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Stigma Impacts Substance Abuse and Mental Health Care in Veterans

What Is Stigma? – A Veterans’ Mental Health Guide 

American veterans have sacrificed their time, family life and health to defend the values their country represents in the world. Since active deployment takes them to many dangerous places on the planet, the risks to their physical well being are well known and documented in mainstream media and culture. But military life leaves many scars on their mental wellbeing. Veterans are disproportionately affected by a number of mental health stigmas that are not so visible on the inside but can be a great burden on their lives.1

Their experiences on the battlefield and life endangering activities make them susceptible to suffering from mental challenges, chief among them conditions like PTSD, anxiety, depression, and in many cases substance abuse. In SAMHSA’s report from 2020, 3.1 million veterans reported that they suffered from mental health conditions. About 833,000 of them had serious mental health issues while 1.3 million suffered from substance use disorder. Alcohol use was reported by 4 out of every 5, and illicit drug use by 1 in 4.2

It is alarming that only 53.3% of veterans that had any mental health condition received treatment. Among those who suffered from substance use disorder (SUD) only 14.9% got treated for their issues meaning that the overwhelming majority of them, some 85%, had no treatment at all. Seeing that substance abuse is a life-changing and in some cases life-threatening condition, this represents a serious cause for alarm. One of the main reasons why veterans fail to consider treatment that is available to them might be a widespread mental illness stigma that exists among military personnel.2

What Is Stigma?

Stigma is basically a negative stereotyping of people due to certain features that make them different. It can lead to various forms of discrimination. In terms of mental health, stigma should be seen as an obstacle that stand in the way of recovery of afflicted individuals and of society as a whole to accept them for what they truly are, just people who need help and who can get better with the right sort of treatment.3

People are often stigmatized because of their sociological and cultural characteristics like religion, ethnicity, and sexual orientation. Stigmas related to age are called ageism since people are discriminated and looked down upon because of their advanced or in some cases immature age. Stigmas can arise as a result of physical deformity like blindness or deafness or due to “blemishes of character” like promiscuity and addiction.4

From the viewpoint of mental health and possible treatment, stigmas can be classified and grouped in 3 distinct categories:5, 6

  • Public stigma is the existence of stereotypes that wider society holds in relation to individuals who suffer from mental health illnesses.
  • Self-stigma occurs when veterans who have mental health challenges start believing in negative labels and prejudices that are attached to their ailments.
  • Anticipated stigma is when people anticipate dismissive reactions or discrimination from others because of their mental health condition.

Living with mental health conditions is hard in itself, but being stigmatized can make the situation even more challenging. Many times individuals have to face unwanted consequences of stigma such as stereotyping, discrimination and in severe cases oppression. This can lead to feelings of anger, shame, depression, and in some instances outright alienation. In order to deal with these negative perceptions, people might engage in social withdrawal to minimize their exposure to such unpleasant experiences.7

Where Does Stigma Come From?

Negative labeling and the use of language in a manner that downgrades people from the position of prejudice and ignorance is an important disseminator of stigma within the society. Traditional and social media and popular culture, whether music, films or games tend to portray people with mental illnesses in bad light, representing them as unstable, violent, predictable and altogether dangerous. Instead, available research shows that mental illness shouldn’t be synonymous with violence since people who suffer from them are more often victims than perpetrators of violence.8

According to scientific research, mental conditions are mostly caused by genetic predisposition and life experience which means that people have little choice or control over them. One survey even found that many Americans reported they would rather tell their employers that they served time in jail than admitting to having visited an addiction recovery clinic. Unfortunately addiction stigma has been cited as one of the main reasons why Americans with serious mental health issues decided not to seek professional help.8

How Does Mental Health Stigma Affect Veterans?

Impact of stigma makes it very hard for veterans to return to their normal everyday lives. In addition to these, excessive anxiety and stress makes them susceptible to look for solutions in the form of alcohol and drugs misuse. Veterans are also more prone to suicide ideation than other segments of society. Another important factor is the macho culture that exists within the army resulting in some common false self-stigmas, such as:7

  • Veterans are reluctant to seek medical help out of fear of being perceived as “soft”.
  • Falsely thinking that they shouldn’t complain since this is what they should have expected when they signed up.
  • Believing that since they went through tough times before they will also be able to deal with mental health issues.
  • Drawing on their military identity thinking “I’m a veteran I don’t need anybody’s help”.

