Life in a foreign country, dangerous and suspenseful situations, and first-hand combat are just some of the situations that commonly occur during a career in the military. These experiences tend to be hard to shake off and remain influential in shaping the rest of people’s lives. All these aspects contribute to the fact that US veterans are disproportionately affected by mental health issues, with a specific emphasis on substance use disorders.1

Since the military prides itself on organization and camaraderie, troops’ lives are organized in a structured and efficient manner that provides them with the support they need to stay focused and productive. Problems usually start once veterans are discharged and find themselves in a new environment that they are unable to navigate. Everyday life brings a host of challenges that differ from what they encountered in the army. This period represents a crucial stage in veterans’ lives and in many ways determines their future civilian life away from the military.1

Unable to cope and struggling to find the right answer, many veterans turn to substance use and self-medication. Partly due to stigmas associated with veterans and mental health care and partly due to specific military culture, a very low percentage of veterans turn to professional help when confronted with mental health challenges. Out of 2.4 million veterans who struggle with substance use disorders (SUDs), almost 92% received no treatment in the previous year.2

Why Veterans Commit Suicide?

Although highly stressful situations can result in immediate shock and lasting trauma, the majority of mental health conditions develop slowly over time. Life on the battlefield and direct exposure to combat situations creates the perfect conditions for the development of behavioral and addiction issues. Some military personnel are affected by stigma and may be afraid of being perceived as weak or “crazy” for seeing a doctor for their mental health issues.1

Alcohol is the most widely abused substance among US veterans. Due to its prominent role within our culture, veterans tend to underestimate the severity of their alcohol intake and the overall dangers associated with alcohol use. Excessive alcohol use among veterans has been steadily growing for years, with research pointing to the fact that 7 in 10 veterans struggle with alcohol-related issues. This means that 1.7 million veterans are at risk of developing serious alcohol-related mental and physical health issues.2

Another big problem of substance use among veterans is that they tend to underestimate the extent and dangers of their substance use. Even though the use of dangerous substances like opioids carries multiple health-related risks, research found that 70% of veterans perceived their opioid overdose risk as lower than that of an average adult. Military deployment and previous stressful experiences make veterans prone to developing issues like:3

  • Substance use disorder (SUD), particularly alcohol use disorder (AUD)
  • Post-traumatic stress disorder (PTSD)
  • Depression
  • Traumatic brain injury (TBI)
  • Anxiety and paranoia

Veteran Suicide Rate

Alongside rural populations, middle-aged adults, tribal populations, and sexual and gender minorities, veterans represent one of the most vulnerable groups when it comes to suicide. The adjusted veteran suicide rate is roughly 52% higher than for adult non-veteran Americans. Almost 14% of all adult suicides in America were committed by former military personnel. Another alarming fact is that suicide attempts among former active-duty service members in the 18 to 25 age group almost doubled during the 2009-2019 period.4

The problem of suicide among veterans was further exacerbated by the emergence of the COVID-19 pandemic. Many mental health experts expressed concern pointing to the unfortunate fact that the pandemic has the potential to increase the number of suicides among vulnerable groups, and especially US veterans. Although it’s too early to tell, there are multiple warning signs that the pandemic’s lingering effects may contribute to the problems of already vulnerable veteran population.5

What are the Risk Factors of Veterans to Suicide?

There are numerous factors that predispose veterans to suicide and other mental health issues. One of the major factors is the deployment status. Research that looked at suicide rates for veterans of the Afghanistan and Iraq wars found that actively deployed personnel had lower suicide risk than non-deployed troupes. The risk of suicide was higher for non-deployed personnel by 33%, highlighting how hard it is for veterans to transition from active service in the military.6

The risk of suicide among veterans is highest during the first 3 years of life away from the army. Civilian life presents veterans with everyday challenges that differ from the high-stress situations they experienced in the army. Many turn to substance use, further aggravating their mental well-being and increasing the chance of developing a co-occurrence of addiction and mental health issues like anxiety, PTSD, or depression. Almost a third of all military suicides in the past 20 years involved alcohol use.1, 4

One unexpected risk factor for suicide is low cholesterol. Numerous studies were conducted in the past 3 decades that looked at the connection between cholesterol levels and suicidal behavior. Researchers found that low levels of cholesterol plasma played a major part in the development of suicidal ideation. Since these findings were surprising, researchers explored this issue further and found evidence of a connection between the two.7

