Veterans: PTSD and Substance Abuse Addiction

The Link between PTSD and Substance Abuse Addiction in Veterans

Research studies that analyze substance abuse among army veterans have found that military deployment, combat exposure, and post-deployment reintegration challenges put army veterans at an increased risk of developing substance use disorders.¹

As a result of a specific lifestyle and experiences, which are different from those of the general population, there are some causes and patterns of substance abuse characteristic for army veterans. There is evidence of a strong correlation between post-traumatic stress disorder (PTSD) and substance abuse, which often occurs in this population.² In addition, there is a tendency towards certain types of substances among the army: they mostly resort to alcohol, smoking, prescription painkillers, and sedatives.³

These are the reasons why there is a need for a specifically designed setting for veteran’s substance abuse treatment and treatment for first responders suffering from PTSD.

What Is the Relation Between PTSD and Substance Abuse?

PTSD is defined as a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event.⁴

People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. Some common symptoms of PTSD include:⁵

• Nightmares and insomnia.
• Flashbacks of the traumatic event.
• Intensive unpleasant feelings such as sadness, fear, anger, guilt, and shame.
• Detachment and estrangement from other people.
• A tendency to avoid situations that remind the person of the traumatic event.

Signs and Symptoms of PTSD In Veterans

Symptoms of PTSD typically start within three or so months after living through a traumatic event. In the case of veterans, PTSD symptoms may begin a few weeks or months after coming back from war or being involved in combat. Being injured in combat, witnessing the death of a friend or fellow soldier, or being in one of the many near-death situations associated with war and combat all increase the odds that a veteran will suffer from PTSD after the fact.

War and exposure to combat are not the only potential causes of PTSD, however. Military sexual trauma (MST), which includes both sexual assault and sexual harassment, can be a causal factor for PTSD, and this can occur at any time and not just at wartime.

Symptoms of PTSD may not start right away; they may appear several years after the actual traumatic event. When symptoms last a month or longer, and interfere with work production and interpersonal relationships, PTSD can be diagnosed. Mood swings, uncharacteristic aggression, irritability, restlessness, tension, and edginess, which often accompany PTSD, can disrupt families and lead to issues with spouses or partners.

How Can PTSD Lead to Substance Abuse in Veterans?

When a person experiences a life-threatening event, or is the victim of (or witness to) something extremely traumatic, the fight-or-flight response kicks in. This is the body’s natural defense mechanism that protects people in times of danger. The stress response causes heart rate to accelerate, blood pressure and body temperature to rise, and breathing to become shallow while focus is heightened, and energy and attention levels spike. This is a normal and healthy reaction.

Post-traumatic stress disorder, or PTSD, is a mental disorder that can cause people to re-experience a trauma, experience flashbacks, and feel fear when the danger or threat has already passed. Essentially, those with PTSD live with a high level of stress, and the fight-or-flight response is often triggered when no threat is actually present.

About seven or eight out of every 100 people will suffer from post-traumatic stress disorder (PTSD) in their lifetime, the National Center for PTSD reports. The National Institute on Mental Illness (NIMH) publishes that approximately 3.5 percent of the American adult population battles PTSD, and around one-third of the time the illness is considered to be severe, meaning that it interferes with daily functioning abilities.

PTSD in Army Veterans

PTSD does not occur only in army veterans, but this group is particularly vulnerable because they are exposed to combat, violence, and serious injuries. Studies show that PTSD and substance abuse in veterans are strongly correlated, which can also be seen from the official statistics of the US Department of Veterans Affairs:⁶

• More than 2 of 10 veterans with PTSD also have substance use disorder (SUD).
• Almost 1 out of every 3 veterans seeking treatment for SUD also has PTSD.
• The number of veterans who smoke nicotine is almost double for those with PTSD (about 6 of 10) versus those without a PTSD diagnosis (3 of 10).
• About 1 in 10 returning veterans from Iraq and Afghanistan abuse alcohol or other drugs.
• War veterans struggling with PTSD and alcohol abuse tend to binge drink.

What Percentage of Veterans Have PTSD?

PTSD is commonly associated with war veterans, as soldiers and members of the military are regularly exposed to traumatic and hazardous situations and events. War veterans have an increased risk for developing PTSD, and this population may suffer from the disorder at higher rates than the general public. Rates of PTSD in the military veteran population vary depending on service era, but they have been estimated to be 10-30 percent, the National Center for PTSD publishes.

Drugs are a common method of self-medicating PTSD symptoms, as they can provide temporary relief from difficult emotions and a respite from troubling thoughts. Drug abuse can only compound the potential side effects, severity, and duration of PTSD side effects, however, as they only serve as a temporary solution to the problem. In fact, drugs and alcohol can make PTSD worse, interfere with treatment protocols, and cause additional problems.

