to 32%.1,2 Substance use disorders are three to four times more prevalent in the veteran population, likely related to specific stressors of military service.1,2 Substance use disorders are also rising, with reports showing an increase of more than 50% in recent years.2 Substance use disorders lead to an array of health issues affecting multiple different organ systems. Although gastrointestinal and cardiovascular diseases predominate, substance use disorders can also manifest with central nervous system issues, pulmonary complaints, or infectious diseases.3

Substance use disorders can occur in isolation, but they are more common as a comorbid condition. One study of returning veterans showed that 82% to 93% of those with mental health disorders also had a substance use disorder, rates that closely mirror studies on Vietnam-era veterans.1,4 Another report indicated that 30% of completed suicides in veterans were preceded by alcohol or drug use.1 Substance use disorder is strongly associated with chronic pain, and active duty soldiers experience 1.6 million musculoskeletal injuries annually, which is troubling given the well-established link between chronic pain and mental health diagnoses. More than half of veterans seen in the outpatient setting report experiencing pain on a regular basis, and in 2009, 24% of Department of Veterans Affairs patients received prescriptions for opioids.1 Although opioid prescribing rates have decreased over the past few years, this is still concerning in a population already prone to abuse potential.5

Shame, denial, and stigma are personal barriers to substance use disorder treatment, as well as systematic barriers such as finances and access.6 Veterans may be particularly vulnerable to barriers related to health care benefits and more sensitive to the perceptions of fellow service members regarding mental health and substance use disorder.

Substance use disorders are prevalent in the veteran population, are comorbid with many common veteran health issues, and are likely to compound other health complaints. Complete care of the veteran should include regular screening for substance use disorders and intervention strategies that are informed by veterans' unique risk factors, barriers to care, and comorbidities.

The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army, Department of the Air Force, Department of Defense, or the U.S. government.

Editor's Note: This letter was sent to the authors of “Care of the Military Veteran: Selected Health Issues,” who declined to reply.

Author disclosure: No relevant financial affiliations.


show all references

1. Teeters JB, Lancaster CL, Brown DG, et al. Substance use disorders in military veterans: prevalence and treatment challenges. Subst Abuse Rehabil. 2017;8:69–77....

2. Lan CW, Fiellin DA, Barry DT, et al. The epidemiology of substance use disorders in US Veterans: a systematic review and analysis of assessment methods. Am J Addict. 2016;25(1):7–24.

3. Dugosh KL, Cacciola JS. UpToDate: clinical assessment of substance use disorders. Accessed January 2020. https://www.uptodate.com/contents/clinical-assessment-of-substance-use-disorders

4. Schulte MT, Hser YI. Substance use and associated health conditions throughout the lifespan. Public Health Rev. 2014;35(2).

5. U.S. Department of Veterans Affairs. Department of Veterans Affairs opioid prescribing data. Accessed January 2020. https://www.oit.va.gov/reports/opioid/

6. Seal KH, Cohen G, Waldrop A, et al. Substance use disorders in Iraq and Afghanistan veterans in VA healthcare 2001–2010: implications for screening, diagnosis and treatment. Drug Alcohol Depend. 2011;116(1–3):93–101.

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This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



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