Opioid Use in Veteran Students

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Table of Contents

Opioid Use in Veteran Students and Other Populations
Factors of Veteran Students Transitioning into Higher Education
Situation
Self
Support
Strategy
Impact of Opioid Misuse on Veteran Students and Solutions
Conclusion
References

The paper focuses on the rates of opioid use for pain management in university-level veteran students in contrast with other populations. As such, I am studying the use of opioids as medical treatment in this particular population within higher education settings. Additionally, It will be essential to highlight and categorize types of opioid misuse and discern the current social issues that arise from it. The relationship between pain management, transition to civilian life, and possible opioid misuse is also central to the theme of the paper. I am synthesizing recent articles on the topic, including questionnaires, to determine why veteran students fail to adapt to the new environment. Difficulties and factors that accompany the transition of former service members may have a causal effect on opioid misuse. My hypothesis is that veteran students need comprehensive support in their transition from military service to the collegiate environment to adapt to civilian life and avoid developing opioid use disorder.

The core issue of opioid misuse is due to many factors, one of which includes the frequency at which it is prescribed for pain management. Understanding the intricacies of typically sustained injuries that veteran students may suffer is critical for the analysis. This also includes the distinct risk factors that veteran students face and other obstacles that are either systematic, medical, social, or legal. In the end, I will compare the found correlations or noticeable patterns between opioid use and risk factors, environments, mental health, and medical prescription, and the rates of suicide or overdosed in relation to opioids. Lastly, some solutions to the opioid misuse problem within the veteran student population will be developed.

Opioid Use in Veteran Students and Other Populations

Recent studies have continued to expose the prescription and illicit opioid crisis that often results in misuse, user disorders, and overdoses (Blanco et al., 2020; Smith et al., 2016; Zesiger, 2018). As of 2018, two million individuals have met the diagnostic criteria for opioid use disorders, which is a decrease from the previous years while still being incredibly concerning (Blanco et al., 2020). Though the misuse of opioid is not found strictly in specific communities and has an expansive reach, the adverse effects are more prevalent and frequent in certain populations than in others. These populations include groups within the judicial system, rural populations, veterans, youth and adolescents, and individuals who inject drugs. Each faces unique obstacles towards treatment while certain issues overlap between groups. Many of the barriers student veterans face with opioid misuse are actually not exclusive to their social group and have much deeper roots. Opioid use disorder, or OUD, is widely prevalent in veteran groups due to a number of distinctive factors such as risk factors related to OUD, chronic pain, and pain that is made further complicated by mental illness. During conflicts in Iraq and Afghanistan, prescriptions of opioids increased while opioid overdoses increased appropriately.

Student veterans face similar barriers towards treatment that the general population does, with certain exceptions. Stigma can often be the origin of many obstacles, such as system-level limitations that can appear as a lack of insurance coverage or laws restricting information sharing of OUD treatment. The barriers can also appear on the provider level, with certain ensuring companies lacking the motivation or knowledge on OUD treatment. Barriers may even be self-imposed by a patient in cases when they are unaware of effective treatments for OUDs.

As the focus of the paper addresses the use of opioids among veteran students, it is essential to understand their presence within higher education environments, especially in relation to their non-military peers. Smith et al. (2016) compared veteran and non-veteran students in six areas of transitioning into college, which were health, fitting in or social acceptance, emotional adjustment, productivity, perceived career support, and social engagement. The study assessed that veteran students rated with more difficulty in social engagement with negative trends in emotional adjustment, with certain researchers hypothesizing that they may only feel at ease with other veterans. In comparison to civilian students, veteran students displayed more issues with hostility and anger, higher work and family obligations, and a sense of lack of support. Outside of the education field, veterans face a probability of engaging in binge drinking, substance abuse, depression, and suicidality. Data collected from over 298,000 veterans returning from Iraq and Afghanistan illustrated that nearly 37% of veterans were diagnosed with a mental illness (Smith et al., 2016). Currently, the data suggests that veteran students may adapt to higher education life but are likely to experience difficulties in social, psychological, and personal ways. These factors can be made more complicated by physical pain and susceptibility to misuse of opioids.

