Table 2.

SEM levels, themes, and supporting respondent quotes from homeless veterans living with SUDs and mental illness.

SEM Levelsa	Themes	Supporting Respondent Quotes
Individual	Substance Use and Addiction	“The euphoria … You get the first euphoria, then it wears off and you just doing it, just to do it. After a while, the money you get is not going to be legitimate … and if you do get it legitimately, like for me, it wouldn't last long …” [VET05]
Individual	Suicidal behaviors	“… some group of like the transient group I was with that was like helping me get by, I thought they were out to get me, you know, but like I was like feeling really paranoid because they found out I cheated on my girlfriend and was doing shitty things in the community … And, you know, they wanted to fight and they wanted to, like, stab me and shit. So, it's like, I wanted to just fucking end it before they did, you know?” [VET03]
		“… I still like … Kind of [have] thoughts of ‘what if he [friend] didn't do it?‘ … or what if I could have stopped it, or what would be a different outcome if I had talked to him, like, I had just listened. I still at times catch myself blaming myself because of what happened.” [VET07]
		“I had a razor …. I just wanted … I just wanted to die. You know, I ain't had nothing to live for, you know, and like I wasn't getting nowhere. You know, the thought came, the feeling came and everything else came along with it.” [VET14]
		“I was on the bridge at one time, and then I looked in the water, I said [to myself], ‘you know you can't swim.’ [Then], this guy I knew came, he was walking by, I was on the bridge or whatever, and he came by [and] he said … get off that bridge!” [VET04]
Individual	Drug use is like suicide	“No, no, I never considered committing suicide. Never been on the table. Only suicide I was committing was, like, each time I went out to go get some drug that does not have any type of ingredients on it … I feel as though that's slowly committing suicide.” [VET05]
		“Well, mainly the hard drugs I did when I was homeless was kind of suicidal because it's very dangerous, you know? I think it could have been somewhat suicidal, you know, because it's very dangerous to do a lot by yourself and you don't really notice what you're getting into.” [VET08]
Relationships	Physical and Emotional Traumatic Events	“It takes a toll on you physically and mentally. But I would say it was more so mental than physical because seeing, you know, seeing some of the stuff that I've seen, and hearing, like, people tell stories about the stuff that they witnessed or been through on deployment ….” [VET07]
		“… I was attacked by a Company Commander sergeant in the shower. You know, she tried to …. Rape me … And I fought her off and the words she used out her mouth …, ‘You'll never be nothing, you'll never get nowhere … [if] you tell anybody I'm in here … ’ [VET14]
		“… I deployed to Afghanistan … and, you know, I've dealt with a lot of anxiety and depression and ‘flashbacks’ and, you know, a bunch unwanted feelings and thoughts that I never had prior to my deployment.” [VET10]
Relationships	Substance Use to Cope with Death	“… I didn't have no help, I didn't have family, no friends, my mom had [died] … I lost my mom during that time, too. I wasn't able to go see her because I was in Texas transitioning from the military. So, I just really went to a real dark place and I didn't want to eat … I would just wake up, you know, I just [didn't] want to feel that. I didn't want to feel it … so, I ran to alcohol.” [VET10]
		“I went to [a treatment facility] because I had a downfall when …. Somebody - my sister, and I had to bury her … and aunts [died] … Everything was like … they were dying, like, back-to-back, months apart and stuff. I went to [a treatment facility] and I got back on [Suboxone].” [VET14]
		“… when I come out the door, and I'm looking, and I'm like, who are these guys with a gun at my son's head? … and when he handed them the 20 dollars, the guy said, ‘is that all?‘ … And he pulled the trigger. So, I actually sat there and witnessed it … But I was, like, stuck and I couldn't move to do anything.” “That picture I dealt with for about … I say nine years my life. I was trying to get this picture out … Then, all of a sudden, I just started self-medicating.” [VET13]
Community	Homelessness	“At the time, I didn't know where I was going to go as far as when I got out … we pretty much like bounced around from place to place, anywhere we could lay our head.” [VET07]
		“I joined the military around 17 and a half … And I was homeless immediately after my discharge, which was around when I was 21. Went to Towson University and I was homeless again when I was 23 …” [VET03]
		“… being homeless and me drinking pretty much ran hand in hand …” “ …. I did it to pretty much, like, get away from that [homeless] world …” [VET07]
Community	Social Influence of Substance Use in High-risk Communities	“Well, the main thing was that I can't be homeless alone. There's too much things to worry about and to do. So, I usually have to team up with somebody, and you just naturally meet people … and these people have drugs on them, you know, and Molly is the least of them.” [VET03]
		“… I ain't had no money, but if I met somebody who was buying, I was drinking.” “… one thing, you meet all the homeless people out there, and I don't know if you have ever seen people panhandle, but that's how we did what we did … by panhandling.” [VET04]
		“I tried it to see how the cocaine felt … I liked the experience that I enjoyed [during] that period of time … and [I] went from me indulging in it from every two weeks, then it went from every two weeks to every week, and then it went from every week to every weekend, then from every weekend to every day … It went from a fun thing to becoming misery down the road.” [VET05]
Community	Violence and Crime in Homelessness	“I was waiting outside [food pantry] and these guys … I don't know … these young guys … I didn't do anything to them … and they jumped me. One of them hit me with something. I was sitting outside in broad daylight, 1:00 [pm].” “They took $60 … and my cigarettes.” [VET02]
		“I didn't think small petty money, I was looking for a large lump sum of money to have it last longer … And so the (illegal) stuff I was doing provided a large sum of money at a faster pace and faster time.” [VET05]
Societal	Veterans' Perception of the Veterans Affairs Health System	“… doctors aren't supposed to give any one of those … Pain pills that long. I mean, for four years, how am I not supposed to be hooked on drugs?” [VET01]
		“My father is a veteran and I've seen how they treat him and they're just being gutted with their budget … and I think that, you know, it's a political thing. They just don't have the funds to keep it going …” [VET03]

^aSocial-Ecological Model (SEM) levels and themes were displayed in Fig. 1.