Policy changes in the mid-1990s sent veterans to outpatient facilities for treatment, mirroring trends in the overall U.S. health care system.

Substance use disorders are a major problem among the nation's veterans. The U.S. Department of Veterans Affairs(VA), which provides health care to more than three million veterans, is the nation's largest provider of substance abuse treatment. The VA trains large numbers of physicians and other mental health professionals; it plays an important role in defining standards of mental health care in the United States.

In the past decade several initiatives have transformed the VA. These policies were inspired by changing views about the role and size of government and by growing use of managed care. This paper considers the effect of these changes on specialized VA programs for substance abuse treatment.