Veteran students ranked much lower in the fitting in or social acceptance category of the questionnaire. The analysis of the results suggested trauma to be a significant predictor of the levels of social acceptance. However, students with trauma did not have to be veterans to score lower in the social acceptance area of the survey. Despite this, veteran students were significantly more likely to have trauma than their civilian peers, reaching 88% of the participants. The authors concluded that while veteran students faced alienation, it was the trauma that predicted a student’s ability to fit in regardless of their veteran or civilian status. Additionally, while civilian students with trauma scored lower in emotional adjustment, veteran students only suggested a negative trend but otherwise matched others in the same area. This may be due to the expectancy effect, as veterans always have a higher expectation of experiencing trauma and may develop a type of immunization towards it to cope while also likely to have received treatment for trauma prior.

Both veteran and civilian students fall into groups of individuals who have records of opioid misuse. Opioid misuse and abuse have slightly different definitions within higher education settings, with misuse focusing on the use of heroin or non-medical use of opioid prescriptions. Zesiger (2018) investigated which individual, social, or institutional factors led to opioid misuse, whether misuse was higher in veteran students, and the effect of misuse of sleep, physical and mental well-being, and suicidality. Data collected from a large sample size revealed that certain characteristics such as being an undergraduate often correlated with high opioid misuse. Veteran students, especially those with experience in hazardous duty, reported having elevated opioid misuse. Additionally, students that reported misusing opioids noted to have suicidal thoughts or past suicide attempts twice as frequently as non-using students. Often, they also reported that they have health complications such as chronic illness, depression, and anxiety. This suggests that opioid misuse is a hazard in social, economic, and medical ways and affects large groups, irrelevant of their military or non-military status. However, since veteran students are the most exposed to trauma, pain management, and opioid prescriptions, they become especially vulnerable to the misuse of opioids within a higher education environment.

Factors of Veteran Students Transitioning into Higher Education

College or university time is an essential developmental and transitional period for all kinds of students. During this period, they acquire needed knowledge/skills, learn new behavior patterns, and shape their lifestyle, adapting to new roles in their life. Under Schlossberg’s Transition Theory (1984), transitions lead to changes in one’s conventions, roles, relationships, or patterns, while the quality of such changes is determined by personal and external factors (Higgerson, 2017). This theory is known for individual focus concentrating on adult’s perceptions rather than particular events. Transitions can be divided into moving in, moving through, and moving out phases (Higgerson, 2017). During the initial stage, people recognize that they should embrace a new identity and abandon the old one to progress in their life. Next, moving through is a threshold zone when one stops to be who they were earlier but have not become those they plan to be. Finally, the moving out phase is when individuals incorporate and integrate new knowledge, behavior patterns, and roles into their lives and start looking for new things.

Veterans who consider pursuing higher education move out of their military career and enter the moving in stage to become students. During this period, both young and experienced adults are expected to “learn the ropes”; become familiar with new routines, relationships, and roles (Jenner, 2017). For typical first-year college students, such transition occurs more naturally since they are familiar with the environment and culture they will experience. The latter usually have more robust engagement that they carry through the linear transition from primary and secondary education to higher education in order to attain the degree (Jenner, 2017). For that reason, the Input-Environment-Output model is not applicable for returning students who have more complex input characteristics and deal with consequences of interrupted education careers.

There are four major sets of factors under Schlossberg’s theory that influence an individual’s ability to manage transition: Situation, Self, Support, and Strategies (Schlossberg, 1984). The Situation covers issues related to triggers, role change, control, and stress, while Self assesses how an individual views life under specific personal and demographic characteristics (Higgerson, 2017). Support considers social assistance that one may receive from institutions, friends, families, or other relationships. The last S is dedicated to the assessment of coping responses during the transition.

Situation

Many student veterans consider the military career as their primary option, not a temporary occupation. They are often involuntarily discharged from the military service due to medical or physical reasons and related circumstances. Although the number of former servicemen who apply for the GI Bill program is growing, approximately 80% of veteran students drop out of higher education and ultimately fail to receive anticipated degrees (Marcus, 2017). They have specific, usually involuntary and frustrating, reasons behind college enrollment. Thus, they instead turn to an education career as a backup prospect lacking aspiration to pursue a degree. They also find it challenging to accommodate the new environment.

