Perspectives of homeless veterans living with substance use disorders (SUD) and mental illness

Christian A Betancourt; Debora G Goldberg; Beth A Hawks; Panagiota Kitsantas

doi:10.1016/j.heliyon.2023.e20364

Perspectives of homeless veterans living with substance use disorders (SUD) and mental illness

Heliyon. 2023 Sep 21;9(10):e20364. doi: 10.1016/j.heliyon.2023.e20364. eCollection 2023 Oct.

Authors

Christian A Betancourt¹, Debora G Goldberg², Beth A Hawks¹, Panagiota Kitsantas³

Affiliations

¹ Department of Preventive Medicine and Biostatistics, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
² Department of Health Administration and Policy, George Mason University, 4400 University Drive, Fairfax, VA, 22032, USA.
³ Department of Population Health and Social Medicine, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA.

Abstract

Upon returning home from the military, America's veterans face complex challenges such as homelessness and substance use disorders (SUD). Veterans who have experienced SUDs and homelessness are more likely to struggle with depression and suicidal behaviors. This study aims to understand homeless veterans' lived experiences of their everyday life and social interactions. We used semi-structured interviews to conduct a phenomenological study of 14 homeless veterans with known SUDs living in the Baltimore-Washington D.C. Metropolitan area. A Social-Ecological Model (SEM) was used to create themes, a priori, then used open coding analytic methods to identify emerging themes. Two-thirds of veterans used illicit drugs or abused alcohol, and nearly all reported a history of depression or anxiety. Suicidal behaviors were present in a third of all veterans. We found that veteran homelessness and substance use are strongly associated with emotional and physical trauma suffered while on active duty. Consequently, once homeless, a veteran's community may encourage and exacerbate SUDs, thus impeding a path toward sobriety. Homeless veterans who have struggled with SUDs and later experience a death in their family often relapse to substance use. Deeply exploring a veteran's relationships with family, friends, and their immediate community may reveal opportunities to address these issues using healthcare and community interventions.

Keywords: Homeless; Mental illness; Social-ecological model (SEM); Substance use; Suicide; Veteran.