Even though only a small number of suicidal veterans will try taking their own lives, it’s important to keep a close eye on individuals who exhibit risk factors associated with suicidal behavior, including:8

  • Specific military-related risk factors, such as:
    • Stubborn chronic pain from a combat injury
    • Frequent mission deployments
    • PTSD caused by stressful, traumatic, or life-threatening situations
    • Stigmas that make veterans feel ostracized or looked upon
    • Falling out with close family members or friends, especially among former military comrades
    • Witnessing a serious injury or the death of a companion in arms
    • Experience of killing someone on the field of battle
  • Individual risk factors that are common to all demographics, like:
    • Built up stress
    • Severe or long-term addiction issues
    • Low levels of cholesterol plasma
    • History of family violence or sexual abuse
    • Severe or long-term depression or anxiety
    • Family history of substance abuse and suicide
    • Presence of co-occurring disorders
    • Psychosocial stressors, including divorce, loss of a job, terminal or incurable illness, or death of a close friend or a family member.
    • History of previous suicide attempts

What are the Warning Signs of Suicide in Veterans?

People sometimes find it hard to approach individuals whom they suspect of harboring suicidal thoughts. Talking about suicide is never an easy thing to do, but studies have shown that connecting with at-risk individuals in a thoughtful and compassionate manner is unlikely to escalate their suicidal thoughts. In fact, it can have a beneficial effect and even reduce the number of suicide deaths.9

Talking with veterans whom we suspect of suicidal ideation is important because it may be the only way to discern what is bothering them and what their real thoughts are. Although a cry for help is not uncommon among people who are contemplating suicide, veterans are more likely to keep their issues to themselves due to stigmas and attitude of self-sufficiency within military culture. If you’ve noticed that a veteran is struggling, try talking to them and be on the lookout for some of the following warning signs of suicide:10

  • Indirect warning signs of suicide that shouldn’t be ignored, including:
    • Hopelessness or feeling of despair
    • Social withdrawal and seclusion
    • Purposelessness and lack of reason to live
    • Irritability or mood changes
    • Frequent episodes of anxiety or agitation
    • The overwhelming feeling of guilt or shame
    • Rage and angry confrontational behavior
    • Problems with sleeping patterns or insomnia
  • Direct warning signs of suicide that mandate immediate reaction, such as:
    • Extreme recklessness and risky life-threatening behavior
    • Severe substance abuse that carries the risk of overdose
    • Enquiring about possible suicide methods
    • Preparing for suicide through financial arrangements for their beneficiaries or updating of the will, and saying goodbye to family members or people they are close with
    • Clearly stating a desire to die or end their life

How is Substance Abuse Related to Veterans’ Suicide?

People turn to substance use when they are unhappy with their lives or when they need help getting through difficult periods of their lives. However, addiction soon takes hold and people lose the ability to think clearly and recognize the dangers associated with their newly developed unhealthy habits. Alcohol and illicit drug use have the potential to contribute to suicidal behavior by aggravating an individual’s existing mental health conditions like depression, anxiety, or PTSD. It also lowers people’s inhibitions, making them more prone to reckless behavior that can result in serious harm.11

There is a strong correlation between substance use, mental illness, and suicidal thoughts. Overlapping of mental illness and addiction, called dual diagnosis or co-occurring disorder, is a big issue among veterans, with 33% of veterans with mental health conditions reporting drug use in the past year. This puts 1 in 3 veterans with mental illness, or 1.3 million people, in a seriously endangered position when it comes to serious mental illness, suicidal tendencies, and the possibility of death from overdose.2

Available research also backs the existence of a strong correlation between addiction issues and suicidal ideation and behavior. For example, veterans with substance use disorder are as much as 7 times more likely to engage in serious suicidal thoughts, and 5 times more likely to make a suicide plan than their counterparts who have no SUD issues.2

Veterans and Mental Health Care

Living with mental illness is hard and people who don’t get treatment usually turn to self-medication or drug and alcohol use. The latest SAMHSA survey found almost 4 million adult US veterans who suffer from mental illnesses, with a third of them having serious mental illnesses. It’s extremely worrying that more than half of these 4 million veterans received no treatment at all for their mental health issues.2

If we add to this number the veterans who have a substance use disorder, which classifies as a behavioral mental health issue, we get 5.2 million veterans who had mental health concerns in 2020. Finding oneself in a war zone is fraught with dangers. Constant feelings of fear or loss of control can lead to various mental health issues like depression, anxiety, constant stress, or burnout. In addition to behavioral issues like depression and anxiety, the mental health issue that veterans mostly suffer from is PTSD.2

What Are the Risk Factors of PTSD?