The success of transition often depends on how a former military member perceives the role change that may be considered a loss or gain. Gregg et al. (2016) reveal that 15% of respondents tend to judge their situation negatively and find it difficult to adjust to their new roles in regular society. Financial issues have the most significant impact on the ability to continue the studies for both traditional and veteran students. These issues, together with the drastic change in the culture, undermine their sense of control. Military members have used to live in a highly structured and regimented environment where they followed a specific chain of command and rules. More loose and independent collegiate culture makes them less confident, contributing to the feeling of being out of control. Student veterans tend to develop a culture shock by comparing their former structured life to their current experience as students. They also face challenges when balancing other nontraditional roles (spouse, parent, or employee) and their studies.

Self

Veteran students have used to identify themselves by affiliation with different military branches and their military ranks. For that reason, they struggle to find their military self inside the educational institution. In the college environment, former military members become simply students identified by their age, race, socioeconomic status, or ethnicity. They also struggle to self-identify their veteran status and find other ways to determine if they are successful within the new environment (Higgerson, 2017). Student veterans are usually older than others, have their own families and full-time jobs, and may define themselves in multiple ways. All these roles impact their psychological resources, including commitment and resilience.

Support

Social support plays a vital role in every transition process. Active military members subordinate to their commanders and find support within the structure and members of their unit. When they enter a collegiate environment, they tend to disconnect from other students who do not have similar experiences and interests. For that reason, student veterans opt to socialize with other former military members with whom they have more in common. Student Veteran Offices (SVO), faculty, staff, and peers are expected to deliver the support necessary to help former servicemen abandon their military identity. The support inside the institution is vital to former soldiers in combating isolation and improving social connections (Higgerson, 2017). Family members, especially spouses, provide the most support outside the institution. The most crucial task is defining how student veterans identify themselves to determine if they want to be isolated or seek assistance from university and peers for further socialization.

Strategy

To cope with transitions, individuals should follow strategies that help manage the situation, direct actions, and mitigate related stress. In the military, individuals have specific instructions and training that provide information and ways to cope with various issues. In college or university, adult learners with a military background may struggle to overcome barriers to information. It contrasts with traditional students who usually do not face similar challenges. For that reason, veteran-specific services initiated by institutions and Veteran Offices are welcomed to provide student veterans with strategies delivering valuable and accurate information. Some may find strategies related to local organizations, families, and peers more appropriate to cope with the transition.

To conclude this part, student veterans lack engagement and involvement to contribute to the higher education experience. They face unique barriers during their transition from military to civilian life, including difficulties in satisfying their family and social roles, difficulties socializing with other students and peers, and acculturating to campus life. Following the military service, student veterans struggle to balance school with their family responsibilities and other obligations stemming from civilian life. In their case, the role exit is often not voluntary and hampers the process of disengagement from the previous role. This student group struggles to accommodate the collegiate culture where their military identity is not recognized and appreciated by traditional students. In other words, they face a culture shock and do not know how to cope with it, and often turn to additional opioids to mitigate their pain. Different co-identity organizations, faculties, peers, and families play an essential role in supporting and guiding former military members for a successful transition. When they lack strategies to cope with stress caused by transition, the risk of dropout, mental disorders, and opioid misuse becomes higher.

Impact of Opioid Misuse on Veteran Students and Solutions

Impact on Health and Civilian Life

All student veterans are at high risk of developing OUD or substance use disorder (SUD) due to a variety of factors not influencing traditional students. Military service often ends with trauma or mental health issues (PTSD, depression, or anxiety disorders) that may require a prescription of painkillers. While facing challenges adjusting to school and civilian life, brave former service members may engage in opioid or alcohol misuse to cope with their pain and frustration. They divert from prescription, increasing the dosage, and take opioids beyond pain-management purposes. Chronic pain is often complicated by mental health issues and struggles to adjust to the new social roles (Blanco et al., 2020). Those who experienced combat, lost their friends, or were wounded are even more vulnerable to OUD than those deployed, non-exposed to hostilities (Kime, 2019). Misuse of prescription opioids may lead to death by overdose and even impair already poor mental health. Blanco et al. (2020) report that veterans are two times more likely to experience overdose than other populations. OUD ultimately leads to poverty, incarceration, social dysfunction, and poor health.

