Perceived Needs of Veterans Transitioning from the Military to Civilian Life

  • Karen J. Derefinko
  • Troy A. Hallsell
  • Matthew B. Isaacs
  • Lauren W. Colvin
  • Francisco I. Salgado GarciaEmail author
  • Zoran Bursac


Despite existing separation services provided by the military, many transitioning to civilian life report continued or even worsening issues, including anger outbursts, PTSD, sustained substance use, and strained family relationships. Further, only 61% of the 1,906,754 veterans separated since 2002 participate in the VA health care system after separation, indicating that at least three quarters of a million veterans are not captured by research conducted in VA systems. The current study (N = 90) examined the perceived needs of veterans transitioning from the military to civilian life, assessed issues that prevent these individuals from participating in VA health care upon separation, and captured veteran recommendations to improve existing separation services, either prior to or after the transition to civilian life. Veterans identified several needs, including improved access to care, mental health and substance use counseling, and preparedness for adjustment and economical/financial issues. Implications for both care and policy are discussed.


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Segal DR, Segal MW. America’s military population. Population Bulletin. 2004;59(4):1-40 Available online at Accessed March 7, 2018.Google Scholar
  2. 2.
    Morin R. The difficult transition from military to civilian life. Pew Research Center’s Social & Demographic Trends Project. Available online at Published December 2011. Accessed March 7, 2018.
  3. 3.
    Lutz A. Who joins the military?: A look at race, class, and immigration status. Journal of Political and Military Sociology. 2008;36(2):167–188.Google Scholar
  4. 4.
    Saladin ME, Brady KT, Dansky BS, et al. Understanding comorbidity between PTSD and substance use disorders: Two preliminary investigations. Addictive Behaviors. 1995;20(5):643–655.CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Swendsen JD, Merikangas KR. The comorbidity of depression and substance use disorders. Clinical Psychology Review. 2000;20(2):173–189.CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Grant BF, Stinson FS, Dawson DA, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry. 2004;61(8):807–816.CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Edens EL, Kasprow W, Tsai J, et al. Association of substance use and VA service-connected disability benefits with risk of homelessness among veterans. The American Journal on Addictions. 2011;20(5):412–419.CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Barlas FM, Higgins WB, Pflieger JC, et al. 2011 Health Related Behaviors Survey of active duty military personnel. Defense Technical Information Center; 2013. Available online at Accessed March 7, 2018.
  9. 9.
    Bray RM, Pemberton MR, Hourani LL, et al. 2008 Department of Defense Survey of Health Related Behaviors among active duty military personnel: A component of the Defense Lifestyle Assessment Program (DLAP). Research Triangle Park, NC: RTI International; 2009. Available online at Accessed on March 7, 2018.
  10. 10.
    Norman SB, Schmied E, Larson GE. Predictors of continued problem drinking and substance use following military discharge. Journal of Studies on Alcohol and Drugs. 2014;75(4):557–566.CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Golub A, Bennett AS. Substance use over the military–veteran life course: An analysis of a sample of OEF/OIF veterans returning to low-income predominately minority communities. Addictive Behaviors. 2014;39(2):449–454.CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Thompson C. VA Suicide prevention program facts about veteran suicide July 2016. July 2016. Available online at Accessed on March 7, 2018.
  13. 13.
    Institute of Medicine. Access and barriers to care. In: Returning home from Iraq and Afghanistan: Assessment of readjustment needs of veterans, service members, and their families. National Academies Press; 2013:413–445. Available online at Accessed on February 12, 2018.
  14. 14.
    Hussey P, Ringel J. Resources and capabilities of the Department of Veterans Affairs to provide timely and accessible care to veterans. Santa Monica: RAND Corporation; 2015. Available online at Accessed on February 13, 2018.Google Scholar
  15. 15.
    Elnitsky CA, Andresen EM, Clark ME, et al. Access to the US Department of Veterans Affairs Health System: Self-reported barriers to care among returnees of Operations Enduring Freedom and Iraqi Freedom. BMC Health Services Research. 2013;13:498.CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Bagalman E. The number of veterans that use VA health care services: A fact sheet. Congressional Research Service; 2014. Available at Accessed on March 7, 2018.
  17. 17.
    Vazan P, Golub A, Bennett AS. Substance use and other mental health disorders among veterans returning to the inner city: Prevalence, correlates, and rates of unmet treatment need. Substance Use & Misuse. 2013;48(10):880–893.CrossRefGoogle Scholar
  18. 18.
