Journal of Medicine conducted a survey that showed military members who experienced a traumatic brain injury were more than twice as likely to suffer from PTSD later on than service members who did not suffer a TBI. According to the RAND Center for Military Health Policy Research, 20 percent of the vets who served in Iraq or Afghanistan suffer from either major depression or post-traumatic stress disorder; 19.5 percent of vets in these two cate- gories have experienced a traumatic brain injury. These three disorders related to service alone have an enormous impact on the demand for veteran mental health treatment. An important component of veteran mental health treatment is being able to identify when treatment for certain areas is needed. For newly released veterans with a TBI, the delay between the injury and the onset of PTSD means that the serv- ice member may have been discharged before they experience severe symptoms. It often takes three to four months for PTSD symptoms to appear. Substance Abuse A long with PTSD, substance abuse plays a large role in the mental health of veterans. The National Institute of Drug Abuse (NIDA) reports that substance abuse among veterans is strongly related to their exposure to combat. In fact, one of their studies found that 25 percent of returning Iraq and Afghanistan veterans showed signs of substance abuse disorder. Another study by NIDA showed that active- duty and veteran military personnel abused prescription drugs at more than twice the rate of the civilian population. “Psychiatric symptoms and substance use have been described as the primary risk factors for homelessness among veterans,” according to RAND Corporation research. “Studies of veterans indicate that psychiatric symptoms and substance use were stronger predictors of homelessness than combat exposure or any other military factor.” “Up to 80 percent of homeless veterans suffer from mental health and/or substance use disor- ders. The path into and out of homelessness is often complicated by untreated or under treated mental health and substance use disorders,” according to the VA’s website. “Even after hous- ing has been obtained, the presence of these disorders can further isolate homeless veterans, resulting in greater rates of emergency room visits and hospitalizations.” Fox News’s report eloquently sums up the state of veteran mental health: “When people, however brave or strong, live for protracted peri- ods in a war zone, in which they must bury the natural fear of death, natural pangs of grief, and the natural horror of killing, all that buried emo- tion does not remain underground. It resurfaces like shards of glass and steel, walled off under the skin, until abscesses develop and eventually burst to the surface, shredding any façade of peace.”  WWW.CITYGATENETWORK.ORG MARCH/APRIL 2019 27 Another study by NIDA showed that active­duty and veteran military personnel abused prescription drugs at more than twice the rate of the civilian population. Kristi, Instigate’s managing editor, has been a magazine writer and editor for more than 20 years, as well as a contributing author for devotionals and curriculum. She and her husband, Jess, are the parents of three children. Email her at krector@citygatenetwork.org.