Substance Abuse & PTSD Treatment for 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.
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.
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.
SUD & Co-Occurring Disorders in Veterans
Veterans diagnosed with SUD commonly suffer from the following co-occurring disorders:8
- Mental health disorders, such as PTSD, depression, anxiety, and adjustment disorder.
- Medical conditions, such as obesity, sleep disturbance, physical injury, and chronic pain.
Veteran’s substance abuse treatment usually also addresses these disorders.
Frequently Asked Questions
- The choice of treatment depends on the type of substance abuse and co-occurring disorders. In general, programs should be tailored to each individual and comprehensive, consisting of some of the following components:8
- Preventive screening
- Outpatient counseling
- Intensive outpatient treatment
- Residential (live-in) treatment
- Medically managed detoxification
- Continuing care and relapse prevention
- Marriage and family counseling
- Self-help groups
- Pharmacotherapy – use of maintenance drugs that reduce craving
Since PTSD in many cases lies at the root of addiction, there are also specialized PTSD treatment programs for veterans.
More than 10% of veterans who seek care at the US Veteran’s Administration meet the criteria to be diagnosed with a substance use disorder.7However, despite the relatively high risk and actual substance abuse disorder rates, data indicates that few veterans seek treatment.In an anonymous military health survey, 19.9% reported they received some counseling from a professional (half of those saw a military mental health professional), while only 1.6% said they had sought help for a substance use problem.7There could be several reasons for this:
- Access to care, particularly mental health services, may be problematic for veterans residing in rural areas or who have physical disabilities, poor support networks, and inadequate health insurance. It may also be hindered by overwhelmed VA care providers.
- Another vulnerable category are homeless veterans, who are estimated to be a large portion (around 11%) of homeless adults in the U.S.1
- Historically, women veterans were less likely to receive addiction treatment compared to men. This has improved by introducing more gender-specific services in the military, which has encouraged more women to seek treatment.7
- A strong barrier may come from some aspects of the military culture. As other people with substance issues, veterans often fear the stigma associated with substance abuse. Seeking help may signal perceived weakness, thus negatively influencing their self-image and possibly connection to others.10
Some survey data shows that as many as half of military personnel have reported that they believe getting help for mental health problems would have a negative effect on their military career.1
- In addition to the possibility of sustaining serious physical injuries, deployed service members also experience traumatic events that may have a lasting and significant impact on their psychological well being. Substance abuse and PTSD treatment programs for veteransshould dedicate a lot of attention to these “invisible wounds” that a person may have as a result of traumatic military experiences.3 It is important to heal those injuries in order to avoid relapse.Some individuals need more support to reintegrate back into their environment after military deployment.9 Effective counseling in this area can prevent addiction and/or relapse.
1. National Institute on Drug Abuse. (2019).Substance Use and Military Drug Facts.
2. US Department of Veteran Affairs.Substance Abuse in Veterans – PTSD: National Center for PTSD.
3. Larson, M. J., Wooten, N. R., Adams, R. S., & Merrick, E. L. (2012). Military Combat Deployments and Substance Use: Review and Future Directions. Journal of Social Work Practice in the Addictions,12(1), 6-27.
4. American Psychiatric Association. (2020). What Is PTSD?
5. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). Washington, DC: American Psychiatric Publishing.
6. American Psychiatric Association. (2017). What Is Addiction?
7. Teeters, J. B., Lancaster, C. L., Brown, D. G., & Back, S. E. (2017). Substance use disorders in military veterans: prevalence and treatment challenges. Substance Abuse and Rehabilitation, 8, 69-77.
8. US Department of Veteran Affairs. (2020). Substance Use Treatment For Veterans.
9. Elnitsky, C. A., Fisher, M. P., & Blevins, C. L. (2017). Military Service Member and Veteran Reintegration: A Conceptual Analysis, Unified Definition and Key Domains. Frontiers in Psychology, 8, 369.
10. Vogt, D. Fox A., Di Leone B. (2014). Mental health beliefs and their relationship with treatment seeking among U.S. OEF/OIF veterans. Journal of Traumatic Stress, 27, 307–313.