Exposure to dangerous and out-of-control situations makes veterans especially vulnerable to PTSD. People who lived through a life-threatening situation may have trouble sleeping, eating, or concentrating on everyday issues due to upsetting flashbacks or pervading feelings of distress and anxiety.12

If these feelings persist for a longer period and start negatively impacting a person’s ability to function, the person should seek help for PTSD. In some cases, PTSD may start developing long after the traumatic event took place. It can be triggered by some tragic incident, like a death in the family or a natural disaster. Substance use can also trigger PTSD, especially in cases of severe alcoholism or long-term drug use.12

The prevalence of PTSD among veterans varies according to the military service area or the  type and duration of combat deployment. It ranges from roughly 12% for Gulf War veterans, 10 to 20% for those who fought in Iraq and Afghanistan, and 15 to 30% for veterans of the Vietnam War.13

Traumatic events that are known to cause PTSD are:12

  • Combat, bombings, explosions, and similar stressful military experiences
  • Sexual or physical assault
  • History of child sexual or physical abuse
  • Natural disasters, like tornados or hurricanes, floods, earthquakes, or fires
  • Life-threatening incidents
  • Traffic accidents
  • Witnessing the death or injury of fellow a combatant
  • Terrorist attacks and shootings

What are the Treatment Options Available for Veterans Suicide Prevention?

According to SAMHSA’s 2020 National survey of treatment facilities, the Department of Veteran Affairs operated 228 treatment centers that specialized in addiction recovery of veterans and related mental health issues. All these facilities offered suicide prevention programs, 93 % of them offered suicide risk evaluation and suicide risk screening services, and 90% of them provided evidence-based suicide prevention interventions.14

The passing of the MISSION Act of 2018 made significant improvements in the availability and quality of treatment procedures for US veterans. The biggest change was the introduction of the Community Care program that expanded on the choice of local and private providers veterans can choose from. MISSION Act enables veterans to get the highest quality rehab treatment using existing VA coverage.15

Proven rehab treatments that deal with veterans’ addiction issues include:16

  • Detoxification procedures that help veterans detoxify from unwanted harmful substances
  • Medication-assisted treatments that use FDA-approved medication
  • Self-help and mutual support groups that utilize 12-step programs including AA, NA, Al-Anon, and CoDA
  • Regular outpatient programs that are delivered in outpatient or primary care clinics
  • Short-term inpatient programs that last for 30 days for less severe cases of addiction
  • Intensive outpatient treatments (IOT) and Partial hospitalization programs (PHP) 
  • Long-term inpatient treatment for co-occurring disorders and more stubborn forms of SUD

You can look for treatment using the VA’s Find VA Locations tool that browses facilities according to the location and type of service offered, or you can try searching for VA facilities using an interactive state map to look for treatment near you. Another option is exploring American Addiction Centers rehab facilities, which offer Salute to Recovery programs that take into account the unique needs of military personnel. Salute to Recovery is a premium veterans’ rehab program designed to provide tailored treatments that are adjusted according to the individual needs of each veteran.

How to Connect Veterans to a Suicide Hotline?

Veterans who suffer from addiction issues face multiple barriers on the road to recovery. When asked about their challenges, veterans cite funding, transportation, lack of awareness and knowledge about their treatment options and VA programs and initiatives. Transportation was also identified as a major barrier to treatment throughout the country. Some veterans have financial problems with transportation while others felt triggered by vehicle transport due to previous traumatic experiences.17

One of the best ways to raise veterans’ suicide awareness is to encourage the use of veterans’ suicide hotlines. Hotlines are an essential tool for information dissemination and education about treatment procedures, addiction risks, potential warning signs of suicide, and the information concerning insurance benefits and coverage in general. Some hotlines connect veterans with comrades who underwent similar stresses, while others are staffed with people who are trained to deal with specific issues facing US veterans.

The VA operates a Veterans Crisis Line that doesn’t require callers to be enrolled in VA benefits programs. It’s available round the clock and guarantees full confidentiality and privacy. Crisis Line also offers a chat or text option for those who aren’t ready to talk. Another option is the American Addiction Centers veterans’ suicide hotline that is also confidential, available 24/7, and doesn’t carry any obligation on the part of the caller to enter into treatment.

Frequently Asked Questions