Contemporary Social Work Practice with Veterans: An Introduction to the Special Issue

This special issue is a historical marker for contemporary social work practice with veteran populations. The editors requested papers from private, public, and academic settings that illustrate the special needs of veterans. The articles in this issue address the impact of military culture and the veteran identity, diversity, eras of service, access to care, and different stages psycho-social development on clinical practice. This introduction places the articles submitted in the context of historical and current trends in veterans’ research concluding with a call to recognize resilience inherent in this population. It is hoped that this issue will serve as a tool for clinicians, researchers, and educators to improve upon their work as well as bring a new generation to serve and support those who served.     

Suffering in the Shadows: Interviews with Wives of Combat Veterans Suffering from Post-Traumatic Stress Disorder and/or Traumatic Brain Injury

The body of research examining issues confronting combat veterans of the Afghanistan and Iraq wars continues to grow. However, this research focuses primarily upon veterans with very less attention given to the challenges confronting their spouses. Using a semi-structured interview methodology and a feminist perspective, this study examines what it means to be a wife of a combat veteran who suffers from post-traumatic stress disorder (PTSD) and/or traumatic brain injury (TBI). Our findings indicate these women—who experience tremendous emotional, financial, and social challenges that arise from being the caregiver for their husbands—feel isolated from and abandoned by both the military community and the civilian community. Furthermore, the social and emotional disconnection of these women experience amplify the stresses they confront in daily life—stresses that are unique to their relationship to being with a combat veteran spouse who has PTSD and/or TBI. We argue future research should build upon this exploratory study to better understand how both the military community and the civilian community impact the subjectivity of these women and their efforts to reintegrate themselves and their families into civilian life.     

Gambling in a National U.S. Veteran Population: Prevalence,Socio-demographics,and Psychiatric Comorbidities

This study aimed to examine associations between gambling level and clinically relevant measures, including psychiatric disorders and suicidality, in a nationally representative sample of U.S. veterans. Data on 3157 U.S. veterans were analyzed from the National Health and Resilience in Veterans Study. Chi square tests and analyses of variance were used to assess associations between gambling level, and demographic, military, and personality characteristics. Multinomial logistic regressions using stepwise selection were used to identify independent correlates of recreational gambling and at-risk/problem gambling (ARPG). A significant proportion of U.S. veterans engage in gambling activities, with 35.1% gambling recreationally and 2.2% screening positive for ARPG. ARPG was associated with greater prevalence of substance use, anxiety, and depressive disorders, as well as with a history of physical trauma or sexual trauma, having sought mental health treatment (particularly from the Veterans Administration), and minority group status. A similar pattern was found associated with recreational gambling, although the magnitudes of association were lower relative to ARPG. Younger age, self-identifying as black, being retired, and trauma burden were associated with increased odds of ARPG, whereas older age, being single, non-white Hispanic, being retired or not having a job, screening positive for alcohol- and drug-use disorders, and trauma burden were associated with increased odds of recreational gambling. More than a third of U.S. veterans gamble recreationally, with a significant minority (2.2%) screening positive for ARPG. Both recreational and ARPG were associated with elevated trauma burden and psychiatric comorbidities. These findings underscore the importance of routine screening and monitoring of gambling severity, and interventions for ARPG in this population.     

Differential association between unemployment status and mental health among veterans and civilians

This study aims to examine the negative effect of unemployment on mental health among 2,762 veterans and 45,095 civilians aged 18 to 50 years. The data were from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) survey. We used ordinary least squares regression to test the interaction association between employment status and veteran/civilian status with mental health status. Findings revealed that long-term unemployed veterans had a significantly greater number of days with poor mental health than long-term unemployed civilians. The study highlights the need for future research concerning the negative effects of long-term unemployment on veterans’ mental health as well as the reciprocal relationships between mental health and occupational functioning for veterans. The findings challenge researchers to question the meanings that are associated with employment status for veterans as compared to those of their civilian peers. In addition to this, the study raises the need for further exploration into the topics of identity, self-perception, and the notion often present in the military/veteran culture that there is “dignity in labor.”     

Female Veterans: Navigating Two Identities

Female veterans differ from their male veteran counterparts in terms of ratio of men to women, minority status, economic status, and age. In 2014, female veterans totaled over 2 million; roughly 10% of the veteran population. In addition to balancing personal and professional responsibilities, many female veterans also have to adjust to and cope with the physical and/or mental health conditions they experience post-deployment. The extent to which female veterans succeed in transitioning back to civilian life post-deployment may be determined by biological, psychological, and social factors within their home and community. Circumstances that can support or hinder female veterans’ reintegration process include: (a) availability of gender-specific Veterans Affairs policies and services; (b) access to education and employment; (c) supports specific to mental health and/or military sexual trauma; and (d) social stigmas associated with being a female veteran. Along with other healthcare professionals, social workers have an obligation to promote social justice, and to empower underprivileged populations, including female veterans, whose needs may differ from male veterans and require specific expertise and knowledge.     

