A powerful sense of pride is still one of the key features of military life, connected to which is a sense that if you do have problems then you‘ just get on with it’.
build up trust with veterans?‘ Not necessarily,’ he says.‘ All clinicians at Combat Stress are very experienced, and veterans know they’ re attending a service that has a good understanding of their needs – they know we don’ t judge the substance misuse, and understand it as a method of coping.’
IMPROVED OUTCOMES There are also some optimistic signs that veterans are no longer leaving it so late to get help, with organisations working hard to raise awareness and encourage people to access support early – as that’ s clearly related to better outcomes, he says.‘ Veterans are seeking help earlier and younger than before, although it can still take many years for a variety of reasons – of which pride and stigma may be a feature for some, but not all.’ The armed services have
Dr Lee Robinson is consultant clinical psychologist, clinical lead, head of clinical information and accountable clinical safety officer for Combat Stress. always had a big drinking culture, so it’ s no surprise that the substance problems experienced by veterans have tended be with alcohol rather than drugs. Actual figures can be hard to come by, however, at least with relation to the UK. Unsurprisingly it seems to be something that the Ministry of Defence might be keen to play down, if possible. Its 2024 document, UK armed forces mental health: annual summary & trends over time, 2007-08 to 2023-24 states that‘ Despite media attention focusing on prevalence of PTSD and psychoactive substance misuse due to alcohol in the UK … these disorders remain low, with around 2 in 1,000 of serving UK armed forces personnel assessed at an MOD DCMH [ Department of Community Mental Health ]’ – although that relates to those still serving, rather than veterans.
A 2020 study by King’ s College London, Mental health disorders and alcohol misuse among UK military veterans and the general population: a comparison study, however, found that the prevalence of alcohol misuse among UK veterans who’ d served at the time of recent military operations was almost double that among non-veterans. Some Combat Stress clients also use cocaine or cannabis along with the alcohol, says Robinson,‘ and we’ re seeing a rise in the number of ketamine users among the younger veterans’.
SUPPORTIVE NETWORKS Organisations like his also work hard to refer people to other services they might need, such as health, education or housing.‘ We offer supported referrals and warm handover where possible, rather than cold signposting, but will also recommend services where appropriate to do so,’ he says.‘ We have strong collaborative partnerships with other providers, and operate as a specialist provider within a supportive network.’ When it comes to housing, rates of homelessness among veterans do appear to be falling significantly, with their proportion among London’ s single homeless population estimated to have
Combat Stress was founded in May 1919, just after the First World War ended. Originally called the Ex- Servicemen’ s Welfare Society, the founders witnessed how thousands of servicemen with severe mental health problems received little or no sympathy, and believed that veterans could be helped to cope through rehabilitation. In 1919 they began providing occupational therapy including basket weaving, opening their first‘ recuperative home’ in 1920 on Putney Hill in South West London.
Today the charity focuses on helping veterans with trauma-related conditions like PTSD, anxiety, and depression. They provide a variety of support such as clinical treatment, intensive PTSD programmes, out patient appointments, peer support and online
resources. www. combatstress. org. uk
dropped from more than 20 per cent in the late 1990s to 6 per cent just a decade later.
But it’ s not just hyperarousal and trauma that veterans can struggle with. The feelings of guilt and shame can be overwhelmingly intense, particularly if they’ ve witnessed the death or serious injury of friends or civilians and felt they were unable to help. Many veterans also describe the military as having been like a brotherhood, making it difficult to adjust to civilian life. The feeling that no one else can understand what they’ ve been through – or even that it hasn’ t been appreciated – can have a deeply isolating effect.
LONELINESS AND SECRECY‘ Certainly, for a significant number of veterans, withdrawal, isolation and loneliness can be a consequence of attempts to cope with PTSD or complex PTSD,’ says Robinson – the latter defined as PTSD with additional symptoms such as difficulties in controlling emotions or problems with relationships. Loneliness of course can also be a‘ consequence of the secrecy that’ s often around substance misuse’, he adds, as well as being‘ an important factor in risk to self-harm, suicide and accidental death’.
A powerful sense of pride is still one of the key features of military life, connected to which is a sense that if you do have problems then you‘ just get on with it’. Do people still feel that seeking help could be seen as a sign of weakness – by others or themselves?‘ Yes, unfortunately this is still a barrier for a number of veterans,’ says Robinson. This is why the charity’ s support services and educational materials will always try to offer them a‘ different perspective’, he says.‘ That can make all the difference in taking that first courageous step.’ DDN
WWW. DRINKANDDRUGSNEWS. COM NOVEMBER 2025 • DRINK AND DRUGS NEWS • 15