Risks, Warning Signs, and Prevention Methods for Veteran Suicides

Military veterans represent an extremely sensitive group of the general population of the United States of America in terms of their vulnerability to developing a substance abuse disorder, or an SUD for short. Their susceptibility originates in their tribulations sustained during active service and their inability to adequately reintegrate back into civilian life after finalizing their service. This process is highly delicate, as veterans often struggle to reestablish connections with their family, friends, and local communities.¹

This period of readjustment is fraught with a wide range of psychological tremors, leaving veterans exposed to environmental stressors connected to their time spent in active service. All of this increases the possibility a veteran will develop a substance abuse disorder in an attempt to find solace, inadvertently exacerbating their mental health issues. This is why, upon the completion of active military participation, the rate of drug and alcohol abuse in veterans increases.²

Approximately 70% of veterans underestimate their own susceptibility for the development of an SUD, further increasing the likelihood of experiencing problems with alcohol and drug use. Also, roughly 11% of veterans struggle with a form of SUD, which represents a higher rate in comparison to the rest of the U.S. population. According to currently available information, 6% of veterans abuse cocaine, 10.7% use heroin, and as many as 65% abuse alcohol.¹

What Are the Causes of Suicides in the Veteran Population?

Suicide is described as an act of enacting both intentional as well as successful harm on oneself when attempting to bring your life to an abrupt end. Attempted suicide represents an unsuccessful act of suicide following a period of suicidal ideation. The sad truth is that both attempted and successful suicides in veterans far exceed average national rates across the U.S. due to a wide range of contributing factors.³

In part, the high rates of suicide in the veteran population stem from unique and extremely stressful challenges active military personnel faced during their time spent in service, especially in cases of serving on the front lines. What’s more, these mental health problems often go overlooked and untreated, which only aggravates them over time, leading to the development of different mental health issues over time.¹

Many service members also experience constant discouragement from seeking treatment due to potential negative consequences with advancing their military career and seeking future deployment opportunities. All this creates an incredibly complex psychological landscape which represents fertile ground for the development of a wide range of mental health problems, including depression, TBI, SUD, PTSD, a variety of co-occurring psychological disorders, as well as suicidal intentions.¹

Veteran Suicide Statistics

In the year 2019, the number of suicides in the United States of America was 45,861, representing a significant rise from the 29,580 suicides during the year 2001. The numbers of veteran suicides exhibited a slower increase during this period, rising from 5,989 in 2001 to 6,261 in 2019, indicating a decrease in the percentage of veteran suicides from 20.2% to 13.7%. Nevertheless, this remains a large share of the overall number of suicides across the nation, especially when considering that the veteran population accounts for approximately 6.86% of adult population of the U.S. according to the information from the 2019 American Community Survey.^{4, 5}

In 2016, the rate of suicide in the veteran population was 1.5 times higher in comparison to all other adult groups when adjusted for age and gender, leading to 17.2 successful veteran suicides occurring on a daily basis in 2019, with approximately 6.8 suicides committed by those veterans who established some contact with the Veterans Health Administration in 2018 and in 2019, signifying a strong need for achieving greater success in helping veterans resolve their suicidal ideation.⁴

What Risk Factors are Associated With Veteran Suicides?

The currently available data states that the suicide rate in both deployed active-duty and non-deployed veterans is highest in the period of three years upon leaving active service. Interestingly, deployed veterans express lower risk of suicidal intentions and successful suicides in comparison to non-deployed service members, signaling the need to comprehensively approach this problem in both groups of veterans.⁶

What’s more, one of the most significant contributing factors to the development of substance abuse disorders in veterans are difficulties when attempting to reintegrate into civilian society and reestablishing their civilian life after finalizing their active service career. These challenges often lead veterans to finding solace in alcohol and drugs. The presence of an SUD often portends suicidal ideation in veterans, with 45% of attempted suicides and 30% of successful suicides after the year 2003 stemming from a type of alcohol or drug use.¹

Predicting suicidal tendencies in veterans can highly difficult. In most cases, those veterans who exhibit certain risk factors linked to suicidal attempts will not try to take their life. This makes successful prediction of suicidal ideation extremely difficult. Some of the most common risk factors related to attempted suicides in veterans are:³

