They volunteered their time and service to our country. They sacrificed their comfort and peace of mind. “They” are the veterans of the United States military. Many men and women retire from the military with memories they wish they didn’t have. For many of them, these plaguing thoughts have the power to wreak havoc on their lives and those of their loved ones. In many cases, veterans turn to drugs and alcohol as a result of various mental disorders associated with these thoughts, especially PTSD. Luckily, there are resources available to help.
Are you a veteran struggling with a substance misuse or co-occurring disorder (PTSD, depression, anxiety, etc.)? Are you a friend or other loved one of a veteran, and you want to learn more about substance use and PTSD among veterans or the ways you can help them? If so, you’ll find the answers to your questions on this page, including information on rehab centers and VA options.
Why Is Veteran Substance Abuse So Common?
Drug and alcohol abuse is a concern for the entire country, especially among the veteran population. While active duty drug use is low as a result of stringent bans on controlled substances, veteran drug use is, unfortunately, more prevalent. Alcohol and opioids in particular impact veterans at a staggering rate. The U.S. Department of Veteran Affairs estimates that 1 in 10 returning Iraq and Afghanistan war soldiers face problems with alcohol or other drugs. In order to treat and prevent future problems, it’s important to understand the reasons why so many former military men and women struggle with substance abuse.
There are many reasons that veterans may suffer with substance abuse, including difficulty transitioning back into civilian life, emotional and mental health struggles, and chronic pain. While drugs and alcohol are detrimental to so many, there are several veteran substance abuse programs available to help former service members, including VA addiction treatment and private substance abuse centers. With proper treatment and continued efforts to prevent further substance issues, veterans can overcome the destructive nature of substance use disorders.
Veteran Substance Abuse While Transitioning to Civilian Life
Any type of transition or change in life can be challenging. But for veterans, returning to civilian life after active duty can be especially difficult. The military provides a highly structured environment, which can be difficult to reconcile with more traditional jobs where titles, roles and duties are not as clearly defined. These challenges can be heightened for those who have been in high-risk, life-threatening situations.
The U.S. Department of Veteran Affairs highlights several difficulties that veterans face while transitioning into civilian life, including finding gainful employment, housing and other necessities. Other challenges include:
Finding community and camaraderie outside of the military
Returning to or finding a civilian job (some may need additional training and education)
Adjusting to new, overwhelming choices and decisions in everyday life
Navigating services and benefits previously provided by the military, including medical and dental care
Finding housing, especially for families
One of the most overlooked challenges a former service member faces when transitioning into civilian life is the overwhelming amount of daily choices. For many, everything from clothing and scheduling to housing and food can be inundating. The sudden influx of decisions and stressors, coupled with the potential for unemployment and loss of identity, can lead some to use substances to cope.
The most commonly abused substance by veterans (and active duty service members) is alcohol. In a survey of 1,120 recently deployed soldiers, 25 percent had misused alcohol, while a separate survey indicated that 53 percent admitted to binge drinking. These unhealthy relationships with alcohol are often the result of not knowing how to manage and cope with the difficult experiences faced during duty. This is only exacerbated when a veteran transitions back into civilian life and is faced with daunting choices and uncertainty, all while still managing the emotional and psychological effects of their previous post.
The most important step in treating veteran alcohol misuse and addiction is prevention. Ensuring that service members have the resources they need to securely transition into civilian life is key. It’s also important for many to seek extended counseling for the mental and emotional hardships that can come from service. But for those who are already struggling with alcohol or other substances, there are many resources available, including VA alcohol rehab and private treatment centers like The Recovery Village, a nation-wide network of rehabilitation facilities. The Recovery Village has several locations throughout the United States and is dedicated to helping patients of all backgrounds overcome substance use disorder and any co-occurring mental health disorders, which is especially important for veterans.
According to a 2013 SAMHSA report, 65.4 percent of veterans in substance abuse treatment suffered from alcohol addiction, compared to 37.4 percent of non-veterans in treatment.
Veteran Drug Abuse and Chronic Pain
Chronic pain is an issue that many Americans struggle with. In fact, about 30 percent of Americans suffer from some form of long-term pain. Veterans, on the other hand, deal with frequent and constant pain at an even higher rate — 60 percent of those previously deployed in the Middle East and 50 percent of older veterans experience chronic pain.