Trends in Bio-Behavioral Gambling Studies Research: Quantifying Citations

Both the National Gambling Impact Study Commission and the National Academy of Sciences have evaluated the current state of gambling studies research in general while making specific suggestions for future efforts in the psychological and biomedical areas in particular. Recognizing the importance of evaluating the state of the field on a macro level, this paper considers and categorizes several decades of psychological and biomedical gambling research. By examining the number of references to gambling in two major bibliographic databases, quantifiable trends and observations are presented about gambling-related psychological and biomedical research. Two trends in particular are salient: the rate at which gambling-related articles are published in scholarly journals is increasing, and the plurality of these articles deals with issues of cognition and personality as related to gambling.     

Homeless Military Veterans and the Intersection of Partner Violence

The objective of this paper was to identify, screen, and assess homeless veterans through outreach for domestic abuse services. This study focuses on 507 homeless veterans, from 2002 to 2007 identified in a homeless shelter and a transitional housing program. Homeless veterans completed the Domestic Violence/Abuse Screen (DV/AS) and psychosocial assessment. The majority were males, African American, divorced, Army, Vietnam, substance-dependent, and homeless, while the minorities had combat-PTSD; were charged and convicted of domestic violence; were on supervised parole or probation; had juvenile records; were victims of domestic violence during rearing; had a perpetrator relative; had prior domestic violence treatment; and were referred for domestic abuse treatment services. There is a lack of research evidence for the effectiveness for screening of homeless veteran partner violence. This sample shows the benefit of integrating domestic abuse screening into homeless programs and more research.     

Family Influences on Adolescent Gambling Behavior: A Review of the Literature

Gambling, and gambling related problems, are recognized as an emerging health issue among adolescents. Adolescent gambling is associated with numerous individual, social, and family characteristics. This paper provides a review of 21 empirical studies published between 1997 and 2008 that examine family influences on adolescent gambling behavior. Family influences on gambling behavior are conceptualized in the following five domains: (1) family sociodemographic factors, (2) general family climate, (3) family members’ attitudes and behaviors, (4) parenting practices, and (5) family relationship characteristics. Based on the review of extant literature, there is empirical evidence that family characteristics are associated with adolescent gambling and further examination of family system influences on gambling behavior is needed. Gaps in the current literature and recommendations for future research are discussed to help inform the study of family influences on adolescent gambling behavior.     

Stigma and problem gambling: current knowledge and future research directions

Stigma has been identified as a major barrier to help-seeking, treatment and recovery from gambling problems. However, little research has attempted to examine in any depth the causes, characteristics and consequences of stigma in relation to people experiencing gambling problems. The effects of stigma on people experiencing gambling problems, although not directly examined, are apparent through low rates of problem disclosure and treatment-seeking. In this paper, we aim to inform research into stigma associated with problem gambling by highlighting gaps in existing research and by providing direction for future research. The contribution of this paper is that for the first time stigma and problem gambling are drawn together and reviewed using broad constructs and literature from a range of seminal and new sources to present a synthesis of new and important information on stigma. In regard to problem gambling, the dimensions of stigma, except for origin, have yet to be investigated, as well as the processes of stigma creation, the characteristics of public and felt stigma, and coping strategies used to manage stigma. The practical implications of this review are summarized in a framework provided to inform future research into stigma related to problem gambling.     

Gambling and the Reasoned Action Model: Predicting Past Behavior,Intentions, and Future Behavior

Gambling is a serious concern for society because it is highly addictive and is associated with a myriad of negative outcomes. The current study applied the Reasoned Action Model (RAM) to understand and predict gambling intentions and behavior. Although prior studies have taken a reasoned action approach to understand gambling, no prior study has fully applied the RAM or used the RAM to predict future gambling. Across two studies the RAM was used to predict intentions to gamble, past gambling behavior, and future gambling behavior. In study 1 the model significantly predicted intentions and past behavior in both a college student and Amazon Mechanical Turk sample. In study 2 the model predicted future gambling behavior, measured 2 weeks after initial measurement of the RAM constructs. This study stands as the first to show the utility of the RAM in predicting future gambling behavior. Across both studies, attitudes and perceived normative pressure were the strongest predictors of intentions to gamble. These findings provide increased understanding of gambling and inform the development of gambling interventions based on the RAM.     

