Why Are Female Veterans More Prone to Substance Abuse?

Service women often experience unique struggles while serving their country. While female veterans face similar problems as their male counterparts—such as homelessness, suicidal thoughts and attempts, substance abuse, PTSD, depression, anxiety, and more—women experience many of these problems more severely than male veterans, often with less support.

In short, female veterans are more likely to have musculoskeletal issues, mental health issues, and substance use disorders than male veterans.¹

In this article, you’ll find helpful information about:

• How women came to serve in the military.
• Why female veterans experience higher levels of stress and PTSD.
• How these stressors can lead to drug or alcohol addiction.
• Treatment options for female veterans.

Women in the Military

According to the United States Department of Defense (DoD), women made up about 16% of the active-duty force and about 9% of veterans in 2017.² While many sources are clear that women have played a role in U.S. military operations since the Revolutionary War, female presence in the armed services has been on the rise since the 1960s.³

In 1967, lawmakers repealed the ceiling on the percentage of female service members. In 1993, lawmakers repealed all laws prohibiting women from serving in any occupation. In 2013, the DoD rescinded their Direct Ground Combat and Assignment Rule, which stopped many women from seeing active duty or combat.

In 2015, the military was required to open all combat jobs to women with no waivers or exceptions. Women also comprise about 20% of new recruits, with that number continuing to rise.³

Stress & PTSD in Female Veterans

Women who are veterans of the U.S. Armed Forces struggle with high rates of substance abuse, when compared to both male veterans and female civilians.¹ Female veterans struggling with addiction have high rates of other disorders (known as co-occurring disorders) and underlying problems, including:

• Exposure to trauma, especially sexual trauma and intimate partner violence.
• Psychiatric co-occurring disorders, like post-traumatic stress disorder (PTSD) and depression.
• Medical co-occurring disorders, like cardiovascular disease.⁴

Women serving in the military are much more likely to experience traumatic events that are non-combat scenarios, as you’ll read below. Experiencing trauma puts anyone at greater risk of developing PTSD. Those who develop PTSD are at greater risk of developing a substance use disorder, likely as a method of self-medicating the negative thoughts and high stress levels associated with the mental health condition.⁵

Sexual Trauma

Female veterans are much more likely than their male counterparts to experience personal forms of trauma, including:

• Rape.
• Sexual assault.
• Sexual harassment.
• Intimate partner abuse or domestic violence.

A study placed the prevalence of traumatic histories—including sexual or physical abuse, domestic violence, military sexual trauma, and others—among female veterans between 81 and 93%.⁶

Studies regarding sexual assault in civilian populations routinely find that PTSD is the frequent result. About half of women who suffer sexual harassment, assault, or rape report lifetime rates of PTSD.⁷

Major depressive disorder (MDD) is also a common result of sexual assault, with about one-third of victims reporting MDD in their lives.⁸ Abusing drugs or alcohol is associated with self-medicating PTSD and MDD in civilian populations, so it makes sense that these issues would be prevalent with service members and veterans, too.

Military Sexual Trauma

Military sexual trauma (MST) is a specific experience defined by the VA as both sexual harassment and sexual assault in military settings.¹⁰ This may include:⁹

• Harassment on tour.
• Assault by an officer during training.
• Intimate partner violence from a fellow military spouse.

Both men and women have reported experiencing MST from the opposite and the same gender; however, women experience much higher rates of MST, typically from male service members. One study reported that 23% of female veterans using VA healthcare services had experienced at least one sexual assault while serving in the military.¹⁰

Combat Trauma

The U.S. Department of Veteran Affairs (VA) notes that women serving in the military are not always trained for combat even though they are increasingly experiencing combat or hostile situations during their service. This is due to changes in policy and a lack of updates to the types of training they receive.¹¹

Today, women on active duty are:¹¹

• Experiencing enemy fire.
• Returning fire.
• Becoming injured due to enemy activity.
• Seeing their comrades in arms get injured.

Female Veteran Poverty

More female veterans live in poverty or suffer from homelessness compared to male veterans, which can lead to or worsen PTSD and/or substance use.

• 4% of women vets live in poverty compared to 6.7% of male vets.
• 3% of disabled women vets live in poverty compared to 9.4% of male vets.¹²

Homeless female vets are overrepresented in the homeless population compared to civilian women.

Differing PTSD Symptoms in Women

The VA details that women may experience different PTSD symptoms than men. Women with PTSD:¹³

• May be more likely to be jumpy, have more trouble feeling emotions, and avoid things that remind them of the trauma more so than men.
• Are more likely to feel depressed and anxious, while men with PTSD are more likely to have problems with alcohol or drugs.

