Barriers to Care

While the researchers found that most WWP veterans lived about an hour’s drive of VA facilities and about a half-hour from community treatment facilities that treated veterans with co-occurring disorders, most veterans with SUD and mental health disorders did not receive treatment. Concerns about stigma associated with seeking care, logistics, lack of awareness of effective treatments and a determination to resolve their issues on their own were the leading reasons for not pursuing treatment overall.

Women veterans also may be uneasy about the potential for harassment at VA facilities and childcare coverage, the researchers said. Veterans who do not qualify for VA care face significant cost barriers, with residential programs costing as much as $3,500 per day. Programs that do not integrate care also create barriers by requiring abstinence in veterans seeking treatment for mental health disorders.

The RAND researchers recommended several steps that the VA and veteran-serving facilities could take to improve care for post-9/11 veterans with co-occurring mental health disorders and SUDs. Those include:

  • early prevention efforts,
  • screening for the disorders and
  • offering standardized, consistent, integrated and evidence-based treatments that treat mental health and SUDs concurrently.

They urged providers to regularly evaluate progress and outcomes in terms of both mental health and SUDs throughout treatment and to develop a clear after-care plan for both to minimize the risk of relapse. They also advocated incorporating veterans’ preferences into treatment plans.

On a systemic level, the RAND researchers suggested that the VA and other facilities that serve veterans consider expanding their capacity and enhancing access to integrated treatment programs. Further, they recommended more research on telehealth programs that address SUDs and co-occurring mental health disorders as a way to further reduce barriers to treatment.

“We must continue the work to meet the mental health needs of post-9/11 veterans,” said Mike Richardson, Wounded Warrior Project’s vice president of mental health. “This important research will help us support veterans by supporting programs that can help those suffering from both substance use disorders and mental health challenges.”


  1. Pedersen, ER, Bouskill KE, Holliday SB, Cantor J, Smucker S, Mizel ML, Skrabala L, Kofner A, Tanielian T. Improving Substance Use Care: Addressing Barriers to Expanding Integrated Treatment Options for Post-9/11 Veterans. Santa Monica, CA: RAND Corporation, 2020. Also available in print form.