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Unmasking the Hidden Battle: Veterans, PTSD, and Substance Abuse

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Are veterans at higher risk for substance abuse, and where can they find help? Veterans often carry the weight of service-related trauma, leading many into the grips of substance misuse. This article breaks down why veterans and drug and alcohol dependence are so closely linked and what resources are in place to support their recovery.

Key takeaways

  • Veterans face a high risk of developing substance use disorders (SUDs) due to PTSD and other service-related trauma, with a significant number using substances as a coping mechanism.
  • The Department of Veterans Affairs (VA) provides various treatment options such as counselling, therapy, and residential care, with behavioural interventions and pharmacotherapy playing critical roles in recovery.
  • Overcoming barriers to treatment access and employing innovative approaches, like integrated psychosocial treatments, are vital to improving outcomes for veterans with co-occurring disorders.

Understanding the link between veterans and substance abuse

The interplay between serving in the armed forces and substance consumption is intricate, involving several layers. The susceptibility to substance use issues often increases among active duty service members due to trauma or injuries sustained in combat exposure. Yet, this represents just a fraction of a broader scenario.

The influence of PTSD on veterans, paired with the adoption of substance misuse as a method for managing stress, are notable factors that exacerbate this challenge.

The impact of posttraumatic stress disorder on veterans

PTSD is one of the many anxiety disorders commonly found in veterans, especially those coming back from conflicts in Iraq and Afghanistan, and has been significantly linked with substance use disorders. Many of these veterans who are struggling with issues related to substance use also fit the diagnostic criteria for posttraumatic stress disorder. In an effort to alleviate their suffering and intrusive memories associated with PTSD symptoms, it’s not uncommon for them to turn towards self-medicating through drug or alcohol abuse as a coping mechanism aimed at diminishing the severity of their trauma.

The intersection between PTSD and SUD is often exacerbated by various elements, such as the nature of military service, the pressures associated with deployment, and direct exposure to traumatic events. These factors collectively contribute to a heightened risk of both PTSD diagnosis and related patterns of illicit drug use among veteran populations.

Substance misuse as a coping mechanism

Many veterans turn to substance misuse as a way to handle the physical discomfort and psychological trauma resulting from their time in service. It has been reported that over 65% of veterans regularly suffer from pain, which may lead to an increased prevalence of substance misuse.

If prescription medications are inaccessible or prove inadequate, both male and female veterans who have developed addictions might seek out illegal drugs such as marijuana, cocaine, methamphetamines, and heroin.

Prevalence of substance abuse among veterans

Among veterans, the frequency of substance use disorders is notably high, with those suffering from comorbid substance use disorders representing a significant portion. In one year alone, 11% of veterans who accessed Veterans Affairs health care services for their initial visit were diagnosed with a substance use disorder. This encompasses a spectrum of drug abuse challenges involving substances like:

  • Alcohol
  • Tobacco
  • Illicit drugs
  • Prescription medications

There has been an alarming increase in opioid overdose rates among veteran populations, signalling a distressing escalation in severe outcomes related to substance misuse.

Alcohol use disorder in veterans

Military service members, both men and women veterans, exhibit a higher incidence of alcohol use disorders when juxtaposed with the average adult population, especially in terms of binge drinking behaviours. It has been observed that a substantial proportion of veterans within both age brackets – those between 18 and 25 years old and those aged 26 or above – suffer from an alcohol use disorder.

Various evidence-based treatments have been developed to address alcohol use disorder in veterans, especially those with comorbid PTSD. Cognitive processing therapy (CPT) and prolonged exposure therapy (PE) are among the trauma-focused psychotherapies recognised for their efficacy in treating PTSD symptoms. These therapies not only target the underlying trauma but also address the substance abuse intertwined with it.

In addition to psychotherapy, pharmacological interventions have shown promise in treating comorbid alcohol dependence and PTSD. Topiramate treatment, for instance, has been studied in randomised controlled trials as a potential medication for reducing alcohol consumption and PTSD symptoms in veterans. However, further research is needed to determine its long-term efficacy and safety, to prevent poorer treatment outcomes.

Prescription drug abuse and drug overdose risks

The abuse of opioid pain medication among veterans poses considerable dangers. Over 65% of veterans report experiencing chronic pain. In 2019, over half a million veterans were reported to be misusing opioids, signalling the pervasive problem of opioid abuse within this population. There is also a disturbing uptick in rates of opioid overdose that accompanies the misuse of these prescription drugs.

There exists a troubling connection between doses of prescribed opioid pain relievers and veteran suicide rates. Specifically, those veterans who are on the highest dosages have more than double the risk of dying by suicide compared with their counterparts who are on the lowest dosages.

Treatment options for veterans substance use disorders

Despite the overwhelming statistics, there is a ray of optimism for those who want to seek treatment. For veterans struggling with substance use disorders, the Department of Veterans Affairs provides an array of immediate treatment choices such as:

  • Individual and group counseling
  • Various forms of therapy
  • Medication assistance
  • Inpatient residential treatment facilities
  • Tailored programmes to meet specific needs

Within these treatment modalities, two critical elements include behavioral interventions and pharmacotherapy. Both will be explored comprehensively in subsequent discussions.

