brand logo

Am Fam Physician. 2020;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.

Email letter submissions to afplet@aafp.org. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

Continue Reading


More in AFP

More in Pubmed

Copyright © 2020 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.