Former military personnel with both an Alcohol Use Disorder (AUD) and Common Mental Disorder (CMD) should be treated for both at the same time, says new research.
Research by Lancaster University and Liverpool John Moores University, funded by Forces in Mind Trust, calls for integrated and accessible treatment to address issues around eligibility for services for those with both AUD and CMD – a “no wrong door” approach.
The recommendations outline:
- The need for approaches that use integrated services, increase awareness of available support and reduce stigma.
- That Alcohol use should not delay former Service personnel from getting the support they need for their mental health.
- Non-military services should understand what support is available to former Service personnel.
What was the research?
More than 30,000 former Service personnel have both CMD and AUD, but this group are more likely to delay seeking help than the general population. People with CMDs – such as depression, anxiety, or post-traumatic stress – are twice as likely to report an Alcohol Use Disorder (AUD) but they are often excluded from mental health services until they have stopped drinking. Former Service personnel can also face additional challenges, such as an inability to recognise how severe problems are, stigma, and service providers being unaware of the potential impact of unique military experiences.
Researchers conducted a series of studies, including a review of existing international evidence, interviews with treatment-seeking former service personnel with co-occurring AUD and CMD, an analysis of data from an NHS Military Veterans’ Mental Health Service, and focus groups and an online survey with service providers to produce recommendations to improve care.
What did the research find?
They found that integrated interventions which target both AUD and CMD and alcohol-focused interventions are more effective than usual care for improving alcohol use, and integrated interventions were more beneficial than alcohol-focused interventions for treating CMD.
The interviews with former Service personnel highlighted that aspects of military culture, such as norms around masculinity and the normalisation of heavy alcohol use (which masked mental health symptoms), could delay help seeking.
Former Service personnel highlighted that mental health services often required individuals to be abstinent before accessing support, which led to delays in receiving care and encouraged people to hide their alcohol use.
“They said to me, whatever you do, don’t tell them you’re drinking. Otherwise, they won’t treat you so I basically lied all though my therapy.”
In contrast, other services, such as veteran-specific NHS and third-sector services, implemented integrated and flexible approaches without automatically excluding individuals who were drinking.
Many participants described care as most effective when providers demonstrated both an understanding of military culture and a trauma-informed approach. Feeling that providers “spoke the same language” helped build trust and fostered an instant connection.
Focus groups with service providers largely echoed these findings, describing the mental health and alcohol care system as fragmented and disjointed. Integrated and coordinated treatment of both disorders, ideally within a single service or through collaboration, was widely regarded as the most effective but not a common practice.
“By adding in the addictions work alongside the mental health work, they have suddenly flown and got better from both counts”.
The analysis of data from the NHS Military Veterans’ Mental Health Service showed that former Service personnel with co-occurring AUD and CMD show similar levels of improvement and recovery from mental health treatment compared to former Service personnel with only a CMD. However, former Service personnel with co-occurring problems faced more challenges staying engaged in treatment.
Recommendations
The findings from these studies led to the development of 15 key recommendations to improve care. There are recommendations around:
- Co-ordination across mental health and alcohol treatment services (through “no wrong door” approaches, such as removing abstinence-only policies from mental health services)
- The need for mainstream services to build their awareness of veteran-specific support organisations
- The need for personalised care plans, which reflect the needs of former Service personnel.
The research project, funded with £148,000 by the Forces in Mind Trust, was led by Dr Laura Goodwin from Lancaster University and Dr Patsy Irizar from Liverpool John Moores University with
Dr Shumona Salam and Professor Steven Jones from Lancaster, Dr Deirdre MacManus from King’s College London and Dr Neil Roberts from the University of Cardiff.
Dr Laura Goodwin, Senior Lecturer in Mental Health at Lancaster University said
“Former service personnel with co-occurring alcohol and mental health problems are often turned away from mental health services until they have stopped drinking, yet our research shows that they are able to benefit from mental health treatment. Our recommendations call for more flexible eligibility criteria within services, which remove abstinence-only policies.”
Dr Patsy Irizar, Senior Lecturer, Liverpool John Moores University, said
“Many former service personnel with co-occurring alcohol and mental health problems delay seeking help, which can cause problems to worsen. The recommendations from our research suggest a need for increased visibility of services, so veterans know where to access support, and for national campaigns which aim to reduce stigma and encourage help seeking.”
Michelle Alston, Chief Executive, Forces in Mind Trust, said,
“Whilst most Service personnel transition successfully to civilian life, there are some who have served that struggle with alcohol and mental health issues together. This report sends a very clear message about how we should be helping this group. They are supported best when both issues can be treated together. It is great that this model is already being used in some organisations, and we hope this report encourages more services to adopt an integrated model.”
The report can be accessed here.