Behavioural interventions and relapse prevention

The implementation of behavioral interventions is essential for the treatment protocol. Strategies such as Motivational Enhancement Therapy, Cognitive Behavioral Therapy specifically tailored to substance use disorders (SUDs), Cognitive Processing Therapy and Contingency Management are evidence-based treatment methods designed to modify behaviors related to substance use and enhance life quality.

In cases where veterans suffer from comorbid PTSD along with substance use disorders, therapeutic approaches like the Seeking Safety program employ cognitive-behavioral methods geared toward treating PTSD and other concurrent issues effectively.

Pharmacotherapy and its role

Pharmacotherapy is an essential aspect in treating co-occurring PTSD and substance use disorders. Medications like Naltrexone have been found effective in decreasing cravings and reducing alcohol consumption when used alongside trauma-focused psychotherapies. Promising research suggests that innovative pharmacotherapies, including N-acetylcysteine, may simultaneously mitigate symptoms of PTSD and curb the desire for substances.

Support systems and recovery resources

Support networks and accessible resources are critical for recovery. For veterans facing emergencies, the Veterans Crisis Line provides confidential help at any time. To aid those struggling with substance use disorders, free counseling services like SAMHSA’s 24/7 confidential helpline are available to assist with issues related to substance misuse.

Seeking safety treatment and peer groups

Seeking Safety treatment offers structured support tailored for veterans grappling with the dual challenge of substance use disorders and co-occurring PTSD, without focusing on their past traumatic events.

Groups offering peer support, such as the Wounded Warrior Project, play a crucial role in rehabilitation by delivering extensive treatment plans that concurrently tackle issues related to both substance use and occurring PTSD.

Connecting homeless veterans to care

The Department of Veterans Affairs provides support and care for homeless veterans through a range of programs designed to help them and their families secure permanent housing while ensuring they receive top-tier health care services.

It highlights the necessity of linking Iraq and Afghanistan veterans who are experiencing homelessness with essential resources that can aid in their struggles with PTSD, mental health issues, and substance use disorders.

Addressing barriers to treatment access

Despite the availability of resources, military veterans continue to face considerable obstacles in obtaining substance abuse treatment, which includes issues such as:

  • Restricted options for accessing care
  • Inconsistencies and deficiencies in insurance coverage
  • Societal stigma attached to seeking help
  • Apprehensions about potential adverse repercussions
  • A scarcity of services that guarantee confidentiality

In order for military veterans to obtain the necessary SUD and PTSD treatment, it is essential that these obstacles are overcome.

Navigating VA health care services

Veterans grappling with substance use issues may encounter difficulties while trying to find their way through Veterans Affairs health care services in search of treatment. Despite these challenges, there are resources designed to assist veterans in obtaining the necessary treatment for substance abuse. Find VA medical centers near you.

For those veterans who do not have access to VA health care benefits, community Vet Centers provide complimentary private counseling, assessments for alcohol and drug use, along with extra support services.

Enhancing treatment engagement

Enhancing treatment engagement is crucial for bettering treatment outcomes. Techniques like Motivational Enhancement Therapy have been successful in bolstering adherence to treatment among veterans. Tailored treatment initiatives that concurrently target PTSD and SUD have demonstrated increased rates of engagement.

Innovations in treating co-occurring disorders

Innovative approaches are essential in the concurrent treatment of mental disorders with substance use. The intersection of integrated psychosocial interventions and cutting-edge pharmacotherapies offers hope for veterans with distinct treatment requirements. Take, as an example, the COPE program, which combines cognitive behavioural therapy aimed at substance use disorder (SUD) with prolonged exposure therapy for posttraumatic stress disorder (PTSD), achieving substantial reductions in symptoms across both conditions. Many substance use treatment programs also offer a dual diagnosis treatment programme to treat co-occurring PTSD and SUD.

Investigating a range of pharmacological treatments—including those already approved or considered off-label – plays a crucial role in crafting holistic care strategies for veterans struggling with SUD and PTSD. This is supported by findings from a recent randomised controlled pilot trial.

The hidden battle veterans fight

In the journey to unmask the hidden battle of veterans with PTSD and substance use disorders, we have traversed through a landscape of substance use prevalence and treatment challenges, as well as resources available to treatment-seeking veterans. We’ve also highlighted how PTSD often plays a significant role. We’ve explored various treatment options, from behavioral interventions to pharmacotherapy, and emphasized the importance of support systems in recovery.

Yet, the journey is far from over. Addressing barriers to treatment access, enhancing treatment engagement, and continuing to innovate in treating co-occurring disorders are crucial. The fight against PTSD and substance use disorders is a battle that our veterans should never face alone. Armed with knowledge, understanding, and compassion, we can stand with them, supporting them in their journey towards recovery and peace.




Jeffrey Grant, a psychology graduate from the University of Hertfordshire, has a keen interest in the fields of mental health, wellness, and lifestyle.

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