Abstract: Background: Substance misuse problems have been found to be higher in the military, in particular in veterans than civilians. The efficacy of a case management approach for veterans was examined in the UK with Combat Stress running it as a pilot study. This pilot service was set up in 2014 and was called the Veterans’ Substance Misuse Service (VSMS), which used specialist veteran substance misuse nurses to case manage veterans into appropriate services. Clinical activity: As part of their treatment, veterans were referred to appropriate health services that met their needs. These services included either Combat Stress or another mental health service. 67.3% of the veterans referred to Combat Stress then went on to engage with the service. A greater number of service users engaged in other mental health services than were referred by the substance misuse nurse, suggesting that some may have self-referred. Description of treated population: Data were available for 743 veterans using the VSMS. It was found that 36.6% of service users were aged over 55 years, 96% were male and 98.3% were white. The majority of service users did not have any physical disabilities (69.5%) and did not have any caring responsibilities (84.9%). In regards to health difficulties, 28.6% had posttraumatic stress disorder and 57.5% had a diagnosis of another mental health problem. The majority of veterans had alcohol problems (81.6%), with only a minority using drugs (16.8% using illegal drugs and 2% prescription drugs). Treatment outcomes: Following treatment, service users improved in: managing their mental health, physical health and self-care, living skills, social networks, work, relationships, addictive behaviour, responsibilities, identity and self-esteem and, trust and hope. The greatest improvements were seen for addictive behaviours, managing mental health and identity and self-esteem. The most modest improvements were seen in responsibilities, work and social networks. Service user feedback: Overall, between 99-100% of service users reported being satisfied with the service they had received. Service users reported being particularly satisfied with seeing health improvements, staff input, the accessibility of the service and the fact it was tailored to their individual needs. Very few negative aspects of the service were reported with a few veterans reporting they could have done with the service in the past and were beginning to go backwards. Limitations: It must be acknowledged that there are several limitations concerning the data used in this report. The data were incomplete as some services were unable to share their data, therefore, it may not represent all services users.