In other words, opioid misuse not only postpones and hinders the transition to civilian life among former servicemen but also makes it impossible by strengthening barriers. Spouses and children of adult veterans also feel the adverse impact of OUD. Communication between family members becomes complicated, trust begins to erode, and quarrels occur more often. The latter may cause severe trauma or physical harm to family members, especially to children. In addition, spouses are at high risk of developing unhealthy ways to cope with the situation. As a result, addicted student veterans may fail to satisfy their roles as parents and spouses, become not interested and isolated, ultimately losing their families. A similar effect can be seen in relation to career prospects which deteriorate due to misuse of substances such as alcohol and drugs.

Impact on Education

The majority of articles concentrate on the effect of opioid misuse on academic performance among adolescents and young adults. For instance, Paolini (2020) reveals that students involved in drug usage are at higher risk of developing erratic behavior, absenteeism, have a decline in communication and leadership skills, and receive lower grades. Hence, drug misuse lowers student performance, decreases engagement and motivation, and leads to issues with self-control.

What is more, lower intrinsic motivation accompanied by severe opioid sickness cause the interruption of education. According to Ellis et al. (2020), addicted students cannot focus on education and instead do their best to acquire another dose. As a result, they delay completion of studies or stop their education completely; thus, they attain lower education than others. Many students report the initial benefits of using opioids for non-medical purposes associated with increased energy, ability to focus, and psychological relief (Ellis et al., 2020). Nevertheless, in the long run, opioid addiction causes adverse health problems and hinders the socialization process.

All mentioned consequences may be stronger among student veterans who initially face similar social issues due to trauma, stress, and transition to civilian life. Afuseh et al. (2020) found that young adults and adults between 26-64 years usually develop SUD due to high-stress jobs, academic stress, family life problems, and the use of addictive prescription medications. The authors also reveal that younger veterans with lower income and fewer years of education are more likely to develop opioid misuse than their more experienced colleagues. All these risk factors are present in the life of student veterans who need additional support to avoid addiction.

Solutions

In general, the rising opioid misuse issue among former service members requires comprehensive support strategies and initiatives from governmental agencies, health care institutions, families, and veteran organizations. Counseling and advising interactions are needed in the higher education realm to direct former military members towards alternative pain and coping strategies. Campus healthcare should turn to health screening activities to identify mental health concerns as soon as possible (Jenner, 2017). Additional efforts are needed to reduce stigma and encourage veterans to integrate into the college environment and the fabric of civilian life. Finally, special courses and training are necessary to develop emotional regulation skills and promote adequate health strategy.

Co-identity organizations are important intermediaries that contribute to the socialization of minorities and special social groups. These organizations provide their members with a safe zone and facilitate their transition to higher education by ensuring cultural expression and advocacy. Such institutions are also beneficial because of further support of social involvement developing connections with faculty members (Jenner, 2017). It is in line with Schlossberg’s (1984) theory and her view on the importance of social support. Participants can share their own feelings and stories regarding deployment with former military peers. Thus, it is beneficial for social reintegration and gradual transition to college build relationships. The impact of veteran organizations currently needs additional investigation to obtain more evidence. Nevertheless, membership in such institutions seems to be beneficial for former service members since it reduces the chances of them remaining lost and isolated due to the transition.

