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2012 Toolkit


Address Mental and/or Substance Use Disorders Among Active Military, Veterans, and Their Families

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This is the 2012 Recovery Month Toolkit, the 2013 toolkit will be available in early summer.
“Mental Health Counseling Rates Among Armed Service Branches” infographic

Military personnel and veterans willingly risk their lives to protect our society. In the United States, there are more than 22.3 million veterans1 and more than 2.2 million active military service members (including the National Guard and Reserve).2 Among the challenges these men and women face is the risk of developing or exacerbating behavioral health conditions, which include mental and/or substance use disorders.

The 23rd annual National Recovery Month (Recovery Month) observance this September celebrates the effectiveness of treatment services and the reality of recovery. Recovery Month is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), within the U.S. Department of Health and Human Services (HHS).

This year's theme, "Join the Voices for Recovery:  It's Worth It," emphasizes that while the road to recovery may be difficult, the benefits of preventing and overcoming mental and/or substance use disorders are significant and valuable to individuals, families, and communities. People in recovery achieve healthy lifestyles, both physically and emotionally, and contribute in positive ways to their communities. They also prove to family members, friends, and others that prevention works, treatment is effective, and people recover.

SAMHSA's efforts to curb behavioral health issues in soldiers, veterans, and their families are guided by its Military Families Strategic Initiative, which aims to ensure access to needed behavioral health services to achieve positive outcomes in this population.3

This document outlines the impact of mental and/or substance use disorders on individuals in the military, as well as the prevention, treatment, and recovery resources available to provide support to these individuals and their families. To learn about the recovery journey of a military service member, veteran, or relative, please visit the "Join the Voices for Recovery" document in this toolkit.

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Prevalence of Mental and/or Substance use Disorders

Active military, veterans, and military families are all at risk for developing mental and/or substance use disorders. The rate of behavioral health conditions among military personnel is significant, with serious consequences:

  • Mental and/or substance use disorders caused more hospitalizations among U.S. troops in 2009 than any other cause.4
  • More than 1,100 members of the armed forces died by suicide from 2005 to 2009 - an average of 1 suicide by a member of the armed forces occurred every 36 hours during that time.5
  • Any illicit drug use, including prescription drug abuse, among active-duty personnel more than doubled between 2005 and 2008, from 5 percent to 12 percent.6

Individuals, as well as their friends and family, can help to prevent these disorders by recognizing their prevalence and symptoms and learning more about how these disorders can affect members of the military community.

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Understanding Mental Health Problems in the Military

While serving our Nation, hundreds of thousands of soldiers face exposure to combat. These traumatic war experiences can have a direct effect on mental health. The most common mental health problems among active duty service members include post-traumatic stress disorder (PTSD) and depression:7

  • PTSD is an anxiety disorder associated with traumatic experiences, and approximately 14 percent of service members returning from Iraq or Afghanistan meet the criteria for PTSD.8 Symptoms often include reliving the traumatic event, feelings of emotional detachment, difficulty sleeping, and increased anger or irritability.9
  • Depression is a condition that involves feelings of sadness or low mood that last more than just a few days, and is a common problem that can occur following trauma. For veterans, depression can be caused by painful memories and feelings about their war experiences.10 Symptoms of depression can include feelings of sadness and hopelessness, loss of interest in activities that were once pleasurable, insomnia or excessive sleeping, and thoughts of suicide.11
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Understanding Substance Use Disorders in the Military

While substance use disorders are not as pervasive as mental health problems among military populations, they are still a major health concern.12 The following are signs and consequences associated with substance use among people in the military:

  • Failure to fulfill major personal and professional obligations;13
  • Recurrent use of substances in situations in which they are physically hazardous;14
  • Recurrent alcohol or substance-related legal problems;15
  • Persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol or substance use, while this use often continues without stopping;16
  • Mood and behavior problems;17
  • Financial difficulties;18 and
  • Hurt social relationships.19
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The Extended Impact on Families

In the United States, there are approximately 700,000 military spouses, and more than 700,000 children have experienced the deployment of a parent.20 Military families play an active role in the recovery of a relative's disorder, while at the same time they may also experience difficulties dealing with situations that can arise due to a family member's deployment, injury, or death. Studies show that longer cumulative lengths of combat deployment, or the total number of days overseas, are associated with more emotional difficulties among military children and more mental health diagnoses among U.S. Army wives.21, 22

To prevent the onset of these issues, families need to identify the signs of mental and/or substance use disorders among loved ones - and monitor for symptoms even after a parent or spouse returns home.

