Written by Marchelle Abrahams
Karie Fugett will never forget that morning in November 2008 when she found her husband lying next to her. Suffocating on his own vomit, he turned purple.
Frantically, she performed CPR. When the paramedics arrived, they injected him with naloxone into the heart. Cleve Fugett survived that day. Four years later, he wasn’t as lucky.
The veteran developed a dependence on prescription opioids after sustaining injuries during his deployment in Iraq. He later died from a fentanyl overdose while at an inpatient facility for veterans with PTSD.
Karie says Cleve died afraid of losing his military status. For thousands of military personnel, the shame of addiction weighs heavily on them. And so, Karie wrote a book, Alive Day, detailing the hardships her husband endured.
Today, she remains actively involved in desperately finding a solution to the U.S. fentanyl crisis. Her 2025 opinion piece for The Guardian is grounded in facts and research, pleading with the government to do more for military families.
Trauma and Shame are Major Barriers to Seeking Help
Cleve Fugett should have received addiction counseling when he became dependent on prescription opioids.
Instead, his doctors switched him to something new. It went from Dilaudid to Percocet, then methadone, OxyContin, and eventually fentanyl. The main reason vets don’t enter treatment facilities is the fear of losing their rank.
“Until the military publicly ensures no veteran’s job, rank, or benefits will be taken away for substance abuse, service members and veterans will continue dying from overdoses.” – Karie Fugett via Vox.
Limited Access
Those who choose professional help may find themselves hitting a wall.
On paper, coverage exists. Programs are listed. Resources are available. In practice, families struggle to find a qualified counselor who understands their needs and takes their insurance.
In a treatment setting, this shows up as missed referrals, delayed admissions, and patients arriving after months of trying to get help.
As a counselor, you need to understand where the breakdown happens when working with military-connected clients.
The Demand Is Higher Than Many Realize
Military personnel face increased risks when it comes to substance use and co-occurring mental health conditions.
Exposure to trauma. Repeated deployments. Chronic stress and reintegration challenges. They all play a role.
Research shows strong links between PTSD, depression, and substance use disorders (SUDs) in veteran populations, according to Psychology Today. Citing figures from the 2024 National Survey on Drug Use and Health, the publication claims that 7.5% of veterans reported heavy alcohol use compared to 6.5% of non-vets.
There’s also the issue of identity. Substance use is tied to ongoing struggles around purpose, belonging, and transition back to civilian life. The National Council for Mental Wellbeing says that without a clear mission and support network they once relied on, many experience uncertainty and isolation.
These are not simple cases. They require specialized, often long-term care.
Coverage Doesn’t Equal Care
From the outside, it looks like military families have options. In reality, finding programs that take TRICARE in-network has its limitations.
TRICARE in-network treatment programs cover a wide range of services, including outpatient counseling, inpatient care, and substance use treatment.
Coverage is only one piece of the puzzle.
A shrinking pool of providers, longer wait times, and limited access to specialized addiction care are some of the problems encountered. TricareRehabs.com suggests families consult a private placement service that provides information on addiction treatment programs that accept TRICARE.
Why Providers Opt Out
For counselors, the decision to accept or reject insurance is rarely personal. It’s practical.
Low Reimbursement Rates
One of the biggest concerns is compensation.
Therapists report that reimbursement rates can be substantially lower than other insurance plans, sometimes below Medicaid levels. Over time, that becomes unsustainable.
Administrative Burden
The paperwork is another major issue.
Providers describe increased documentation requirements, ongoing compliance checks, and time-consuming claims processes. In some cases, clinicians are required to submit detailed notes after every session.
That time comes out of clinical work.
A Reddit discussion among therapists highlights the administrative demands. They can outweigh the benefits of participation, pushing providers toward private pay or out-of-network models.
Payment Delays and Uncertainty
Even when services are provided, payment is not always predictable.
Delayed reimbursements and claim denials create cash flow issues, particularly for smaller practices. For counselors, that uncertainty is enough to step away from insurance panels altogether.
Clinical Complexity Requires Specialized Care
Not every provider is equipped to work with military populations.
Emerging Treatments
We’re seeing newer approaches to trauma and addiction treatment, including psychedelic-assisted therapy.
Some veterans are seeking these treatments for PTSD and related conditions outside traditional systems.
Gaps in Continuity of Care
The challenges don’t stop when a patient enters treatment.
Continuity of care is fragmented. Transitions between detox, inpatient, outpatient, and community support are not always smooth.
The National Institutes of Health’s research on substance use treatment systems shows the need for coordinated care across levels of treatment. Unless addressed, these gaps can lead to relapse or disengagement.
Moving Toward Better Access
Understanding the “why” helps counselors set realistic expectations, advocate more effectively, and design treatment plans that account for system-level barriers.
There is no single fix. Yet a few steps can make a difference:
- Building referral networks that include TRICARE-approved rehab centers
- Strengthening case management and care coordination
- Expanding trauma-informed and culturally competent care
- Supporting policy efforts that address reimbursement and access
Awareness is a starting point. When counselors understand the barriers their patients face before they walk through the door, they are better positioned to respond.
FAQs
1. Why don’t more counselors and rehab centers accept TRICARE?
Low reimbursement rates, administrative burden, and payment delays make participation difficult for many providers.
2. Are military clients more complex clinically?
Many present with co-occurring conditions such as PTSD and substance use, which require specialized, integrated care.
3. Does stigma still affect military families seeking treatment?
Yes. Concerns about confidentiality, career impact, and judgment can delay help-seeking.
4. What can rehab counselors do to improve access?
Strengthening referral networks, improving care coordination, and using trauma-informed approaches can help.
Key Facts
| Fact | Source |
| 7.5% of veterans reported heavy alcohol use compared to 6.5% of non-vets | 2024 National Survey on Drug Use and Health |
| Coordinated care improves outcomes in substance use treatment systems | PMC (2023) |
| TRICARE covers a wide range of mental health services, but provider participation varies | TRICARE Newsroom |
| Veterans experience higher rates of co-occurring PTSD and substance use disorders | Psychology Today (2024) |
Recognizing the Obstacles
Military families are not struggling to find addiction counselors because they lack coverage. They are struggling because coverage does not guarantee access.
Between provider shortages, administrative barriers, clinical complexity, and stigma, the path to care becomes harder than it should be.
As a counselor in a treatment setting, recognizing these obstacles is helpful and necessary. It shapes how patients enter treatment, engage, and recover.
Author bio
Writer by day, dream catcher by night. Marchelle Abrahams cut her teeth during the infancy of the internet when the dial-up sound of the modem was more than a soundbite at a rave. Not a Millennial and not a Boomer, Marchelle is an in-betweener, making her a special breed of human. As a qualified journalist, Marchelle believes her superpower is stringing a few words together and people reading them. That, and the ability to take her kids on with her unique brand of gnarly comebacks.
Please also review AIHCP’s Substance Abuse Certification program and our CE courses as well, to see if they meet your academic and professional goals. These programs are online and independent study and open to qualified professionals seeking a four year certification