Smoking cigarettes is one of the most harmful addictions, leading to lung cancer, emphysema, increased risk of lung infections, low birth weight, and much more. The public view of smoking has changed greatly in the last several decades, especially among adolescents and young adults. However, some groups are still at risk of developing an addiction to nicotine, such as people who suffer from mental health issues, especially depression, post-traumatic stress disorder (PTSD), and eating disorders, or those in groups that view smoking as less harmful or more socially acceptable.
Veterans of the United States Armed Forces are at very high risk of smoking cigarettes. This group struggles with higher rates of mental illness, especially depression and PTSD, compared to the civilian population; they have much higher rates of traumatic brain injury (TBI), which can change behaviors; and they are in a culture with more smokers, so smoking may be viewed as more socially acceptable. Veterans need treatment devoted to their specific demographic to help them stop smoking cigarettes.
Higher Rates of Smoking among Veterans
A long-term survey of 48,304 military service members reported that being deployed was the leading risk factor that led former smokers to begin smoking cigarettes again. Tobacco addiction is prevalent among current and former service members. In 2008, according to the National Institute on Drug Abuse (NIDA), about 30 percent of all military service members were current cigarette smokers, which is similar to the 29 percent of the civilian population that reports current tobacco abuse.
The Centers for Disease Control and Prevention (CDC) reported that between 2007 and 2010, male veterans ages 25-64 were the most likely demographic to smoke cigarettes, with 29 percent reporting current tobacco use. In the CDC’s recent statistics, for 2010 to 2015, three out of every 10 military veterans used some form of tobacco product, including smokeless tobacco products like vaporizers.
One survey of 156 US Armed Forces members deployed in Iraq found that, among the men surveyed, 51.9 percent smoked prior to deployment, and 58.3 percent smoked during deployment. Among women in the Armed Forces, 41.7 percent smoked or otherwise abused tobacco prior to being deployed, and 51.2 percent used tobacco during their deployment. Most stated that they intended to quit when they returned home.
Reasons active-duty service members listed for smoking included:
- Stress: 47.7%
- Boredom: 25.1%
- Nicotine addiction: 22.7%
In a larger 2011 survey of people who had recently used Veterans Affairs (VA) health services, 15 percent received a diagnosis of being physically dependent on nicotine. Younger veterans of the Iraq and Afghanistan conflicts are not at higher or lower risk compared to veterans of other combat scenarios, including Vietnam. That survey reports, though, that since higher rates of nicotine abuse among veterans have been reported in other surveys, this condition may be underdiagnosed in VA records. Later reports from the VA, in fact, found that 20 out of 100 veterans, or 1.6 million people, currently smoke cigarettes. Of these, the age demographics break down like this:
- 28.8%: 30 or younger
- 23.6%: 31-49 years old
- 28.6%: 50-64 years old
- 10.8%: 65 or older
Additionally, the VA found, in 2012, that about the same percentage of male veterans enrolled in VA healthcare smoked compared to the civilian average, but more female veterans smoked compared to female civilians: 20 percent of male veterans and 20.5 percent of male civilians smoke compared to 20.8 percent of female veterans and 15.8 percent of female civilians.
Among 2012’s VA enrollees, 70 percent reported being former smokers, which is higher than the national civilian average of former smokers. However, the VA reports that this 70 percent of veterans have successfully quit smoking, often with the help of the VA healthcare system.
Mental Health Struggles like PTSD Increase the Risk of Smoking
The VA found that, among veterans who experienced combat, 27 percent smoked. Experiencing combat does not inherently mean the veteran will develop post-traumatic stress disorder (PTSD), but this stressful and life-threatening situation dramatically increases the risk. PTSD and associated depression are prevalent among current and former service members, with suicide rates among veterans being much higher than that of the general population. Smoking, drinking alcohol, and other forms of substance abuse are also higher among veterans than the civilian population, largely due to specific mental health struggles that too often go unaddressed among former service members.
The CDC found that, among veterans who used tobacco products, 48.2 percent reported serious psychological distress. Many of these veterans had stressful lives, too: 60.1 percent had no health insurance, 53.7 percent lived in poverty, and 37.9 percent had less than a high school diploma, making gainful employment much more difficult. Stress at home after active combat increases the severity of PTSD, depression, anxiety, and other mental health struggles, which increases the risk of substance abuse, including nicotine abuse.
A report gathered by the American Psychological Association (APA) found that, of the 2 million returning American military members who served in Iraq and Afghanistan, one-third reported having a mental or cognitive problem when they came home. Between 19.5 percent and 22.8 percent reported a traumatic brain injury (TBI), and 24.4 percent reported PTSD.
VA reports regarding this group of veterans found that 42.7 percent of study participants were nonsmokers, 24.8 percent were former smokers, and 32.5 percent were current smokers, and 86.6 percent of the current smokers were men and 13.4 percent were women. The current veteran smokers smoked a lot of cigarettes, with men smoking 12.6 times daily and women smoking 10.3 times daily.
Combat-related problems are not the only causes of PTSD, depression, substance abuse, and suicide among current and former service members. National data on sexual abuse and trauma in the military found that one in four women, and one in 100 men, reported that they had experienced some form of sexual abuse while in service. Women who have experienced sexual abuse while in the Armed Forces were nine times more likely to develop PTSD compared to female veterans who had no history of sexual abuse.
Suicide ideation, attempts, and completion are higher among veterans than the civilian population. A 2014 Department of Defense (DoD) report found that there were 1,080 suicide attempts and 245 completed suicides among active-duty service members in the previous calendar year. Among 52,780 active-duty members of the US Air Force, 3 percent of men and 5.2 percent of women reported suicidal thoughts the previous year. Among those, 8.7 percent reported a recent suicide attempt. Veterans with diagnosed PTSD were four times more likely to report thoughts of suicide compared to veterans who screened without PTSD. Veterans with two or more co-occurring disorders, like depression, alcohol abuse, and nicotine abuse, were 5.7 times more likely to experience suicidal ideation.
Several Organizations like the VA Offer Smoking Cessation Help
The VA offers smoking cessation help for veterans, which is a combination of prescription medication and counseling. Nicotine patches, lozenges, and gum can help veterans begin the process of ending their physical dependence on nicotine. A physician will help the veteran taper these products slowly until the body no longer needs tobacco products to feel normal.
Bupropion, the generic version of Wellbutrin, was once an antidepressant but has recently been found to work well helping people who smoke, including veterans, overcome the addiction. A counselor can work with the veteran on life stress and ways to cope that do not involve cigarettes or other tobacco products.
Underlying mental health concerns like PTSD and depression among veterans will also greatly benefit from counseling. The VA has long helped veterans manage PTSD, depression, addiction, and other mental and behavioral struggles. Any veteran suffering from co-occurring disorders, like PTSD and smoking, can get help from a VA counselor. The American Journal on Addictions (AJA) published a 2016 small study that looked at group counseling to help veterans struggling with co-occurring nicotine and other substance use disorders. The study found that including tobacco cessation in group motivational interviewing (GMI) sessions improved outcomes for many participants.
For veterans who may not want to go through VA treatment or those who cannot reach their nearest VA, the federal healthcare system sometimes contracts with other medical providers to ensure access to physical, behavioral, mental, and substance abuse treatment.