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Address Prejudice to Help Military Members on the Road to Recovery

Social prejudice, or fear of being exploited or judged for mental and/or substance use disorders, can interfere with the desire of individuals with behavioral health conditions to seek treatment and support. For example, in 2008, approximately 12.9 percent of all military personnel believed that if they were to seek mental health counseling through the military, their careers would be damaged.23 Perceptions about behavioral health problems can change, however, and research shows that the most effective way of countering prejudice and discrimination is by sharing one's personal experiences with others.24

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Opportunities for Prevention, Treatment, Recovery, and Support

Many States have policies in place to respond to the needs of veterans, and in 31 States, substance use disorder treatment and service providers are required to screen for veterans' mental health status and in 40 States, health care providers screen patients to determine if they need mental health assessments.25 The Department of Defense (DOD) and U.S. Department of Veterans Affairs (VA) promote the integration of behavioral health and primary care to help reduce prejudice, improve access to high-quality behavioral health services, and provide a proven "best practice" for treating depression and PTSD.26

Additionally, the VA has devoted $37.7 million to placing psychiatrists, psychologists, and social workers within primary care clinics27 and has recruited nearly 3,800 new mental health employees, including 800 psychologists.28 Despite an influx in mental health care professionals, only 20 percent of all military personnel received mental health counseling in 2008.29 Army personnel were the branch most likely to have received some sort of mental health counseling (24 percent), compared with personnel in the Marine Corps (20 percent), Navy or Coast Guard (17 percent), and Air Force (16 percent).30

With the help of treatment and the support of family and friends, those in the military can and do overcome mental and/or substance use disorders and sustain happy, healthy, and productive lives.

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Additional Recovery Resources

A variety of resources provide additional information on Recovery Month, mental and/or substance use disorders, and prevention, treatment, and recovery support services. Use the toll-free numbers and websites below to share your experiences, learn from others, and seek help from professionals. Through these resources, individuals, including family members, can interact with others and find support on an as-needed, confidential basis.

  • SAMHSA's Website – Leads efforts to reduce the impact of substance use and mental disorders on communities nationwide.
  • SAMHSA's National Helpline, 1-800-662-HELP (4357) or 1-800-487-4889 (TDD) – Provides 24-hour free and confidential treatment referral and information about mental and/or substance use disorders, prevention, treatment, and recovery in English or Spanish.
  • SAMHSA's "Find Substance Abuse and Mental Health Treatment" Website – Contains information about treatment options and special services located in your area.
  • SAMHSA's "Considerations for the Provision of E-Therapy" Report – Shares extensive information on the benefits, issues, and success of e-therapy.
  • SAMHSA's ADS Center – Provides information and assistance to develop successful efforts to counteract prejudice and discrimination and promote social inclusion.
  • National Suicide Prevention Lifeline, 1-800-273-TALK (8255) – Provides a free, 24-hour hotline available to anyone in suicidal crisis or emotional distress.
  • Veterans Crisis Line, 1-800-273-TALK (8255) – Connects veterans in crises and their family and friends with VA responders through a confidential, toll-free helpline and online chat.
  • United States Department of Veterans Affairs - Mental Health – Maintains and improves the health and well-being of veterans through health care, social services, education, and research.
  • Army Substance Abuse Program (ASAP) – Provides guidance and leadership on alcohol and drug abuse prevention, education, and training programs for soldiers and their commanders.