With traumatic injuries and extreme circumstances, it’s no wonder that veterans experience pain at a higher rate than the general population. But treating this pain has become a problem in recent years. For many, pain management and treatment involves opioids, powerful painkillers only available with a prescription. When taken as directed, these medications can be effective in treating a variety of ailments, including back pain, surgery recovery and other injuries. However, opioids have the potential to contribute to veteran drug abuse, as these powerful pills are potentially addictive.
Until recently, there was an extreme spike in opioid prescriptions, which in turn led to an increase in painkiller addictions among veterans. A 2013 study by the Center for Investigative Reporting found a 270 percent uptick in veteran opioid prescriptions over a 12-year span. This rise resulted in double the amount of addiction and overdose deaths among the veteran population as compared to the national average.
And while the VA and other organizations are beginning to recognize the issue, substance use disorder is still a problem for many veterans who originally sought treatment for chronic pain and ended up with an opioid addiction. VA data notes that between 2010 and 2015, there was a 55 percent rise in veteran opioid-use disorders. Roughly 68,000 veterans, about 13 percent of those using opioids, struggle with addiction.
While opioids and other medications can be effective for many, there are other ways to safely control and reduce long-term pain, especially for veterans. Some VA centers are even incorporating alternative methods like yoga, acupuncture, mindfulness and physical therapy. Because veterans and substance abuse can easily go hand and hand, these alternative programs are slowly beginning to spread to help mitigate the addictive potential of opioid painkillers.
But for those who struggle with opioid addiction, the reality of the situation can be a grave challenge. According to a 2011 study, veterans are twice as likely to accidentally overdose on opioids than other Americans. And although substance abuse can be a struggle for many former service members, it doesn’t have to be the end of their story. There are several VA drug rehab programs throughout the country, along with other centers dedicated to helping veterans. The Recovery Village has a network of treatment centers across the United States and offers a full range of wellness services to help veterans cope with substance use disorder. With the right help, veterans can overcome addiction, manage pain and heal for a brighter tomorrow in the nation they served.
PTSD and Substance Use in Veterans
It’s difficult to comprehend the complex combination of pride, anger, duty, anguish and anxiety many veterans feel after their time in the service. Adjusting back to civilian life in the United States is a tremendously difficult process. And while some veterans sustain only minor physical and psychological wounds from combat, others aren’t as lucky. Thousands are diagnosed with post-traumatic stress disorder (PTSD), a debilitating mental health condition caused by the traumatic events experienced in wartime. Often, struggling veterans will turn to drugs or alcohol to self-medicate, inadvertently worsening their PTSD symptoms.
PTSD and substance use are two of the most serious, pressing issues impacting our country’s bravest men and women. If left unaddressed, PTSD and substance abuse in veterans can be deadly. It’s time to break the stigma surrounding these conditions. Reaching out to others for help isn’t a sign of weakness — it’s proof of strength. With the right therapeutic care, veterans can get to the roots of their addiction, work through their PTSD and go on to lead the peaceful, fulfilling lives they deserve.
What Is Post-Traumatic Stress Disorder (PTSD)?
Post-traumatic stress disorder (PTSD) is a mental health condition caused by trauma. Any horrific, shocking or disturbing event can be a trauma, such as a serious accident, rape, natural disaster, terrorist attack or combat situation. Events where a person believes that their life or the lives of others are in danger are particularly traumatic and most often lead to PTSD.
For people living with this condition, daily life is a constant struggle punctuated by unwanted thoughts about the traumatic event, severe anxiety and intense paranoia. Triggers and danger lurk behind every corner, and the outside world becomes a frightening and unwelcoming place. Many isolate themselves to cope, shutting out close friends and family members and avoiding activities they once loved.
Signs and symptoms of PTSD include:
Reliving the traumatic event
Avoiding people, places or situations that serve as a reminder of the traumatic event
Intense feelings of anxiety and helplessness
Sudden bouts of anger, adrenaline or hypervigilance
Difficulty sleeping, concentrating or controlling emotions
Partaking in impulsive or self-destructive behaviors
PTSD does not discriminate by age, sex, race or religion; it can impact anyone, with approximately 8 percent of the U.S. population developing the condition at some point in their lives. However, people in jobs where traumatic events happen regularly — including firefighters, policemen and soldiers — are more likely to develop PTSD. Recent PTSD research reveals a dose-response curve that explains this trend: The more traumatic experiences a person is exposed to, the more likely they are to experience post-traumatic stress disorder.
