Care for veterans with substance use and mental health disorders needs improvement

July 22, 2020

Veterans who have served in the U.S. military since the 9/11 attacks have a high level of need for both substance use treatment and mental health care, yet many do not receive appropriate help for their co-occurring disorders, according to a new RAND Corporation report.

While the availability of services has expanded in recent years, more effort is needed to encourage providers to adopt evidence-based treatments and structured programs to make them more assessible and appealing to veterans, according to the report.

Among the RAND recommendations are offering evidence-based integrated treatments that target substance use and co-occurring mental health disorders concurrently, evaluating veterans regularly throughout treatment to make sure both substance use and mental health outcomes are adequately addressed, and incorporating veterans' treatment preferences into decisions about their care.

"Despite federal and community efforts to improve the quality and availability of care for veterans, they remain at high risk of developing both mental health disorders and substance use disorders," said Eric Pedersen, lead author of the study, an adjunct researcher at RAND and an associate professor of psychiatry and behavioral sciences at the Keck School of Medicine of USC.

"More work is needed to explore in more detail not only the quality of care available to these high-risk veterans, but also their ability to access it and their treatment outcomes over the short and long terms," Pedersen said.

RAND was asked by the Wounded Warrior Project to examine the state of care provided to post-9/11 veterans who experience both substance use and mental health disorders, and provide recommendations for how to improve care for the group.

"We must continue the work to meet the mental health needs of post-9/11 veterans," said Mike Richardson, Wounded Warrior Project's vice president of mental health. "This important research will help us support veterans by supporting programs that can help those suffering from both substance use disorders and mental health challenges." Veterans with co-occurring substance use disorders and mental health disorders may have poor functioning in multiple areas of their lives, such as in their relationships, and are likely to have other behavioral health and physical health problems.

Frequently, these veterans do not seek behavioral health care, and even when they do they generally have poorer treatment outcomes than those with just a single behavioral health disorder. This may be because both issues are not addressed concurrently and/or with evidence-based approaches.

RAND researchers reviewed the research literature on effective approaches to treating substance use disorders alone and alongside mental health disorders, and analyzed the approaches used at treatment centers that offer substance use disorder treatment by conducting a series of interviews and site visits with treatment providers.

Using information from two federal databases about treatment programs and information about the locations of the post 9/11 veterans who belong to the Wounded Warrior Project, the study found that alumni of the Wounded Warrior Project have relatively convenient access to mental health and substance use treatment facilities with specialized programs for co-occurring disorders and that also offer specialty programs for veterans.

However, despite access to these facilities, visits and telephone interviews with representatives from a sample of treatment facilities revealed that evidence-based practices and data-driven decision making were not standardized across facilities.

Although some facilities prioritized innovation, the weight of clinical experience in others perhaps precluded some clinic leaders and providers from implementing novel treatment approaches or adapting current approaches based on the most current evidence.

"Across the board, there was a need for more data and systematic tracking of treatment outcomes over time," said Terri Tanielian, co-author of the report and a senior behavioral scientist at RAND.

The report also notes that the coronavirus pandemic in the United States has made it clear that telehealth and self-help approaches are a necessary option for mental health and substance use disorder care for veterans when access to in-person care is limited or risky.

The Wounded Warrior Project is a nonprofit organization established to support veterans of the post 9/11 era with significant injuries.

The report, "Improving Substance Use Care for Post-9/11 Veterans: Addressing Barriers to Expanding Integrated Treatment Options," is available at http://www.rand.org. Other authors of the report are Kathryn E. Bouskill, Stephanie Brooks Holliday, Jonathan Cantor, Sierra Smucker, Matthew L. Mizel, Lauren Skrabala and Aaron Kofner.

RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries.
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RAND Corporation

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