For more information, read the in-depth version of this guide. Information about treatment options and special services in your area can be found by calling 1-800-662-HELP (4357) or 1-800-487-4889 (TDD), as well as at http://www.samhsa.gov/treatment.

Inclusion of websites and resources in this document and on the Recovery Month website does not constitute official endorsement by the U.S. Department of Health and Human Services or the Substance Abuse and Mental Health Services Administration.

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Sources

  1. U.S. Department of Affairs. (2011, November). Department of Veterans Affairs Statistics at a Glance. Retrieved March 14, 2012 from http://www.va.gov/vetdata/docs/Quickfacts/Stats_at_a_glance_FINAL.pdf.
  2. United States Department of Defense. (2011). Strengthening our Military Families. Retrieved September 1, 2011, from http://www.defense.gov/home/features/2011/0111_initiative/Strengthening_our_Military_January_2011.pdf, p. 1.
  3. Substance Abuse and Mental Health Services Administration. (2011). Leading Change: A Plan for SAMHSA's Roles and Actions 2011-2014 Strategic Initiative #3: Military Families. HHS Publication No. (SMA) 11-4629. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved September 13, 2011 from http://store.samhsa.gov/shin/content//SMA11-4629/05-MilitaryFamilies.pdf, p. 40.
  4. Armed Forces Health Surveillance Center. Medical Surveillance Monthly Report (MSMR). (April 2010). Retrieved March 29, 2012 from http://www.afhsc.mil/viewMSMR?file=2010/v17_n04.pdf, p. 3.
  5. Department of Defense Task Force on the Prevention of Suicide by Members of the Armed Forces. (2010, August). Final report of the Department of Defense Task Force on the Prevention of Suicide by Members of the Armed Forces. Retrieved March 3, 2011 from http://www.health.mil/dhb/downloads/Suicide%20Prevention%20Task%20Force%20final%20report%208-23-10.pdf, p. ES-1.
  6. Bray, R.M. et al. (2009). 2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military - A Component of the Defense Lifestyle Assessment Program (DLAP). Prepared by RTI International. Retrieved September 1, 2011 from http://www.tricare.mil/2008HealthBehaviors.pdf, p. 62.
  7. Armed Forces Health Surveillance Center. (2010, November). Selected Mental Health Disorders Among Active Component Members, U.S. Armed Forces, 2007-2010. Medical Surveillance Monthly Report (MSMR). 2010 November; 17(11). Retrieved September 1, 2011 from http://afhsc.army.mil/viewMSMR?file=2010/v17_n11.pdf, p. 2.
  8. Tanielian, T. & Jaycox, L.H. (2008). Research Highlights - Invisible Wounds of War: Mental Health and Cognitive Care Needs of America's Returning Veterans. Santa Monica, Calif.: The RAND Corporation. Retrieved September 23, 2011 from http://www.rand.org/content/dam/rand/pubs/research_briefs/2008/RAND_RB9336.pdf, p. 2.
  9. PubMed Health. (2011). Post-traumatic stress disorder. National Center for Biotechnology Information & U.S. National Library of Medicine. Retrieved September 13, 2011 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001923.
  10. Department of Veterans Affairs. (2011). Depression, Trauma, and PTSD. Retrieved February 16, 2012 from http://www.ptsd.va.gov/public/pages/depression-and-trauma.asp.
  11. National Institute of Mental Health (NIMH). (2011). Depression. U.S. Department of Health and Human Services. (NIH Publication No. 11-3561). Retrieved September 26, 2011 from http://www.nimh.nih.gov/health/publications/depression/depression-booklet.pdf, p. 4.
  12. National Institute on Drug Abuse. (April, 2011). Substance Abuse among military, veterans and their families. April, 2011. Retrieved September 14, 2011from http://www.drugabuse.gov/publications/topics-in-brief/substance-abuse-among-military-veterans-their-families, p. 1.
  13. Psych Central. (n.d.). Alcohol/substance abuse symptoms. Retrieved September 6, 2011 from http://psychcentral.com/disorders/sx15.htm.
  14. Ibid.
  15. Ibid.
  16. Ibid.
