I sat in the back left corner of my Population Approaches to Mental Health class at the University of Michigan School of Public Health, tasked with choosing an issue to focus on for the duration of the semester. My motivation to pursue Public Health has always stemmed from the people I met along the way, and this time would be no different. My phone lit up, a notification from my boyfriend just waking up 2,500 miles away. As our smiling faces stared back at me from my lock screen, I thought about the unique challenges he and his friends face every day. While the military fosters resilience and camaraderie, it also comes with immense stress, isolation, and high expectations. For some, this comes with lack of a solid social support system, as the “military life” takes much adapting to for friends, family members, and romantic partners. As my mind continued to drift, I knew what I would write.
Unsurprisingly, an increased prevalence of substance use disorders (SUDs) is common among active-duty military personnel. Not only do members deal with high-stress work environments, but they also are part of a group that is already at greater risk for SUDs to begin with. To elaborate, the military is male-dominated (82.5%), enlisted members most often have lower education levels (79.2% without a college degree), and many (43.5%) are between the ages of 18-25 (U.S Department of Defense, 2023). Men and those with lower education typically have higher rates of SUD, while the typical age of onset (early 20s) aligns perfectly with the age of most enlisted personnel (LeWine, 2024; Glantz et al., 2020).
In addition, stigma runs rampant in the military, lowering help-seeking behavior in those already at heightened risk. On a smaller scale, leadership dynamics and peer relationships play a large role in how stigma is perceived. Studies like those by McGuffin et al. (2021) and Clary et al. (2021) highlight how leadership and peer relationships can act as either a protective or risk factor for help-seeking behaviors and disordered substance use. While less supportive leadership has a detrimental effect on help-seeking behavior, McGuffin et al. (2021) demonstrated that supportive leadership — including things like frequent contact with unit members and concern for workplace safety — leads to reduced levels of both public and self-stigma in service members, which is then reflected in their increased willingness to seek help for various mental health disorders, including substance use disorder. Similar research shows that stigma levels may be reduced simply by implementing a short training session with military leaders, with five of the ten stigma-reduction awareness items showing a substantial improvement in officers after one two-hour training session (Hurtado et al., 2015).
The military also boasts a strong “do-it-yourself” mentality, focusing on being strong
from the moment members enlist. In fact, individuals fear that their peers and leaders would feel as if they were unfit for the job or would sense their weakness if they received mental health help due to this mentality (Clary et al., 2021). The numbers support this as well, with Hoge et al. (2004) reporting that 63% of those with a mental disorder believed that their leadership would treat them differently. Likewise, 65% thought they would be seen as weak.
On a much broader scale, there are also organizational barriers to receiving help within the military. When analyzing the Department of Defense (DoD) policies, Campbell et al. (2023) found that 65.2% of mental health-related policies used stigmatizing language – which included problems like using imprecise language, such as“unstable” and “mental defect” or using dated/inaccurate terminology, like “hysteria.” In comparison, over 90% of substance-use-specific policies included such language. Three years after informing the DoD of changes that should be made, Campbell et al. (2023) reevaluated the mental health policies (substance use specifics were left out as insufficient time had passed since the recommendations were given). They found that only 58.9% of language had been modified (Campbell et al., 2023). When combining the negativity and ambiguity related to help-seeking expressed in formal policies with the fact that enlisted members take pride in their careers, it is no surprise that military populations are concerned about the outcomes of seeking help and often settle for keeping their struggles to themselves, allowing them to fester without intervention.
Clearly, a harmful cycle is in progress. While it is near impossible to get an accurate
number representing the prevalence of SUD in active duty troops due to fear of career harm, rates show that 6.5% to 10.5% of members abuse alcohol — which is not even including other substances or reservists and veterans (Judkins et al., 2022). Often, those in the military are thrown to the side due to political debate and incomplete portrayals of the person under the uniform. Yet, most of these individuals are simply trying their hardest to make a name for themselves and provide for their families. They are people. They are struggling. And the cycle must end.
Going forward, supportive leadership must be encouraged. While some are quick to
say the military is incapable of change and leaders would never be open to such interventions, small-scale interventions have already been successful, with 77% of the leaders either agreeing or strongly agreeing that short trainings helped them understand the importance of reducing stigma, and 92% agreed that it was useful in reducing that stigma (Hurtado et al., 2015). Leaders are open to change; however, the Department of Defense must initiate and support this change – something they have shown is incredibly unimportant to them through their language and resistance to improvement.
So, as public health students, public health employees, public health advocates, or
fellow humans, we must intervene. We must push for these leadership dynamics to continue to expand. We must push for policies to be rewritten. We must push for education to continue. We must push for them; for those who love them; for their communities. We must push for the healthcare systems they already flood. We must push.
And, as for me, I will continue to advocate through my work and my research. While I
am one of the lucky ones, who loves someone who is not yet affected, my heart hurts for the families who cannot say the same. Who are watching their child, their sibling, their partner, or their parent slowly slip away to something that could be prevented if the Department of Defense cast more than a sideways glance to the problem. And while I may be in the clear for now, my fear grows stronger with each statistic I see and each deployment I will face from afar.
References
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stigma in Department of Defense Policies: Analysis, recommendations, and
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Clary, K. L., Pena, S., & Smith, D. C. (2021). Masculinity and stigma among emerging
adult military members and veterans: Implications for encouraging help-seeking.
Current Psychology, 42(6), 4422–4438. https://doi.org/10.1007/s12144-021-01768-7
Glantz, M. D., Bharat, C., Degenhardt, L., Sampson, N. A., Scott, K. M., Lim, C. C. W.,
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Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13–22. https://doi.org/10.1056/nejmoa040603
Hurtado, S. L., Simon-Arndt, C. M., McAnany, J., & Crain, J. A. (2015). Acceptability of mental
health stigma-reduction training and initial effects on awareness among military
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Judkins, J. L., Smith, K., Moore, B. A., & Morissette, S. B. (2022). Alcohol use disorder in
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LeWine, H. E. (2024, September 25). Alcohol use disorder (alcoholism). Harvard Health
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