Contributors: Zainab Nadeem, MPH; Zachary Prezotti, MSc PH

Overview

Veterans of the U.S. Armed Forces have specialized health needs stemming from their unique experiences. Compared to the general population, veterans experience mental health and substance use disorders, such as post-traumatic stress disorder (PTSD), depression, anxiety and commercial tobacco use, at a disproportionally higher rate (Olenick et al., 2015). Accessible, culturally competent services are essential to bridge the gap in health outcomes for U.S. veterans. This resource digest describes challenges veterans face related to mental health and tobacco use and provides resources to break down barriers to care.

Veterans and Mental Health and Substance Use Challenges

Combat veterans experience significant mental health and substance use challenges that not only impact their health and wellbeing but also place tension on personal relationships. After deployment, nearly half of service members experience strains in family life, and around 44% report having difficulties adjusting to life outside the military (RAND, n.d.).

Over 25% of veterans struggle with a mental health challenge, most commonly depression, PTSD, substance use disorder and anxiety (Trivedi et al., 2015). Factors contributing to these challenges include being exposed to combat, separation from social support networks, physical injuries and housing insecurity (Mental Health Foundation, n.d.).

While there is an urgent need for high-quality and comprehensive mental health services designed for veterans, only about half of all veterans who need mental health services ever receive them (RAND, n.d.). Barriers to care include organizational challenges like inadequate provider training and limited knowledge of specialized treatment options, logistical issues such as misaligned clinic hours, and social barriers like stigma surrounding mental health support (RAND, n.d.). Health care providers and community organizations can help address these barriers by reducing stigma surrounding seeking mental health support, raising awareness of treatment options, and increasing access to culturally competent specialized care (Oceans Healthcare, 2024).

Veterans and Commercial Tobacco Use

The environment of deployment and combat can lead many to use commercial tobacco products as a way to cope with the intense stress, anxiety, and trauma active they experience (Smith et al., 2008). Many service members are introduced to tobacco during their service, with peer influence and social norms contributing to its use (Chastain et al., 2022). Tobacco use that begins in the military often continues after service, as it becomes a familiar coping mechanism to manage ongoing stress, mental health issues and the challenges of transitioning back to civilian life (National Institute on Drug Abuse, 2019).

Deployment significantly increases the likelihood of tobacco use among service members. Research shows that deployed service members and those who have experienced combat are 63% more likely to start smoking than those who have not been deployed or experienced combat (Millennium Cohort Study, 2024). Additionally, social interactions with fellow service members can reinforce tobacco use as part of group dynamics. Tobacco use can become ingrained in military culture due to the social dynamics that promote bonding, stress relief and group acceptance.

The military environment may contribute to the normalization of smoking, making it a shared activity among service members (Institute of Medicine Committee on Smoking Cessation in Military and Veteran Populations, 2009). It is crucial to acknowledge the unique struggles veterans face when dealing with tobacco use, as the social, psychological and environmental factors contributing to their habits are deeply rooted in their military experiences.

Addressing mental health and substance use challenges among veterans is essential for enhancing their quality of life and overall wellbeing. By providing accessible, culturally competent mental health services and breaking down barriers to care, we can help veterans navigate the psychological toll of their service and reintegrate more smoothly into civilian life. Implementing tailored interventions to support tobacco cessation can mitigate the long-term health impacts of tobacco use and empower veterans to adopt healthier lifestyles. Together, these efforts will not only improve individual health outcomes but also strengthen the resilience and vitality of the veteran community as a whole.

Resources

Use the following research findings, practical resources and actionable information to support veterans in managing their mental health and reducing or quitting tobacco use.

Guides and Workbooks

Demographic-based Support

Community-based Programs for Veteran Mental Health

Apps and Phone Services

Fact Sheets, Infographics and Reports

Webinars

References

Chastain, C., Craig, J., Leonard, J., Link, R., & White-McKnight, T. (2022). Understanding military culture: A primer in cultural competence working with military members and families [PowerPoint slides]. Health Systems Research, U.S. Department of Veterans Affairs. https://www.hsrd.research.va.gov/for_researchers/Understanding-Military-Culture.pdf

Institute of Medicine Committee on Smoking Cessation in Military and Veteran Populations. (2009). Factors that influence tobacco use. In S. Bondurant & R. Wedge (Eds.), Combating Tobacco Use in Military and Veteran Populations (pp. 79–114). National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK215329/

Mental Health Foundation. (n.d.). Armed forces and mental health. Retrieved January 22, 2025, from https://www.mentalhealth.org.uk/explore-mental-health/a-z-topics/armed-forces-and-mental-health

Millennium Cohort Study. (2024). Smoking risk factors and patterns among U.S. service members and veterans. https://www.millenniumcohort.org/files/milco/2024/briefs/smoking.pdf

National Institute on Drug Abuse. (2019, October). Substance use and military life drugfacts. https://nida.nih.gov/publications/drugfacts/substance-use-military-life

Oceans Healthcare. (2024, October 14). Veterans and mental health: Addressing barriers to treatment. https://oceanshealthcare.com/veterans-and-mental-health/

Olenick, M., Flowers, M., & Diaz, V. J. (2015). US veterans and their unique issues: Enhancing health care professional awareness. Advances in Medical Education and Practice6, 635–639. https://doi.org/10.2147/AMEP.S89479

RAND. (n.d.). Veterans’ barriers to care. Retrieved December 17, 2024, from https://www.rand.org/health-care/projects/navigating-mental-health-care-for-veterans/barriers-to-care.html

RAND. (n.d.) Veterans’ mental health issues. Retrieved December 17, 2024, from https://www.rand.org/health-care/projects/navigating-mental-health-care-for-veterans/mental-health-issues.html

Smith, B., Ryan, M. A. K., Wingard, D. L., Patterson, T. L., Slymen, D. J., & Macera, C. A. (2008, December). Cigarette smoking and military deployment: A prospective evaluation. American Journal of Preventive Medicine, 35(6), 539–546. https://doi.org/10.1016/j.amepre.2008.07.009

Trivedi, R. B., Post, E. P., Sun, H., Pomerantz, A., Saxon, A. J., Piette, J. D., Maynard, C., Arnow, B., Curtis, I., Fihn, S. D., & Nelson, K. (2015, December). Prevalence, comorbidity, and prognosis of mental health among US veterans. American Journal of Public Health105(12), 2564–2569. https://doi.org/10.2105/AJPH.2015.302836

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