How Common Is PTSD Among Veterans?
While nearly anyone can suffer from PTSD, veterans are more likely to develop the condition than the general population. Military life exposes soldiers to frequent deadly — and thus potentially traumatic — situations, leaving them at an increased risk of physical injury and the invisible wounds of PTSD. Military sexual assault also contributes to high veteran PTSD rates, particularly in female members. The U.S. Department of Veterans Affairs reported that 23 out of every 100 women who use VA care experienced a sexual assault while in the military.
The number of veterans affected by PTSD varies by service era. According to the U.S. Department of Veterans Affairs:
An estimated 30 percent of Vietnam veterans experienced PTSD in their lifetime.
An estimated 12 percent of Gulf War (Desert Storm) veterans experienced PTSD in their lifetime.
An estimated 11–20 percent of Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF) veterans experienced PTSD in their lifetime.
These numbers may seem staggering, but they’re likely lower than they should be. Until recent years, many treated PTSD as a failure of character or a manifestation of inner weakness rather than one of the countless tragic, human consequences of war. Because some guilt and shame surrounding the condition still exists, many instances of PTSD and other mental health conditions go unreported. Perhaps this is why a new study conducted by the Department of Veterans Affairs revealed that roughly 20 veterans commit suicide every day in the United States. About 70 percent of these individuals were not regular users of VA services, which include mental health care and counseling that are known to improve PTSD symptoms.
Are Veterans With PTSD More Likely to Have Substance Use Disorders?
The around-the-clock anxiety and flashbacks characteristic of PTSD can be emotionally and physically debilitating. Unsurprisingly, many struggling with the condition turn to drugs and alcohol as a way to numb their pain. According to the 1995 National Comorbidity Survey, 52 percent of men and 28 percent of women with PTSD met the lifetime criteria for alcohol misuse or dependence, and 35 percent of men and 27 percent of women met the lifetime criteria for drug misuse or dependence.
Unfortunately, veterans with PTSD are no exception to this trend. In response to the relentless symptoms of PTSD, many consume alcohol and prescription drugs to cope. For veterans injured physically during combat, the risk of substance abuse is even higher. What starts off as a pain pill prescription for an injury can quickly escalate to full-blown dependence and addiction, particularly when PTSD is present.
Studies show that there is a strong relationship between PTSD and substance use disorders in veterans. The following are some veterans and substance abuse statistics, according to the U.S. Department of Veterans Affairs:
1 in 10 soldiers returning from the wars in Iraq and Afghanistan misuse drugs or alcohol
Nearly 1 in 3 veterans seeking treatment for a substance use disorder also have PTSD
The number of veterans who smoke is nearly double for those with PTSD (6 in 10) than those without it (3 in 10)
While drugs and alcohol dull the pain of PTSD in the short-term, they cause the condition to worsen significantly over time. Co-occurring PTSD and substance use disorders begin to chip away at a person’s relationships with their spouse, children, friends and coworkers. And while substance use seems to “help” those suffering from the condition escape their feelings in the short-term, it actually exacerbates and lengthens the intensity of PTSD-related flashbacks, anxiety and trauma in the long term.
If left unaddressed, PTSD and substance use disorders wreak havoc on the affected individual’s mental and physical health, causing:
Increased stress levels
Isolation from family and friends
Working Through PTSD and Substance Abuse in Veterans
If you’re currently struggling with PTSD and substance use disorders, choosing not to seek professional treatment is one of the worst things you can do. If left untreated, PTSD only gets worse. But with the aid of dedicated mental health professionals and counselors, you can overcome your condition and go on to lead a happy, healthy life.
Which Substances Do Veterans Commonly Misuse?
The life of a veteran is a colorful one peppered with moments of honor, pride and joy, but it can also include suffering, heartache and unwanted memories. These distressing experiences leave many veterans in doctor’s offices for various prescription medications to numb the pain. For some, the pain is emotional. With others, it’s physical. And for many, it’s both. Some veterans turn to alcohol to self-medicate instead of — or in addition to — drugs.