Both women and men who experience PTSD may develop physical health problems.¹³

Substance Use Disorders Among Female Veterans

Female veterans of the U.S. Armed Forces, when screened by Veterans Affairs (VA) health clinics, were found to abuse several substances like their male counterparts, especially alcohol, prescription sedatives, opioids, and amphetamines. Rates of substance abuse among women vets included:¹⁴

• Alcohol use disorder (AUD): 3-10%
• Other drug use problems: 1-6%
• Substance use disorder (SUD) overall: 3-16%

Women veterans ages 35 and older were more likely to struggle with substance abuse problems compared to younger veterans.¹⁴

Suicide Risks Among Female Veterans

In general, women veterans are 5 times more likely to attempt and complete suicide than non-veteran women. Like male veterans or anyone who struggles with addiction, female veterans who abuse drugs or alcohol are at greater risk of attempting and completing suicide.¹⁵

Women veterans who struggle with opioid addiction completed suicide at a rate of 98.6 out of 100,000, which is higher than the rate of veterans without a diagnosed addiction.¹⁶

Although both veteran and civilian men are more likely to die by suicide compared to women, the rate of female veterans’ suicides is on the rise.

• In 2001, the rate of female veteran suicide was 14.4 out of 100,000.¹⁵
• In 2014, that rose to 17.3 out of 100,000, a 62.4% increase.¹⁵

However, the rate of suicide among female veterans using VA services was lower than among female vets who did not make use of this healthcare service. In fact, that rate declined during the same 2001-2014 period by 2.6%.¹⁵

Female veterans are more likely to have access to firearms than civilians, which increases their risk of completing suicide. Firearms were used by 40.5% of female veterans who completed suicide compared to 31.1% of civilian women.¹⁵

Treatment for Female Veterans’ Unique Needs

There’s no question that female active duty service members and veterans alike need more resources including better mental and physical health services.

However, the services that currently exist like the VA do help when female veterans who have substance and/or mental health disorders use them.

When receiving treatment, female veterans should be:¹⁷

• Screened for substance abuse and trauma, both combat-related and other forms of trauma
• Assessed for co-occurring mental, behavioral, and physical problems so all the veteran’s issues may be cared for together
• Given treatment that uses medical supervision for drug or alcohol detox, counseling methods that have been proven effective, and any other necessary forms of support like mutual support groups.

The VA and Other Programs

Stress from trauma due to early childhood suffering, domestic or intimate partner abuse, sexual and physical abuse at work, and combat exposure mean that women in the military are at a much higher risk of suffering from PTSD, depression, substance abuse, suicidal thoughts, and other severe problems that all veterans are at risk of.

While more women are joining the U.S. Armed Forces, the number of women actively touring and the number of female veterans is still small overall.² This can lead to difficulty finding community, trouble fitting in, and a sense of loneliness that increases the risk of depression, anxiety, and substance abuse.

The VA offers many specific services for female veterans, but this is just the beginning. Facilities across the U.S. offer specific programs centered on veterans, addiction, co-occurring disorders, and recovery.

Recovery First offers one such program that has many veterans in recovery on staff and creates group therapy environments comprised of veterans to create safe spaces to relate and convey military-specific trauma.

Women must be supported in their communities, by their families, and by fellow veterans to get the help they need to overcome substance abuse, PTSD, and co-occurring problems.

References:

1. Disabled American Veterans. (2018). Women veterans: the journey ahead.
2. Substance Abuse and Mental Health Services Administration, Human Potential, Inc. (2017). Addressing the gender-specific service needs of women with substance use disorders—women veterans supplement.
3. Kamarck, K.N., Congressional Research Service. (2019). Diversity, inclusion, and equal opportunity in the armed services: background and issues for congress.
4. Casey, A. (2017). Years after silently combating sexual trauma, female veterans seek help.
5. S. Department of Veterans Affairs. (2019). PTSD and substance abuse in veterans.
6. Zinzow, H.M., Grubaugh, A. L., Monnier, J., Suffoletta-Maierle, S., &Frueh, C. (2007). Trauma among female veterans: a critical review. Trauma, Violence, & Abuse 8(4), 384-400.
7. Chivers-Wilson, K.A. (2006). Sexual assault and post traumatic stress disorder: a review of the biological, psychological, and sociological factors and treatments. McGill Journal of Medicine 9(2), 111-118.
8. Neilson, E.C., Norris, J., Bryan, A.E.B., & Stappenbeck, C.A. (2017). Sexual assault severity and depressive symptoms as longitudinal predictors of the quality of women’s sexual experiences. Journal of Sex & Marital Therapy, 43(5), 463-478.
9. S. Department of Veterans Affairs. (2019). Military sexual trauma (MST).
10. United States Congress, Committee on Veterans Affairs. (2009). Veterans Health Care Authorization Act of 2009.
11. S. Department of Veterans Affairs. (2019). Traumatic stress in women veterans.
12. S. Department of Veterans Affairs. (2016). Profile of veterans in poverty: 2014.
13. S. Department of Veterans Affairs. (2018). How common is PTSD in women?
14. Hoggatt, K.J., Jamison, A.L., Lehavot, K., Cucciare, M.Am, Timko, C., & Simpson, T.L. (2015). Alcohol and drug misuse, abuse, and dependence in women veterans. Epidemiologic Reviews, 37(1), 23–37.
15. S. Department of Veterans Affairs. (2017). Facts about suicide among women veterans: August 2017.
16. Bohnert, K.M., Ilgen, M.A., Louron, S., McCarthy, J.F., & Katz, I.R. (2017). Substance use disorders and the risk of suicide mortality among men and women in the U.S. Veterans Health Administration. Addiction, 112(7), 1193-1201.
17. S. Department of Veterans Affairs. (2019). PTSD treatment.