Colleges and universities should provide complete information to student veterans on their websites regarding their benefits and financial aid since financial issues are the main constraints among all students. Clear guidance on reaching someone to discuss the benefits process and providing access to DVA certifying officials and veteran offices will foster transition in its initial stage. Tutoring assistance is needed to address the gaps in student veterans’ education by directing them to unique resources. Students should feel that they seek answers independently, not asking for help as they do not like to do it. In this case, the veterans support offices are of high importance since they deliver accurate information/ resources, eliminate barriers, and foster the connection to the institution. The office also should have someone in charge of helping and advocating for local veterans. This person should be able to assist them, explain the institution’s policy and the way military credits are transferred. For instance, he or she can encourage student veterans to take a lower-level course to enrich their fundamental knowledge and facilitate study at a higher level. The office also has to provide career services and mental health counseling. The veterans support offices contribute to the military-friendly culture, and its presence on the campus shows former servicemen that they are valued.

Conclusion

Student veterans are more vulnerable to OUD compared to traditional students due to a myriad of risk factors. During the transition from military service to civilian life, they struggle to identify themselves as veterans and balance their education with family and work obligations. It is also challenging to reestablish social connections away from a rigid and structured military environment. The list of factors that impact transition to higher education includes previous experience, role/control change, psychological resources, social support, and choice of strategy to cope with it. Student veterans often lack support from their families and society as a whole, feeling isolated and abandoned. Involuntary discharge is usually perceived as a loss and leads to lower engagement and motivation. It is often accompanied by opioid treatment of injuries and mental health issues. For that reason, this social group is more vulnerable to engage in binge drinking, depression, substance abuse, and suicidality.

Opioid addiction may not only result in death due to overdose but also deteriorate the physical and mental health of veterans. In the academic environment, drug addiction lowers their engagement and motivation to continue their studies. Instead, it makes them prioritize drug-seeking behavior over attending college or university. Addicts are not interested in their careers, lack leadership skills, and endanger their families. In order to avoid such consequences, colleges and universities should provide former service members with necessary information and assistance. I have found that student veteran offices and their staff help former military members socialize within the previously unknown environment and guide their academic efforts. Other solutions would be financial aid, membership in veteran organizations, regular mental health screening, tutoring, and counseling. To avoid OUD, health care institutions and schools should promote alternative ways of coping with traumas and injuries.

References

Afuseh, E., Pike, C. A., & Oruche, U. M. (2020). Individualized approach to primary prevention of substance use disorder: age-related risks.Substance Abuse Treatment, Prevention, and Policy, 15(1), 1-8. Web.

Blanco, C., Ali, M. M., Beswick, A., Drexler, K., Hoffman, C., Jones, C. M., Wiley, T. R. A., & Coukell, A. (2020). The American opioid epidemic in special populations: Five examples.Nam Perspectives. Web.

Ellis, M. S., Kasper, Z. A., & Cicero, T. J. (2020). The impact of opioid use disorder on levels of educational attainment: Perceived benefits and consequences.Drug and Alcohol Dependence, 206(1),1-6. Web.

Gregg, B. T. , Kitzman, P. H. , & Shordike, A. (2016). Well-being and coping of student veterans readjusting into academia: A pilot study.Occupational Therapy inMental Health, 32(1), 86-107. Web.

Higgerson, P. R. (2017). Student veterans and their transition to becoming a college student (Publication No. 3219) [Master’s thesis, Eastern Illinois University]. The Keep.

Jenner, B. M. (2017). Student veterans and the transition to higher education: Integrating existing literatures. Journal of Veterans Studies, 2(2), 26-44. Web.

Kime, P. (2019). Combat troops at higher risk for opioid, heroin addiction, study says.Military Times. Web.

Marcus, J. (2017). Community colleges rarely graduate the veterans they recruit.The Atlantic. Web.

Paolini, A. (2020). School counselors and fighting the opioid epidemic: Consequences, impact on academic performance, and treatment to overcome the battle.Journal of Family Counseling and Education, 5(1), 1-12. Web.

Schlossberg, N. K. (1984). Counseling adults in transition. Springer Publishing Company.

Smith, J. G., Vilhauer, R. P., & Chafos, V. (2016). Do military veteran and civilian students function differently in college.Journal of American College Health, 65(1), 76-79. Web.

Zesiger, H. A. (2018). Opioid misuse among students pursuing higher education [Unpublished doctoral dissertation]. Georgia State University.

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