Facilitators and barriers to lethal means counseling in veterans with substance use disorder: A qualitative analysis of veteran and clinician perspectives.

Authors

Lauren R DiPaolo, Gillian Geffen, Joseph Simonetti, Deirdra Kelly, Gabriela Khazanov

Published in

Journal of substance use and addiction treatment. Pages 210145. Oct 30, 2026. Epub Oct 30, 2026.

Abstract

U.S. Veterans with substance use disorders are at disproportionately high risk for suicide. Lethal Means Counseling is a collaborative approach where clinicians and Veterans discuss strategies to reduce access to lethal means. While evidence is strong for lethal means counseling reducing suicide risk broadly, the unique needs and experiences of this population are not well understood. This qualitative study sought to elicit perspectives from U.S. Veterans and Veterans Health Administration clinicians about barriers and facilitators to the delivery of and participation in Lethal Means Counseling for Veterans with substance use disorders.
In this pragmatic and postpositivist study, semi-structured qualitative interviews were conducted with 15 U.S. Veterans with substance use disorders identified through electronic health record review and recent completion of lethal means counseling and with 10 Veterans Health Administration clinicians who administered lethal means counseling. Interviews explored experiences with lethal means counseling and substance use in relation to suicide risk. Inductive and iterative thematic analyses were used to code transcripts of interviews for barriers and facilitators at the Individual, Inner Setting, Outer Setting, and Innovation levels of the Consolidated Framework for Implementation Research.
Six themes were identified for barriers, including substance use as a coping strategy, lack of assessment and access to care, nondisclosure and autonomy, ease of access, military culture, and substances increase risk. Three themes were identified for facilitators, including recognition of use as problematic, sharing resources, and providing a rationale for lethal means counseling.
Veterans with substance use disorders experience unique challenges that interfere with efforts to reduce suicide risk. The findings of this study highlight current gaps and opportunities for improving conversations during Lethal Means Counseling and may help enhance implementation among those with Substance Use Disorders. Substance use magnifies suicide risk and it will be important for future research to develop strategies to help mitigate this risk.

PMID:
42962763
Bibliographic data and abstract were imported from PubMed on 31 Oct 2026.

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