After risking their lives to preserve and uphold the style of life that all Americans enjoy, the last thing the veterans deserve when they get back on home soil is to be stigmatized and ostracized by the community that is most indebted to them. This is one of the reasons why veterans find it so hard to deal with mental health stigma. Common misconceptions and myths that the public believes about veterans are:7

  • Veterans are stuck with their illness and have no chance of recovery.
  • Their illness is a sign of their lack of character because they could get better if they really wanted to.
  • Veterans with mental conditions should be considered unstable and dangerous.
  • Veterans with mental illness are unpredictable since they might snap and hurt somebody.

All this can result in veteran’s civilian lives being affected since they will:9

  • Become alienated, isolated, and perceived as “others”.
  • Be seen as irresponsible, childish and incapable of making informed decisions.
  • Experience discrimination when applying for a job.
  • Become afraid of rejection and stop pursuing possible opportunities.

Mental Health Stigma and Veterans

Veterans have to deal with going through some very stressful situations that ordinary civilians won’t find easy to relate to. Military life is riddled with experiences unimaginable in any other profession. Added to this is the fact that deployments take part in places that are far away from home and cultures that are very different and in some cases very hostile. Some of the most often cited stressors that veterans reported experiencing during active deployment were:10

  • Air raids.
  • Lengthy and dangerous deployments.
  • Roadside detonations and bombs.
  • Handling of human remains.
  • Witnessing dead or severely injured countrymen.
  • Being helpless in extreme and life-threatening situations.
  • Killing somebody on the battlefield.

Military training prepares veterans for the things they will face while deployed in their country’s service, but coming back home they are faced with a completely different set of issues and challenges that many of them lack the proper tools to deal with. Most common challenges that veterans have a hard time handling while re-adjusting to non-military world are:11

  • Relating to common folks who simply don’t know what the life of military personnel entails, and even if they do they can hardly comprehend what it really implies.
  • Reconnecting with family members and re-establishing their role within the family unit that went through some changes (since kids grow, have new experiences, and develop new routines while veterans were away).
  • Rejoining or creating a community, including getting back with their old friends and rekindling old relationships that they left behind when they joined the military and went away.
  • Creating structure since the military provides a clear chain of command and responsibilities. Veterans have to work on creating everyday routines, organizing their available time, and adjusting to different lifestyles that might not be so ordered and structured.
  • Returning to a job they held before deployment. In some cases veterans might find themselves doing a desk job a week after witnessing traumatic scenes on the front. They might also find themselves in the situation of having to do some catching up, adjusting to certain changes, or learning new skills.
  • Entering the workforce since they lost their previous job or maybe never even held a civilian job before putting them in a position of having to learn how to write a CV and translate their previous knowledge and military skills and experiences to use in a civilian environment.

Stigma, discrimination and irrational prejudice against certain perceived or existing mental health conditions or traits are called sanism or some cases mentalism. Sanism falls into the same category as other bigoted belief systems like racism, sexism, and homophobia. Problem with sanism is that it’s largely invisible and socially acceptable. People who engage in sanism predominantly base their thinking on stereotypes, myths, and superstition that are masked as a common sense.12

This leads to stigmas about people with mental illnesses that equate them with erratic and deviant behavior, sexual perversity, emotionally instability, laziness, ignorance and moody or crazy demeanor. According to a Royal College of Psychiatrists study, 77% of responders reported that they know someone who suffers from a mental health condition. But even though this number was high, there is still a lot of work to be done to educate people since the same research showed:13

  • 51% believed that those who suffer from schizophrenia “will never fully recover”.
  • 49% felt that people with some type of eating disorder are “different from us”.
  • 62% thought that individuals with severe depression “are hard to talk to”.
  • 50% said that those who had panic attacks are “unpredictable”.
  • 56% stated that persons with dementia “wouldn’t improve even if treated”.