Different drugs serve different purposes and have varying effects on the body. For example, Vicodin (a painkiller) may be prescribed for physical discomfort from an injury, while Lunesta (a sedative) might be prescribed to help a veteran with sleeping problems. These prescription drugs both have the potential to be abused and can lead to addiction (just as with many other substances) so it’s important to take them only as prescribed. Unfortunately, though, some veterans don’t take their prescription medications as recommended. For many of these men and women, the ultimate goal is to treat their behavioral disorders, pain and other related conditions as quickly as possible.
The topic of veterans and substance abuse is an important one, and it should never be overlooked or downplayed, since there are many associated risks. The following are some of most common prescription and non-prescription drugs associated with substance abuse among veterans:
Alcohol Misuse Among Veterans
Alcohol is a drug that can be categorized as a depressant and a stimulant — depending on the amount ingested — with the ability to affect brain chemistry. In small amounts, it acts as a stimulant, resulting in an alteration of excitatory neurotransmitters. Feelings of euphoria typically ensue, which cause people to want to drink more. Moderate amounts may also provide certain health benefits, such as how red wine potentially decreases the risks of heart disease and diabetes. However, it’s important for veterans and others who drink to keep in mind that these benefits are not guaranteed for everyone.
In larger amounts, alcohol acts as a depressant, which means it depresses the central nervous system and alters inhibitory neurotransmitters (chemical messengers). Brain electrical activity decreases as a result, leading to slurred speech, sluggish movements, and poor balance, among other symptoms. It can also lead to drowsiness, respiratory depression or worse, if large amounts are consumed in a short amount of time. This is known as binge drinking (consuming four to five drinks on one occasion), which tends to be more common with military personnel with high combat exposure than those without it.
Alcohol is the substance of choice for many veterans as a means of coping with PTSD and other behavioral disorders to drown out the scarring recollections of war. PTSD and substance abuse — specifically alcohol abuse — often go hand in hand for veterans. The following are some veterans and substance use statistics, according to the U.S. Department of Veterans Affairs:
Sixty-eight percent of Vietnam veterans seeking PTSD treatment have alcohol use problems.
War veterans with PTSD and alcohol problems tend to be binge drinkers.
Veterans over the age of 65 with PTSD are at higher risk for a suicide attempt if they also have drinking problems or depression.
Alcohol misuse among veterans is a serious matter, one that can affect more than just the veterans. Family members, friends and other loved ones can all be impacted. This is why it’s so important to seek help if you’re a veteran struggling with alcoholism.
Opioid (Painkiller) Misuse Among Veterans
There are hundreds of thousands of disabled veterans in the country, according to the U.S. Department of Veterans Affairs. Injury is a common result of combat for military service members and can include anything from lost limbs to back pain to chronic headaches. With the many war-related ailments that exist among veterans, there are various types of opioids that are prescribed to treat them. Opioids are synthetic (man-made) substances derived from opiates which are used as painkillers. Unfortunately, the misuse of these drugs has become an increasing problem in the U.S. since the late ‘90s, with the number of opioid-related deaths steadily climbing.
Some of the most popular opioid brands include Lortab, Vicodin and Oxycontin — all of which are successful in treating varying levels of pain. However, these medications can all become very addictive for veterans and anyone else to whom they’re prescribed. Dr. Gavin West, who heads the Opioid Safety Initiative at the Department of Veterans Affairs, stated in a recent NPR article that prescriptions for narcotics to treat pain are worse for combat veterans than other veterans or civilians. They “have more pain to deal with than most,” he said.
In many cases, opioid misuse begins while troops are still in the field. Veteran Mike McDonel witnessed this firsthand, which he shared on NPR in July 2014. “The troops, if they got hurt, they’d just shove you a bag of pills,” he said. “You never got a bottle and knew what was in it; you always got a baggie.” He also claimed that there were numerous medications prescribed for virtually any type of pain, and additional drugs for the side effects. This led many military personnel to become dependent.
Anti-Anxiety Medication and Sedative Misuse Among Veterans
Two other prevalent ailments of veterans are anxiety (and related disorders) and insomnia. This is why benzodiazepines and sedatives are commonly prescribed. Benzodiazepines (also called “benzos”) are a group of psychoactive drugs that affect GABA receptors, which inhibit or reduce brain activity. Some popular benzodiazepine brands include Ativan, Valium and Xanax. These drugs are often prescribed for anxiety, seizures and panic disorder, among other disorders.