• Experience of ending another individual’s life is often difficult to cope with and can trigger a wide range of serious mental health issues.
• History of failed attempts at suicide represents a significant contributing risk factor and a clear warning sign of strong veteran suicidal ideation.
• Wide range of psychological stressors, including divorce, death of a family member or a loved one, presence of a terminable or incurable illness, job displacement or loss, and other situations.
• Fallouts with family and close friends, especially if those friends are service members, leaving the veteran feeling ostracized and unvalued.
• Stigma associated with a veteran seeking treatment.
• Intense stress.
• PTSD, or post-traumatic stress disorder resulting from traumatic war events, battlefield scenarios, life-threatening situations, and overall high levels of stress in active military service.
• Depression which can transition into extreme depression with suicidal tendencies in veterans.
• Different mental health issues, such as SUDs and various co-occurring disorders.
• History of suicides, substance abuse disorders, and mental health issues in the veteran’s family.
• History of violence and trauma in the veteran’s family, especially physical and sexual abuse.
• Chronic pain stemming from combat-related injuries.

Which Warning Signs Indicate the Potential for Suicides in Veterans?

Distinguishing between different warning signs which point to the potential for suicidal attempts and contributing risk factors can be extremely difficult, which complicates the process of ascertaining whether or not a veteran is struggling with suicidal tendencies. This is especially true for individuals who either spend the majority of their time in small groups or alone, making it essential to engage in honest and thoughtful conversation, establish a deeper connection, foster understanding and potentially detect any mental health issues with a veteran.⁷

Warning signs of veteran suicides can be distributed into two distinct categories, indirect and direct. Indirect signs serve to raise awareness about potentially existing mental health problems and get you to pay attention:⁷

• Serious SUDs, especially if the veteran is abusing a substance with a strong potential to end their life prematurely, such as heroin, cocaine, alcohol, methamphetamines, opinions, and many others.
• Recklessness and overall risky behavior.
• Rage, anger, and confrontational behavior.
• Withdrawal and social avoidance with tendencies for seclusion and isolation.
• Long-term sleep deprivation or disturbance.
• Guilt and shame leading to humiliation and distress.
• Mood swings and irritability which leads to the veteran becoming socially unbearable.
• Anxiety and agitation which the veteran has difficulty overcoming.
• Loss of reason and meaning for living accompanied by a general lack of purpose.
• Hopelessness, despair, and an overall feeling of life only getting worse, not better.

However, it’s also essential to pay attention to direct warning signs of veteran suicides that require individuals to take immediate action in order to prevent suicidal attempts:⁷

• Preparing for their untimely and premature death by saying their final goodbyes to family and friends, giving away the majority of their possessions, making future arrangements for their children and parents, and updating their wills.
• Storing and purchasing items they can potentially use for attempted suicide as well as researching suicide methods on the internet.
• Longing to successfully commit suicide and talking, writing, and researching the topic of suicide.

How Are Veteran Suicides and Substance Abuse Disorders Connected?

Substance abuse disorder represents a major contributing factor to an increased likelihood of attempted and successful suicide in the veteran population. Those individuals who are struggling to overcome their SUDs are much more likely to harbor suicidal intentions during their day-to-day life. Problems with alcohol and drugs also serve as contributing factors to other types of risky behavior in addition to increasing the potential for suicidal attempts as they can exacerbate various risk factors including anxiety, hopelessness, depression, and impulsiveness, which can all eventually cause the need for self-harm.⁸

Roughly 1.3 million military veterans across the United States struggled with a type of SUD while approximately 481,000 suffered from both a mental health disorder and a substance abuse disorder. About a million veterans, representing approximately 80% of the veteran population, also struggled with alcohol use disorder, or AUD. What’s more, there are 343,000 veterans struggling with drug abuse, in addition to roughly 100,000 individuals who used to indulge in alcohol and drug use, which represents 8% of the veteran population.⁹

In addition, most veterans exhibited difficulties either with the process of returning to their civilian life or dealing with the period of perceived idleness between deployments. The information shows that both periods of repeated and extended deployment can lead to an increase in the development of substance abuse disorders in veterans as well as the appearance of mental health issues. Finally, SUD can also appear after several years of reintegration into civilian life instead of immediately upon reintegration.¹⁰

What Is the Connection of Mental Health Issues and Suicides in Veterans?