    Seal KH, Maguen S, Cohen B, et al. VA mental health services utilization in Iraq and Afghanistan veterans in the first year of receiving new mental health diagnoses. Journal of Traumatic Stress. 2010;23(1):5–16.PubMedPubMedCentralGoogle Scholar
  19. 19.
    U.S. Department of Health and Human Services. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. Phase I report: Recommendations for the framework and format of Healthy People 2020; 2008. Available online at Accessed on March 7, 2018.
  20. 20.
    Institute of Medicine, ed. Returning home from Iraq and Afghanistan: Assessment of readjustment needs of veterans, service members, and their families. Washington, D.C: National Academies Press; 2013. Available online at Accessed on February 13, 2018.
  21. 21.
    VA Office of Inspector General: Office of Audits and Evaluations. Audit of the veteran wait time data, choice access, and consult management in VISN 6. Veterans Health Administration; 2017. Available online at Accessed on February 12, 2018.
  22. 22.
    Street AE, Vogt D, Dutra L. A new generation of women veterans: Stressors faced by women deployed to Iraq and Afghanistan. Clinical Psychology Review. 2009;29(8):685–694.CrossRefPubMedCentralGoogle Scholar
  23. 23.
    Resnick EM, Mallampalli M, Carter CL. Current challenges in female veterans’ health. Journal of Women’s Health. 2012;21(9):895–900.CrossRefPubMedCentralGoogle Scholar
  24. 24.
    O’Hanlon C, Huang C, Sloss E, et al. Comparing VA and Non-VA quality of care: A systematic review. Journal of General Internal Medicine. 2017;32(1):105–121.CrossRefPubMedCentralGoogle Scholar
  25. 25.
    Bloeser K, McCarron KK, Batorsky B, et al. Mental health outreach and screening among returning veterans: Are we asking the right questions? US Army Medical Department Journal. 2014:109–117.Google Scholar
  26. 26.
    Institute of Medicine. Substance use disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press; 2012. Available online at Accessed on March 7, 2018.
  27. 27.
    Watkins KE, Pincus HA, Paddock S, et al. Care for veterans with mental and substance use disorders: Good performance, but room to improve on many measures. Health Affairs. 2011;30(11):2194–2203.CrossRefPubMedCentralGoogle Scholar
  28. 28.
    Hoge CW, Castro CA, Messer SC, et al. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine. 2004;351(1):13–22.CrossRefPubMedCentralGoogle Scholar
  29. 29.
    Brown MC, Creel AH, Engel CC, et al. Factors associated with interest in receiving help for mental health problems in combat veterans returning from deployment to Iraq. The Journal of Nervous and Mental Disease. 2011;199(10):797–801.CrossRefPubMedCentralGoogle Scholar
  30. 30.
    Valenstein M, Gorman L, Blow AJ, et al. Reported barriers to mental health care in three samples of U.S. Army National Guard soldiers at three time points. Journal of Traumatic Stress. 2014;27(4):406–414.CrossRefPubMedCentralGoogle Scholar
  31. 31.
    Calhoun PS, Elter JR, Jones ER, et al. Hazardous alcohol use and receipt of risk-reduction counseling among U.S. veterans of the wars in Iraq and Afghanistan. The Journal of Clinical Psychiatry. 2008;69(11):1686–1693.CrossRefPubMedCentralGoogle Scholar
  32. 32.
    Seal KH, Cohen G, Bertenthal D, et al. Reducing barriers to mental health and social services for Iraq and Afghanistan veterans: Outcomes of an integrated primary care clinic. Journal of General Internal Medicine. 2011;26(10):1160–1167.CrossRefPubMedCentralGoogle Scholar
  33. 33.
    Substance Abuse and Mental Health Services Administration. The NSDUH Report: Substance use, dependence and treatment among veterans. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2005. Available online at Accessed on March 7, 2018.
  34. 34.
    Substance Abuse and Mental Health Services Administration. SAMHSA’s efforts to support veterans and military families. Available online at Published January 20, 2017. Accessed on March 7, 2018.
  35. 35.
    Chinman M, Young AS, Hassell J, et al. Toward the implementation of mental health consumer provider services. The Journal of Behavioral Health Services & Research. 2006;33(2):176–195.CrossRefGoogle Scholar
  36. 36.
    Hundt NE, Robinson A, Arney J, et al. Veterans’ perspectives on benefits and drawbacks of peer support for posttraumatic stress disorder. Military Medicine. 2015;180(8):851–856.CrossRefPubMedCentralGoogle Scholar
  37. 37.
    Greden JF, Valenstein M, Spinner J, et al. Buddy-to-Buddy, a citizen soldier peer support program to counteract stigma, PTSD, depression, and suicide. Annals of the New York Academy of Sciences. 2010;1208(1):90–97.CrossRefPubMedCentralGoogle Scholar
  38. 38.
    Department of Veterans Affairs Office of Inspector General. Healthcare inspection: Readjustment counseling service Vet Center report. Washington, DC: Department of Veterans Affairs; 2009. Available online at Accessed on April 10, 2018.

Copyright information

© National Council for Behavioral Health 2018

Authors and Affiliations

  1. 1.Department of Preventive MedicineUniversity of Tennessee Health Sciences CenterMemphisUSA
  2. 2.Department of HistoryUniversity of MemphisMemphisUSA
  3. 3.St. Jude Children’s Research Hospital, Clinical Trials AdministrationMemphisUSA

Personalised recommendations