For veterans struggling with insomnia, a sedative like Ambien or Lunesta is often prescribed. These sedatives are also called hypnotics, and they affect brain chemicals that may be unbalanced in people with sleeping problems. As a result of this effect, they induce a state of relaxation by reducing excitement or irritability. Benzos can also be used as hypnotics to induce sleep when used in higher amounts than what’s prescribed for anxiety.
Contrary to popular belief, one of the conditions that benzos and sedatives should not be used for is PTSD. The reason is that there is currently insufficient data on their effectiveness. There is also growing evidence for the potential health risks of using these drugs for PTSD. But despite the VA’s guidelines against it, these medications are still prescribed to veterans for this disorder. Almost a third of veterans being treated for PTSD are prescribed benzos, according to Dr. Nancy Bernandy, a clinical psychologist with the VA’s National Center for PTSD. She also stated that “mounting evidence suggests that the long-term harms imposed by benzodiazepine use outweigh short-term symptomatic benefits in patients with PTSD.”
Substance Abuse Among Veterans: Learn How You Can Help
As the loved one of a serviceman or woman, you can provide a wellspring of emotional support. There’s more than one way to help someone who’s served our country, and these are just a few:
Provide a listening ear. Struggling with a mental health disorder or addiction can make a veteran feel lonely, angry, isolated, useless and hopeless. In a society that still largely views mental health issues through the lens of stigma, it can seem impossible to speak up about struggles with depression, anxiety or PTSD. That’s why it’s so important for veterans to have a support network of friends and family who are willing to listen and be there for them whenever they need a shoulder to lean on. Even though many veterans find it difficult to open up about the trauma they experienced during deployment, knowing they have emotional support from others can make a big difference.
Learn about veteran substance abuse and PTSD — from those who have been there. While you may never know exactly what your loved one is going through, you can learn about PTSD and substance abuse in veterans from a variety of trusted resources. AboutFace is one such website devoted to providing family members of veterans with answers and advice on a variety of topics that are difficult to face. Video testimonials from veterans and their family members discuss issues like, living with someone with PTSD, how treatment changed things, and the how PTSD affects a family.
Encourage treatment. For too many veterans, PTSD and substance abuse go hand in hand. And the hardest part of being the friend or family member of a veteran with an addiction or mental health issue is watching them suffer. Left untreated, mental health and substance use disorders can ruin a veteran’s life, and oftentimes self-medicating and home-detoxing can do more harm than good. It may be up to you as a loved one to guide your veteran to the treatment they need before it’s too late. The good news is that veteran substance abuse programs exist, and they are more widespread than you might think. To discuss types of treatment, your loved one’s addiction, and how to get him or her into rehab, call The Recovery Village. It’s free and confidential, and there’s no obligation to commit to our programs to learn how to get your veteran the care they need.
Veterans and Substance Abuse: How Can a Rehabilitation Center Help?
The heroic men and women who serve our country are celebrated and praised for their selflessness and bravery. But sadly, for some there’s no amount of praise that can erase the emotional ravages of war that are deep-seated in their memories. War veterans experience things no one should have to experience. These painful recollections are what leave so many with mental disorders, including post-traumatic stress disorder (PTSD), insomnia, anxiety and depression, among other conditions.
To manage war-related mental disorders, some veterans turn to alcohol or drugs — or both — as a coping mechanism. According to the National Institute on Drug Abuse, heavy alcohol use and prescription drug abuse are more prevalent with U.S. military personnel than civilians. PTSD is one of the most common disorders associated with substance use disorders (SUD) among veterans. The following are some veterans and substance abuse statistics from the U.S. Department of Veterans Affairs:
More than 20 percent of veterans with PTSD also have a substance use disorder.
War veterans with PTSD and alcohol problems tend to be binge drinkers.
Almost 33 percent of veterans seeking treatment for SUD also have PTSD.
In the wars in Iraq and Afghanistan, about 1 in 10 returning soldiers seen in the VA have a problem with alcohol or other drugs.
There was a 52.7 percent increase in the number of the outpatient veterans who were treated for substance use disorders from 1995 to 2013.
Substance use disorders can result in various physical side effects, and they can affect the family and friends of veterans as well. The good news is there are many programs and rehabilitation centers in the country that can help veterans with these disorders.
