Date of Award

6-2025

Degree Name

Doctor of Philosophy

Department

Interdisciplinary Health Sciences

First Advisor

Kieran Fogarty, Ph.D.

Second Advisor

Rob Lyerla, Ph.D.

Third Advisor

Decker B. Hains, Ph.D.

Keywords

Barriers, military, perception, post-9/11, substance use disorder, veteran

Abstract

Substance use disorders (SUDs) represent a critical public health concern, particularly within military and veteran populations. The complex interplay of mental health challenges, combat exposure, and the unique stressors associated with military service contribute to a heightened vulnerability among veterans. Research from the United States Department of Veterans Affairs (USDVA) underscores the prevalence of these issues, indicating that approximately 1 in 10 veterans from the Iraq or Afghanistan wars treated by the VA are diagnosed with a SUD (Veterans Affairs, 2023). Additionally, veterans from all eras show a higher propensity for binge drinking when compared to the general population, further complicating their health outcomes and quality of life (Veterans Affairs, 2023).

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), categorizes SUD on a spectrum ranging from at-risk to severe, reflecting its varied and pervasive impact on individuals (American Psychiatric Association, 2013). The challenges inherent in recognizing and seeking treatment for SUDs are well documented. For instance, Mojtabai et al. (2002) found that a mere 32% of individuals diagnosed with an SUD, mood disorder, or anxiety disorder acknowledged the need for professional help, and among those who did, only 59% pursued treatment. This gap between diagnosis and treatment underscores the multifaceted barriers veterans face, including stigma, logistical challenges, and attitudinal obstacles, all of which impede access to care.

Furthermore, the literature highlights the attitudinal barriers prevalent among veterans, particularly those returning from Operation Iraqi Freedom and Operation Enduring Freedom. Hoge et al. (2004) identified that 65% of service members perceived seeking mental health treatment as a sign of weakness. Additionally, concerns about negative career implications and the inability to take time off from work to prioritize mental health care further exacerbate the reluctance to seek treatment. These findings suggest that the stigma surrounding mental health and SUDs within the military culture plays a significant role in hindering veterans from accessing necessary care (Seal et al., 2011; Suijkerbuijk et al., 2017).

This dissertation seeks to address the pressing issue of SUD treatment among veterans by exploring two primary research objectives. The first objective is to investigate whether combat exposure or service during the Post 9/11 wartime era is associated with a higher prevalence of veterans seeking treatment for SUDs compared to non-combat veterans of the same era and the general population. This examination is crucial for understanding the specific factors that may contribute to or deter treatment-seeking behavior among veterans. The second objective is to identify perceived barriers that limit access to SUD treatment among both combat and non-combat veterans and to analyze how these perceptions influence their likelihood of seeking treatment.

To achieve these objectives, this study will utilize secondary data from the National Survey on Drug Use and Health (NSDUH). The analysis will employ Chi-square tests of independence and logistic regression techniques to examine the relationships between key independent variables—such as combat exposure, wartime service, and perceived barriers—and the dependent variable of whether veterans sought SUD treatment in the past 12 months. By comparing these outcomes to the general population, the study aims to provide a comprehensive understanding of the unique challenges veterans face in accessing SUD care.

The significance of this research lies in its potential to inform both policy and practice. By elucidating the factors that influence SUD treatment-seeking behavior among veterans, this dissertation aims to contribute to the development of targeted strategies that enhance access to care. Moreover, understanding the role of perceived barriers in preventing treatment can guide the creation of more effective outreach and intervention programs tailored to the specific needs of veterans.

In summary, this dissertation addresses a critical gap in literature by examining the complex factors influencing SUD treatment among veterans. Through a rigorous analysis of secondary data, this study seeks to provide empirical evidence that can shape future SUD treatment protocols, improve outreach efforts, and ultimately enhance the health and well-being of veterans who have served our nation.

Access Setting

Dissertation-Open Access

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