A scoping review of co-morbidity in individuals with disordered gambling

Individuals with disordered gambling often report at least one other lifetime psychiatric diagnosis. Although prevalence rates vary, there is substantial evidence for co-morbidity being the rule rather than the exception. Despite this known association, there has not been a recent comprehensive review of co-morbidity in disordered gambling other than prevalence surveys. The goal of this study was to broadly summarize and review the current literature on the extent, range and nature of disordered gambling co-morbidity. Following an initial search and screening of 6 databases, 251 articles were included in the final synthesis and evaluation. The main findings showed that few studies examine the mechanisms of co-morbidity in gambling beyond prevalence rates; few studies report on temporal sequencing of gambling and co-morbid disorders; there is a lack of treatment evaluation studies designed specifically for dual-diagnosis individuals; there is a need for system-level initiatives to address co-morbidity at the policy level; and the substance use literature may act as a useful model for guiding future gambling research on co-morbidity. The results suggest that despite a reasonable amount of published research on co-morbidity in disordered gambling, most study conclusions relegate to acknowledgements of high co-occurrence between disorders without follow-up.     

Violence and hostility among families of Vietnam veterans with combat-related posttraumatic stress disorder

The current study provides a portrait of emotional-behavioral functioning within a small sample of Vietnam veterans with combat-related posttraumatic stress disorder (PTSD), their partners, and older adolescent and adult children. Veterans, their partners and children reported moderate-low to moderate-high levels of violent behavior. In addition, partner and veteran hostility scores were elevated relative to gender and age matched norms. Partners also reported heightened levels of psychological maltreatment by veterans. Veterans' combat exposure was positively correlated with hostility and violent behavior among children but unrelated to partner variables. Veterans' reports of PTSD symptoms were positively associated with reports of hostility and violence among children, and hostility and general psychological distress among partners. Veterans' violent behavior was also positively correlated with children's violent behavior, but did not yield significant correlations with other child or partner variables. Findings are discussed in relation to prior work and directions for future research are addressed.     

The Effect of 21st Century Military Service on Civilian Labor and Educational Outcomes

I estimate the effect of military service during the Afghanistan and Iraq wars on civilian labor and educational outcomes using several empirical methodologies including sibling fixed effects and propensity score matching. Since military occupations and training have changed significantly in the past few decades, these effects may be different than those found in previous studies on veterans of earlier theaters. I find that veteran status increases civilian wages by approximately ten percent for minorities but has little or no effect on whites in this regard. Veterans of all demographic groups are found to be equally employable and equally as satisfied with their civilian occupation as non-veterans. For females and minorities, veteran status substantially increases the likelihood one attempts college. These veterans are found to be more apt to pursue and obtain a two year (associate’s) degree instead of a four year (bachelor’s) degree. Lastly, I find mixed evidence that veteran status increases the likelihood of public sector employment.     

Pharmacological treatments of pathological gambling

Medication treatment studies have demonstrated short-term efficacy of various SRIs, opioid antagonists, and mood stabilizers in sub-samples of adult treatment seeking pathological gamblers. Pathological gambling is frequently comorbid with bipolar spectrum disorders, substance abuse/dependence, and attention-deficit/hyperactivity disorder (ADHD), and comorbidity may influence treatment response in pathological gambling. This review focuses on recent research examining the treatment of pathological gambling and highlights methodological challenges for future studies.     

Can Anyone Here Know Who I Am? Co-constructing Meaningful Narratives With Combat Veterans

The discourse on psychosocial reintegration of combat veterans in the United States has largely been confined to discussions of the best treatment for those diagnosed with psychiatric disorders. Yet analysis of the data indicates that all combat veterans are changed by their experience. It also indicates that the current medical model of treatment is insufficient. The author suggests that another model is called for; one that benefits from psychoanalytic insights on war and violence. A model that supports veterans’ experience of changed consciousness might best help them form a coherent narrative that connects their past lives and combat experience to their lives going forward. She argues that this approach may not have been taken because the same mental processes that cause combat veterans to split off their experiences also cause society as a whole to distance itself from them. Clinicians can be most effective when they create a link to the veteran by acknowledging the veteran as part of society, not a split off aberration, and recognizing the universal role of aggression within and without in creating the war that the veterans fought, and shaping the social response to their return. Literature drawn from psychoanalysis, cognitive neuroscience, and clinicians from the global south is combined with that of military psychiatry and global relief and development to support these positions.     

Gambling in children and adolescents

The topic of adolescent gambling is attracting growing interest, but there has still been little controlled or systematic research into the area, and much of what has been written would best be described as “armchair theorizing.” The literature concerning pre-adult gambling behavior falls into three general categories: (a) direct and indirect studies concerning adolescent gambling; (b) studies of the economic socialization of children, and (c) consideration of gambling as play and games as precursors to gambling. This paper presents an overview of the literature examining each of these three categories. Special emphasis is placed upon the playing of fruit machines, as it is this activity which is currently regarded as the biggest problem concerning young gamblers, particularly in the U.K. Recommendations for future research are discussed, particularly for work using a functional/behavioral analysis model to determine the variables which influence how adolescents “learn” to gamble.