Drug Rehab Centers for Veterans
The Recovery Village is one of the many rehabilitation centers in the country that helps veterans with substance use disorders. With centers in Florida, Colorado, Ohio and Washington, The Recovery Village offers comprehensive treatment for dual diagnosis-based drug and alcohol cases, among other conditions. Top-of-the-line medical care, wellness programs, and holistic therapy designed to treat the whole self are just a few of the many treatments you can expect at our centers. Each facility is also staffed with experienced specialists who all share the same goal of helping patients on the road to recovery.
Some of the programs and treatment therapies offered at The Recovery Village and various other drug rehab centers include:
Medical Detoxification: This is the first phase of rehabilitation, and it’s necessary before any other phase can begin. It involves clearing the body of a particular substance under medical supervision, with 24-hour inpatient care. Because the detox phase involves withdrawal symptoms, it’s very important that it be done only under the care of medical professionals.
Residential and Partial Hospitalization Treatments: These programs usually occur after detoxification. Residential treatment involves treating patients with round-the-clock care (residential) and counseling. Partial hospitalization involves on-site housing, in addition to 24-hour access to staff every day.
Outpatient Programs: Outpatient services emphasize developing skills to prevent relapse and improve mental health with therapy at the rehab center, and support from friends and family at home. Some programs also include rehabilitation off-site, and individual and group therapy sessions on-site.
Treatment for Co-Occurring Disorders: A co-occurring disorder is a condition in which a person has both a substance use disorder and a mental health disorder at the same time. For a veteran, this may include alcohol and depression, opioids and PTSD, or a similar combination. Many rehab centers, including The Recovery Village, offer a specialized, comprehensive treatment approach to address both disorders.
Medication-Assisted Treatment (MAT): MAT increases the chances of recovery when used in conjunction with evidence-based behavioral therapy. There are many FDA-approved medications designed to treat various substance addictions that reduce the chances of an overdose and alleviate withdrawal symptoms. For an opioid addiction, methadone, buprenorphine, Naltrexone or naloxone may be used. Naltrexone can also be used for alcoholism, along with disulfiram and acamprosate.
Aftercare Options: Aftercare programs are essential in helping patients remain sober and remain in recovery for a lifetime. They involve a variety of beneficial resources, including counseling, therapy and sober living housing.
Additional Resources for Veterans with Substance Use Disorders
There are various VA rehab options available through the Department of Veterans Affairs (VA) Alcohol and Drug Dependence Rehabilitation Program to help veterans struggling with substance use disorders. Comparable to standard rehabilitation centers, many of these programs offer various forms of treatment, including VA alcohol treatment, detoxification, rehabilitation and psychiatric care. If you’re a veteran interested in any of these treatments, you must be enrolled in the VA health care system.
The following are some of the services that veterans can expect from various VA drug rehab centers and VA substance abuse programs throughout the country:
First-time screening for alcohol or tobacco use in all care locations
Short outpatient counseling, including focus on motivation
Intensive outpatient treatment
Residential (live-in) care
Medically managed detoxification (stopping substance use safely) and services
Continuing care and relapse prevention
Marriage and family counseling
Drug substitution therapies and newer medicines to reduce cravings
Evening and weekend programs
Programs for patients with special concerns, such as women, veterans of Operation Iraqi Freedom and Operation Enduring Freedom, and homeless patients
In addition to treatment programs that use medication, the VA offers treatments that do not involve any drugs. These include:
Explaining the correlation between PTSD and substance use problems
Strengthening the veteran’s motivation for change
Helping veterans better identify and deal with triggers and relapse risks
Counseling couples together on how to recover from substance misuse
Recommending outside support for recovery, including groups like Alcoholics Anonymous (AA)
Find Your VA Medical Center:
Locating your closest VA hospital or medical center is simple with this list of healthcare providers in major cities from the U.S. Department of Veterans Affairs.
Locate VA Substance Abuse Programs:
This interactive U.S. map allows you to find VA substance abuse treatment by program type (opioid treatment, inpatient or outpatient care) and state. The same style of map exists to find VA PTSD programs in your state.
The U.S. Department of Veterans Affairs offers a
specifically for female veterans. This resource allows you to discuss issues unique to women and is completely confidential. 1.855.VA.WOMEN