Why Female Veterans Are More Prone to Substance Abuse?
According to the United States Department of Defense (DoD), women made up about 16 percent of the active-duty force and about 9 percent of veterans in 2017. While many sources are
clear that women have played a role in US military operations since the Revolutionary War, female presence in in the armed services has been on the rise since the 1960s.
In 1967, the ceiling on the percentage of female service members was repealed, and in 1993, all laws prohibiting women from serving in any occupation were repealed. In 2013, the DoD rescinded their Direct Ground Combat and Assignment Rule, which prohibited many women from seeing active duty or combat. Then, in 2015, the military was required to open all combat jobs to women with no waivers or exceptions. Women also comprise about 20 percent of new recruits, with that number continuing to rise.
With 2.2 million female veterans of the US Armed Forces, or about 10 percent of the total veteran population, and likely to be millions more in the future, it is important to understand the unique struggles women have while serving their country. Female veterans face similar problems as their male counterparts: homelessness, suicidal ideation and attempts, substance abuse, PTSD, depression, anxiety, and more. Unfortunately, women experience these problems more severely than male veterans, often with less support.
Female Veterans Struggle with Similar Stresses More Often than Male Veterans
Women who are veterans of the US Armed Forces struggle with high rates of substance abuse, both compared to male veterans and compared to female civilians. Female veterans struggling with addiction have high rates of co-occurring disorders and underlying problems, including:
- Exposure to trauma, especially sexual trauma and intimate partner violence
- Psychiatric comorbidities, like PTSD and depression
- Medical comorbidities, like cardiovascular disease
For women who serve in the military, exposure to combat trauma is expected; however, female veterans are much more likely than their male counterparts to experience personal forms of trauma, including rape, sexual assault, sexual harassment, and intimate partner abuse or domestic violence. A study placed the prevalence of traumatic histories among female veterans between 81 percent and 93 percent.
- Approximately 27-49 percent of female veterans experienced childhood sexual abuse.
- About 35 percent experienced childhood physical abuse.
- Roughly 29-40 percent experienced sexual assault in adulthood.
- About half experienced physical assault in adulthood.
- About 18-19 percent experienced domestic violence.
- One in five female veterans has been physically or sexually assaulted by an intimate partner who is often a fellow member of the Armed Forces.
- One in four women report military sexual trauma (MST).
This increased risk of early life and personal trauma increases women’s risk of developing PTSD, including from combat situations later. The VA notes that women serving in the military, due to changes in policy but not in training, are not always trained for combat, even though they are increasingly experiencing combat or hostile situations during their service. Increasing numbers of women on active duty experience enemy fire, return fire, become injured due to enemy activity, or see their comrades in arms get injured.
While more women are joining the US Armed Forces, the number of women actively touring and the number of female veterans are still small overall. 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.
Women are more likely, in general, to be the primary caregivers for elderly parents and children, especially young children. Women serving in the military are more likely to have a spouse who is also in the military compared to male counterparts. While all active-duty service members worry about their loved ones at home, women may have to leave behind relatives who directly need their care, such as toddlers or disabled, aging parents.
Additionally, more female veterans live in poverty or suffer transience compared to male veterans: 9.4 percent of women vets live in poverty compared to 6.7 percent of male vets; and 15.3 percent of disabled women vets live in poverty compared to 9.4 percent of male vets. Homeless female vets are overrepresented in the homeless population compared to civilian women. 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 ideation, and other severe problems that all veterans are at risk of.
Female Veterans More Likely to Deal with 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. This may include harassment on tour, assault by an officer during training, or 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 percent of female veterans using VA healthcare services had experienced at least one sexual assault while serving in the military.
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. Major depressive disorder (MDD) is also a common result of sexual assault, with about one-third of victims reporting MDD in their lives. 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 in service members and veterans, too.
Increased Stress and Trauma Lead Female Veterans to Abuse Drugs and Alcohol
Female veterans of the US 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:
- Alcohol use disorder (AUD): 3-10%
- Other drug use problems: 1-6%
- Substance use disorder overall: 3-16%
Women veterans ages 35 and older were more likely to struggle with substance abuse problems compared to younger veterans.
Female Veterans Experience High Rates of PTSD
In general, women receive PTSD diagnoses at twice the rate as men. Although there is some concern about differences in the quality of healthcare between men and women, and exposure to specific life experiences between genders, it is currently believed that women are more susceptible to developing this stress disorder than men. The VA reports that female veterans are also twice as likely as their male counterparts to develop PTSD and twice as likely to develop other psychological distress.
However, as noted above, women serving in the military are much more likely to experience traumatic events that are non-combat scenarios. Experiencing trauma puts anyone at greater risk of developing PTSDfrom a different event later. Anyone who develops PTSD is 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 condition.
The VA reports that 20 out of every 100 female veterans have been diagnosed with PTSD. This may be different for different eras. For example, 27 percent of female Vietnam veterans developed PTSD compared to 31 percent of their male counterparts.
Female Veterans without Support Are Very Likely to Attempt Suicide
In general, women veterans are five 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. 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.
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; by 2014, that rose to 17.3 out of 100,000. This represents an increase of 62.4 percent.
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 percent.
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 percent of female veterans who completed suicide compared to 31.1 percent of civilian women.
Treatment for Female Veterans’ Unique Needs
Factors that can help protect against a veteran developing a substance abuse problem include:
- Strong social and family support before, during, and after deployment
- Low or no exposure to combat stress, like being fired upon, firing at an enemy, or exposure to dead bodies
- Higher levels of reintegration support and better access to these resources
- Greater, easier access to other services, including physical and mental healthcare
- A sense of community
An article published by Task & Purpose reports that female veterans consistently want five specific things.
- They want to be treated as veterans, regardless of their gender.
- Women veterans have unique healthcare needs because of ill-fitting equipment and tools that are standardized to male bodies.
- Female veterans need more support, especially by support structures like the VA.
- Women veterans rise to their challenges, even as they are held to a higher standard than male counterparts.
- They would like their service recognized.
When receiving treatment, female veterans should be:
- 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 offers many specific services for female veterans, but this is just the beginning. 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.