How Does Mental Health Stigma Affect Treatment in Veterans?

Veterans are especially vulnerable when it comes to addiction and mental health stigma. As much as 11% of veterans can be classified as suffering from substance use disorder but only a small number of them seek treatment. One of the main reasons for this is military culture that can be problematic when it comes to mental health due to peer pressure and widespread stigma.1

For this reason, mental health stigma as a barrier to care for psychological issues among veterans has been studied extensively in recent years. One research estimates that some 60% of military personnel refuse to seek help for mental health related challenges. Most common issues that were a concern for veterans help illustrate the ways in which stigma plays into hindering treatment. In several studies the most frequently mentioned fears were that:14

  • Their unit and leaders might treat them differently, with a prevalence of 44.2% of responders.
  • They would be perceived as weak, for 42.9% of those questioned.
  • Members of their unit will lose trust or have less confidence in them, in 41.3% of cases.
  • It would harm their military careers and future prospects, was the response of 33.4% of veterans.
  • Their leaders and peers would probably blame them for the issues they face, said every fourth person questioned 25.5%.

How to Overcome Stigma?

Since there are several types of stigma and people are not the same, the medical community has been working on developing and improving recovery approaches that are designed to help people deal with addiction and mental illness stigma. Because stigma can depend on the environment and wider set of beliefs within the society, techniques for overcoming stigma can differ depending on the type of community, age and status. Here are some of the ways people can overcome bad feeling associated with stigma:15

  • Try focusing on what you perceive as your strengths in order to grow and achieve your goals.
  • Keep in mind that you are not defined by your mental health condition and that there are still many aspects of your personality.
  • Find as much reliable information as you can to learn about your condition and possible treatment options so you have.
  • When somebody stigmatizes you, keep reminding yourself that that they are speaking from the position of ignorance and fear and not authority.
  • Socialize with people and organized groups that respect you for what you are and are ready to listen to you and offer support.

You are not responsible for other people’s beliefs and prejudices but it’s important to raise awareness within the community and share your knowledge about stigma that can help in dispelling mistaken attitudes towards mental illness. You can be a positive influence for good and help people understand mental health issues better by:16

  • Talking frankly and openly about mental health topics.
  • Being honest about your experiences and treatment.
  • Being conscious of the language you use when addressing this issue.
  • First educating yourself and then others within the community.
  • Showing understanding, compassion, and solidarity with people that have mental illnesses.

To get further information or talk about stigma or any other mental health issues you might be experiencing, contact the Veterans Crisis Line at 1-800-273-08255, or try the VA’s confidential chat. If you are not ready to talk there is a further option of sending a text to 838255.

Veteran-Specific Addiction Treatment at American Addiction Centers

If you are a veteran looking for a suitable rehab center, SAMHSA has an easy to use online locator of rehab centers that helps people find treatment depending on their vicinity and the type of programs they have to offer. You can also check out American Addiction Centers (AAC) which is the nation’s largest network of upscale treatment facilities that are situated across the country and specialize in mental health and addiction recovery programs.

AAC offers you specialized rehab approaches that take into account the complexities and specifics of military life through its Salute to Recovery program that is specially designed for veterans and first responders. AAC offers military personnel a way back to healthy everyday and professional lives through family and couples counseling, anger management, detox and addiction therapies, trauma groups and approaches that deal with PTSD, depression, and anxiety.

AAC has 2 facilities that are part of VA’s network of approved community care providers and as well as in-network options with all of the nation’s biggest health insurance companies.

  • Desert Hope Treatment Center is a high end facility that has individualized treatments located in Las Vegas, Nevada. It offers proven medical detox, co-occurring disorder care, post-treatment support with a commitment to privacy and confidentiality.
  • Recovery First Treatment Center is a top-notch rehab center close to the beach in Hollywood, Florida which is a part of the Miami metro area. It’s a facility known for its evidence-based treatment programs, mental health disorder care, family therapies, and aftercare planning.

Frequently Asked Questions