Individuals battling PTSD are at least 2-3 times more likely to also suffer from issues related to drug abuse and addiction. This is even likelier for veterans, especially those exposed to combat, the journal Clinical Psychology (New York) reports. Veterans who struggle with both drug abuse and PTSD can benefit from specialized treatment programs that cater specifically to this demographic.

How Do You Diagnose a Veteran With Substance Abuse?

According to the guidelines of the American Psychiatric Association, substance use disorders (SUD) are defined as the recurrent use of alcohol and/or drugs that causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.⁶

To be diagnosed with SUD, a person needs to experience two or more symptoms over the course of a 12-month period:⁷

• Impaired control: A person feels a strong need to use the substance; even when they wish to stop, they fail to cut down or avoid substance use.
• Social problems: As a consequence of substance use, the person cannot complete everyday tasks at work, school, or home.
• Risky use: Substance use puts the person at safety risks but the person continues to use them.
• Drug effects: There is tolerance to a substance, which means that a person needs larger amounts to get the same effect; when the person does not take the substance, they experience withdrawal symptoms.

How Veterans Can Get Help For PTSD?

The first step to getting help for PTSD is to recognize the signs of the illness.

What Are the Four Types of PTSD?

NIMH reports the following as classification for a PTSD diagnosis:

• Arousal and reactivity symptoms (at least two must be present):
  • Sleep problems
  • Explosions of anger
  • Feeling on edge
  • Startling easily
  • Self-destructive and/or risky behaviors
• Cognition and mood symptoms (at least two must be present):
  • Unrealistic feelings of shame and guilt
  • Memory difficulties surrounding traumatic events
  • Lack of interest in activities or things that were important or enjoyable before
  • Hopelessness
  • Negative vision of oneself and the world in general
  • Emotional numbness
  • Difficulties concentrating
  • Trouble feeling pleasure
• Avoidance symptoms (at least one must be present):
  • Aversion to thinking or talking about the event
  • Staying away from people, things, or places that might be a reminder of the trauma or event
• Re-experiencing symptoms (at least one must be present):
  • Nightmares
  • Flashbacks that induce a kind of “reliving” of the experience and can include the physical side effects of the stress response
  • Intrusive memories of the trauma at unwanted times
  • Significant emotional or physical response to a triggering person, place, or thing

PTSD can make people feel detached from themselves and the world around them, causing alienation from family and friends. Social isolation and difficulties connecting with people are common, especially in the veteran population when returning home from being deployed for a length of time. Appetite problems, sleep deprivation, depression, and suicidal thoughts and actions are additional side effects of PTSD as is drug and alcohol misuse.

SUD & Co-Occurring Disorders in Veterans

Veterans diagnosed with SUD commonly suffer from the following co-occurring disorders:⁸

1. Mental health disorders, such as PTSD, depression, anxiety, and adjustment disorder.
2. Medical conditions, such as obesity, sleep disturbance, physical injury, and chronic pain.

Veteran’s substance abuse treatment usually also addresses these disorders.

How to Get Help for Veterans with PTSD and Substance Abuse Addiction?

PTSD and drug abuse can be treated on an outpatient or residential basis. The level of care needed will differ from person to person. Typically, in the case of co-occurring disorders, residential treatment programs can provide the highest standard of comprehensive care to help individuals reach healthy emotional and physical balance, free from drugs. Inpatient programs can provide around-the-clock mental health support and medical care as well as offer a highly structured and stable environment that may be highly beneficial for a military veteran.

A set sleeping, eating, and waking schedule is predictable, and this can enhance healing and ease stress. Medications can be properly managed, and therapy and counseling sessions, as well as life skills, relapse prevention, and educational workshops, are built into the daily schedule. Veterans will learn healthier ways for managing stress and coping with potential triggers without the need for mind-altering illicit drugs.

Holistic methods, like chiropractic care, acupuncture, spa treatments, massage therapy, yoga, equine therapy, mindfulness meditation, art therapy, fitness programs, and more, can all enhance a treatment program as adjunctive measures used in tandem with traditional care methods. Support groups that are comprised of other veterans can be very helpful in providing encouragement and aiding in building a healthy peer network of people who understand and support each other. Specialized treatment programs that understand the individual  pressures of a military veteran and work to treat co-occurring drug abuse and PTSD in an integrated and simultaneous fashion can greatly enhance a long and sustained recovery.

Unsure where to start? Take Our Substance Abuse Self-Assessment

Take our free, 5-minute substance abuse self-assessment below if you think you or someone you love might be struggling with substance abuse. This evaluation consists of 11 yes or no questions that are designed to be used as an informational tool to assess the severity and probability of a substance use disorder. The test is free, confidential, and no personal information is needed to receive the result. Please be aware that this evaluation is not a substitute for advice from a medical doctor.