Evaluating Predictive Factors of Veterans Substance Use Disorder Treatment and Mental Health Treatment Utilization

Background and Purpose: Military veterans are a population that faces unique mental health challenges. Research consistently shows high rates of depression, PTSD, and other mental health conditions within this population. Substance use disorders (SUDs) are also highly prevalent among veterans. Together, the comorbidity of mental health conditions and SUDs underscores the importance of timely and appropriate access to integrated treatment. Despite the availability of effective treatment for both mental health conditions and SUDs, rates of treatment utilization remain low among veterans. While some research has examined factors associated with treatment utilization, relatively few studies have focused on the predictors of individual SUD treatment and mental health treatment among veterans. To address this gap, we used data from a nationally representative sample to examine factors associated with SUD treatment utilization and mental health treatment utilization among veterans.

Methods: Study data came from the 2022–2023 National Survey on Drug Use and Health. The sample comprised adult respondents who reported serving in the armed forces in the survey (N=860). Predictor variables included substance use type (alcohol use disorder, marijuana use disorder, opioid use disorder, tranquilizer/sedative use disorder, and stimulant use disorder), SUD severity (mild, moderate, and severe), combat history, mental illness, problem recognition, healthcare visits, and sociodemographic characteristics. Outcome variables were 1) SUD treatment and 2) mental health treatment. Data analyses included descriptive statistics and chi-square tests of independence. Multivariable logistic regression was used to test associations between predictor variables on veterans' 1) SUD treatment status and 2) mental health treatment status.

Results: Among veterans with SUDs, the prevalence of SUD treatment was 17.7%, while the prevalence of mental health treatment was 36.5%. Rates for both SUD treatment and mental health treatment were significantly higher among those with marijuana use disorder, stimulant use disorder, tranquilizer/sedative use disorder, severe SUD, and problem recognition. Multivariable logistic regression results showed that marijuana use disorder (AOR = 2.71, 95% CI = 1.26–5.83) and severe SUD (AOR = 6.78, 95% CI = 2.64–17.40) were associated with higher odds of SUD treatment. Mental health problem recognition was associated with higher odds of both SUD and mental health treatment, whereas being uninsured was associated with lower odds of both treatment types.

Conclusions and Implications: Findings indicate relatively low levels of treatment receipt among veterans with SUDs, with variation by substance use characteristics and problem recognition. As expected, greater SUD symptom severity and problem recognition were associated with higher treatment likelihood, whereas lack of insurance was a barrier to both SUD and mental health treatment. Findings also highlight the need for further research to understand why veterans with marijuana use disorder are more likely to receive treatment relative to other substance use disorders. Interestingly, veterans with combat exposure did not differ significantly from those without combat exposure in treatment receipt likelihood. These results suggest that treatment receipt is concentrated among individuals with more severe SUD profiles, highlighting the need to expand the reach of treatment services and satisfy unmet needs across the range of symptom severity for veterans.