in rural areas a great distance from a VA medical center. Outreach efforts are challenged by this geographic dispersion, and must rely on innovative delivery methods such as Web-based outreach, telephone counseling, and telemedicine consultation. Additionally, members of the National Guard and Reserves and their families may not qualify for the same services as active duty personnel, who receive comprehensive care through the military’s direct care system. Discharge status also can present barriers to accessing care. Reserve component and discharged military personnel must have an honorable or general discharge to be eligible for the special combat veteran medical care at VA health centers. Combat veterans with SUDs are more likely to receive a less than honorable discharge because of disciplinary infractions. Consequently, those in need of care may be ineligible. Furthermore, while family members may be involved in a veteran’s care, VA clinics do not provide individual therapy for family members.

An additional system-level barrier is the lack of a “warm hand-off” from the Military Health System to the VA health system (GAO, 2011a). Service members who have substance use or mental health problems must navigate the complex transition from one system to the other on their own. In contrast with physical injuries (which may result in medical treatment within the military, visible impairment, and a disability rating from the VA), the fact that many military personnel do not receive needed substance abuse care while in the military also means they do not receive a formal referral to VA care. Further, the GAO noted that demobilized members of the National Guard and Reserves may be concerned about a perceived lack of confidentiality of their VA medical record with regard to their current military service. The GAO’s 2011 report identifies key barriers gleaned from a literature review and corroborates those findings through interviews. The barriers identified in that report included stigma, a lack of understanding or awareness of mental health care, logistical challenges to accessing mental health care, and concerns about the quality or appropriateness of the care provided by the VA (GAO, 2011b).


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Bray, R. M., M. R. Pemberton, L. L. Hourani, M. Witt, K. L. Olmsted, J. M. Brown, B. Weimer, M. E. Lance, M. E. Marsden, and S. Scheffler. 2009. Department of Defense survey of health related behaviors among active duty military personnel. Research Triangle Park, NC: RTI International.

Burnett-Zeigler, I., M. Ilgen, M. Valenstein, K. Zivin, L. Gorman, A. Blow, S. Duffy, and S. Chermack. 2011. Prevalence and correlates of alcohol misuse among returning Afghanistan and Iraq veterans. Addictive Behaviors 36(8):801-806.

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