According to the available information from 2019, 3.1 million veterans across the nation struggled with a mental health condition. Of that number approximately 833,000 struggled with serious mental health problems. However, the most alarming fact is that 26.8% of those veterans received no adequate treatment, leaving them to deal with serious mental health conditions on their own. What’s more, 85% of those veterans battling a form of SUD received no treatment or rehab for their medical condition.⁹

In addition to substance abuse disorders, the majority of army veterans experience negative consequences of PTSD and depression, as these mental health conditions often develop simultaneously and reserve an incredibly high potential for mutual aggravation. Studies illustrate that veterans struggling with PTSD alongside a wide range of comorbid conditions need adequate long-term programs to successfully treat their condition. Those comorbidities that follow PTSD, including depression and substance abuse disorders, lead to unwillingness to enter a rehabilitation program, inadequate social functioning, as well as increased suicide rates.¹¹

Which Risk Factors Are Associated With PTSD?

Post-traumatic stress disorder, or PTSD, is a psychological condition resulting from first-hand exposure to traumatic events. It is characterized by the feeling of intensely fearing for your or the life of a person you love. Events such as these usually take all the control over the potential outcome out of the individual’s hands, contributing to the sense of helplessness, stress, and anxiety. These situations can be incredibly common during active military service and a large number of veterans have been affected by them.¹²

After surviving such situations, individuals try to go on with their lives only to experience difficulties sleeping, concentrating, and troubles engaging in day-to-day activities in their civilian lives, including pursuing education and career. For the majority of people, PTSD symptoms become easier to bear as time passes. However, if after the period of two months symptoms of PTSD aren’t subsiding, it’s essential to consult a doctor.¹²

The most common risk factors related to the advent of post-traumatic stress disorder in veterans are:¹²

• Military combat alongside other similar experiences.
• Life-threatening scenarios.
• Traumatic events in the form of natural disasters and traffic accidents.
• Sexual abuse and misconduct.
• Terrorist attacks.

What Suicide Prevention Treatment Is Available for Veterans?

Medical professionals should implement a holistic approach to assisting army veterans and their families overcome problems with suicidal ideation and attempts. The clinicians involved should account for all the unique requirements widespread across the veteran population, as well as military-specific characteristics. The MISSION Act amended the previous legislation from 2014 and granted veterans improved access to treatment options across the nation.¹⁰

Veterans have the choice of different treatment options for substance abuse disorders with can worsen suicidal ideation, such as:⁷

• Inpatient facilities which offer both short-term and long-term programs.
• Outpatient facilities which offer tailored solutions for veterans’ varying needs.
• Medication-assisted treatment, or MAT, which implements FDA-approved medication to alleviate withdrawal symptoms.
• Mutual-support groups, including Alcoholics Anonymous and Narcotics Anonymous, featuring different forms of 12-step programs to assist veterans struggling to overcome their SUD.

The information supplied by SAMHSA’s National Survey suggests there were 228 facilities nationwide under the management of the Department of Veteran Affairs during 2020. All these facilities offered a suicide prevention program with 93% of those facilities offering suicide risk evaluation and screening services and 90% of facilities offering evidence-based suicide prevention interventions.^{13, 14}

How Can a Veteran Connect to One of Suicide Hotlines?

Hotlines are some of the most useful resources available for helping veterans searching for adequate treatment because they both help with locating the available assistance programs as well as raising awareness of increasing knowledge of all the most important issues. They provide information to veterans looking to start rehab and find help with dealing with their suicidal ideation. Helplines and hotlines for veterans connect these individuals with experienced and caring professionals willing to help them overcome their difficulties.^{15, 16}

One such hotline is the American Addiction Centers, or AAC hotline, connecting individuals with dedicated admission navigators who are capable of helping them find the treatment they need. AAC operates numerous nationwide rehab facilities and offers a wide range of tailored treatment options, including:

• Specialized alcohol and drug detox programs
• Professional inpatient and outpatient rehab facilities
• Evidence-based opioid detox treatment
• Rehab programs for couples
• Treatment solutions tailored to the specific needs of men

Also, the professionals at AAC can help you with checking your TRICARE insurance coverage, inspecting how much VA coverage you have for alcohol and drug rehab, as well as explain how to implement that coverage to pay for your treatment. Finally, they can help you verify the extent of your coverage, as well as propose a range of suitable payment options according to your particular situation.

Frequently Asked Questions