  17. U.S. Department of Veterans Affairs. (2010, May 20). Summary of VA Treatment Programs for Substance Use Problems. Retrieved September 28, 2011 from http://www.mentalhealth.va.gov/res-vatreatmentprograms.asp.
  18. Ibid.
  19. Ibid.
  20. U.S. Department of Defense. (2011). Strengthening our Military Families: Meeting America's Commitment. Retrieved September 6, 2011 from http://www.defense.gov/home/features/2011/0111_initiative/Strengthening_our_Military_January_2011.pdf, p. 7.
  21. Lesser, P., Peterson, K., Reeves, J., et al. (2010). The long war and parental combat deployment: effects on military children and at-home spouses. Journal of the American Academy of Child and Adolescent Psychiatry, (4), pp. 310-320. Retrieved March 9, 2012 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875082/?tool=pubmed.
  22. Mansfield, A.J., Kaufman, J.S., Marshall, S.W., et al. (2010). Deployment and the use of mental health services among U.S. Army wives. New England Journal of Medicine, 362, 101-109. Retrieved September 6, 2011 from http://www.nejm.org/doi/pdf/10.1056/NEJMoa0900177, p. 101.
  23. Bray, R.M. et al. (2009). 2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military - A Component of the Defense Lifestyle Assessment Program (DLAP). Prepared by RTI International. Retrieved September 1, 2011 from http://www.tricare.mil/2008HealthBehaviors.pdf, p. 397.
  24. Hyman, I. (2008). Self-Disclosure and Its Impact on Individuals Who Receive Mental Health Services. (HHS Pub. No. (SMA)-08-4337). Rockville, MD. Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. Retrieved September 28, 2011 from http://store.samhsa.gov/shin/content/SMA08-4337/SMA08-4337.pdf, p. 37.
  25. National Association of State Alcohol and Drug Abuse Directors (NASADAD). (2009). Addressing the Substance Use Disorder (SUD) Service Needs to Returning Veterans and Their Families: The Training Needs of State Alcohol and Other Drug Agencies and Providers. Abt Associates Inc. Substance Abuse and Mental Health Services Administration's (SAMHSA). Center for Substance Abuse Treatment (CSAT). Retrieved September 28, 2011 from http://pfr.samhsa.gov/docs/Veterans_Report.pdf, p. 4.
  26. Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (2011). Re-engineering Systems of Primary Care Treatment in the Military. Retrieved November 3, 2011, from http://www.dcoe.health.mil/Content/Navigation/Documents/About%20RESPECT-mil.pdf, p. 1.
  27. Yen, H. (2007, July 17). US to expand veterans mental health services. Associated Press. Retrieved September 26, 2011, from http://articles.boston.com/2007-07-17/news/29230003_1_mental-health-va-medical-centers-vet-centers.
  28. Testimony before the US Senate Committee on Veterans Affairs. (2008, April 9). Oversight Hearing: Making the VA the Workplace of Choice for Health Care Providers. Hearing Before The Committee On Veterans' Affairs United States Senate. U.S. Government Printing Office. Washington, D.C. Retrieved September 28, 2011 from http://www.gpo.gov/fdsys/pkg/CHRG-110shrg41918/pdf/CHRG-110shrg41918.pdf, pp. 3, 8.
  29. Bray, R.M. et al. (2009). 2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military - A Component of the Defense Lifestyle Assessment Program (DLAP). Prepared by RTI International. Retrieved September 1, 2011 from http://www.tricare.mil/2008HealthBehaviors.pdf, p. 101.
  30. Ibid.
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Recovery Month promotes the societal benefits of prevention, treatment, and recovery for substance use and mental disorders, celebrates people in recovery, lauds the contributions of treatment and service providers, and promotes the message that recovery in all its forms is possible. Recovery Month spreads the positive message that behavioral health is essential to overall health, that prevention works, treatment is effective and people can and do recover.

National Recovery Month 2013

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  • Behavioral Health is Essential to Health
  • Prevention Works
  • Treatment is Effective
  • People Recover
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