- Why is Substance Abuse Common Among Veterans?
- Prevalence of Substance Abuse Among Veterans
- Substances Most Commonly Abused by Veterans
- How to Help
- Treatment Programs for Veterans
- TRICARE Insurance and Rehabilitation Coverage
- Support Programs and Organizations
- Key Sources
- Medical Disclaimer
Conrad is a retired military Veteran who served in Iraq. During his service, he was injured several times and lost several fellow service members in combat. After returning home to his family in 2011, Conrad had to undergo physical therapy for his injuries. He also began to exhibit signs of post-traumatic stress disorder (PTSD), so his doctor prescribed him Xanax, an anti-anxiety medication. Conrad soon developed a dependence on Xanax to help him relax, and he also began to regularly abuse alcohol to cope with his anxiety, depression, and intense flashbacks.
While the above story is fictional, it represents the plight of many military personnel when they retire from service. Not only have they experienced distressing and turbulent events during combat, but they also face difficulties when readjusting to civilian life. Due to the trauma and extreme situations that Veterans face, many individuals return from service with an array of physical and mental health issues. Unsurprisingly, this leads many of them to turn to alcohol or drugs to cope.
However, hope is not lost for Veterans who struggle with addiction and symptoms of PTSD. There is a range of treatment options and support networks available for this special group of people.
Why is Substance Abuse Common Among Veterans?
More than 1 in 10 Veterans are diagnosed with substance use disorder in a given year. The cause of these high rates is complex, but they are largely due to symptoms of post-traumatic stress disorder (PTSD) as well as other factors, such as chronic pain and adjusting to regular life.
Many Veterans struggle with chronic pain due to the injuries they sustained in combat, leading to the ongoing use of prescription medications. According to some reports, chronic pain reported among Veterans ranges from 50% to 60%. This can be due to loss of limbs, broken bones, internal organ damage, torn muscles, and more.
One of the most common ways that doctors treat chronic pain is with opioids. However, due to the addictive potential of these drugs — and thanks to programs like the Opioid Safety Initiative launched by the Department of Veteran Affairs (VA) — prescription rates for service members have been declining since 2016. That said, those that do take these medications are at risk of abusing them, either by taking more than prescribed or by taking them long term.
Adjusting to Regular Life
Many Veterans find it difficult to transition back to regular life, especially if they were in combat for a prolonged period. The military is a highly structured environment, which means that the transition back into civilian life can be difficult. According to the VA, some of the key difficulties that Veterans face when reintegrating include:
- Returning to a “normal” job that requires training and education.
- Establishing community and support networks.
- Finding adequate housing, especially for families.
- Adjusting to new decisions that a person is faced with in everyday life.
Due to these challenges, many Veterans find solace in alcohol or drugs to manage their anxieties. Therefore, resources and support networks are vital so that they have access to the tools they need to manage, especially if they have PTSD.
The Significance of PTSD
Post-traumatic stress disorder (PTSD) is a mental health condition that occurs after a person has experienced or witnessed a distressing event. While PTSD can happen to anyone who has experienced trauma, this condition is particularly prevalent among Veterans and was previously referred to as “shell shock” or “combat fatigue.”
Not all Veterans will experience PTSD, and some will only have mild cases of it. However, others will experience intense and enduring symptoms long after combat has ended. This includes anxiety, depression, nightmares, and an inability to face situations that remind them of their wartime experiences.
When Veterans arrive home, many find it difficult to seek help and are overwhelmed by the aftermath of PTSD symptoms. This leads many Veterans to turn to drugs and alcohol to numb their feelings and to cope with symptoms like intense anxiety.
Symptoms of PTSD
Symptoms of PTSD vary between individuals, but largely consist of the following:
- Depression and anxiety.
- Flashbacks of distressing events, accompanied by physical symptoms like sweating and a racing heart.
- Nightmares or bad dreams.
- Frightening thoughts.
- Recurrent memories of the event.
- Avoidance of places, events, or people that remind them of traumatic experiences.
- Being easily startled.
- Feeling “on edge.”
- Irritability, anger, or aggression.
- Reckless or destructive behavior.
- Feeling detached from others.
- Memory problems.
- Loss of interest in regular activities.
- Blaming themselves for the outcome of their traumatic experiences.
- Negative thoughts about themselves.
- Inability to experience positive emotions.
Prevalence of Substance Abuse Among Veterans
- According to the 2013 National Survey on Drug Use and Health, 1.5 million Veterans aged 17 or older (6.6 % of the U.S. population) had a substance use disorder in the past year.
- Nearly 1 in 3 Veterans who seek treatment for substance abuse also have PTSD.
- More than 2 out of 10 Veterans with PTSD also struggle with substance abuse.
- 30% of Veterans from the Vietnam War have experienced PTSD in their lifetime.
- An estimated 12% of Veterans from Operation Desert Storm in the Gulf War have experienced PTSD in their lifetime.
- The number of Veterans who use nicotine is nearly double for those who have PTSD (roughly 6 out of 10 for those with PTSD versus 3 out of 10 for those without).
- According to the Department of Veterans Affairs (VA), in 2017 an average of 16.8 Veterans committed suicide each day.
- There are high rates of cannabis use among Veterans (around 3.5%). Cannabis use disorders have also increased more than 50% among Veterans treated by the VA system.
- Government reports indicate that other drugs of concern for Veterans are heroin (10.7% usage) and cocaine (6.5% usage).
Substances Most Commonly Abused by Veterans
Below are the substances most frequently abused by the Veteran population.
Alcohol is one of the most abused substances by Veterans. Some studies indicate that as many as 65% of Veterans who sought addiction treatment reported alcohol as their primary drug of abuse. In the case of Vietnam Veterans, 60% – 80% who seek treatment for PTSD also have problems with alcohol abuse. Binge drinking (consuming at least 4 or 5 drinks in one sitting) is also high among the Veteran population.
Alcohol works by depressing the central nervous system, which leads to increased sedation and feelings of euphoria. This makes it a common drug of choice, especially for people with PTSD. Alcohol can numb a person and make them forget about the distressing events they experienced. However, alcohol poses a high risk for abuse and tolerance. This can lead individuals down a path of addiction that can be difficult to break without treatment.
Opioids are another class of drugs that are commonly abused by Veterans. Many individuals are prescribed opioids for chronic pain due to injuries that they sustained during combat. In some cases, this can trigger a dependency if a person takes opioids for a long time, or if they start to abuse the drugs by taking more than prescribed.
Opioids also work by depressing the central nervous system, but they can be even more sedating than alcohol. These drugs act on the body’s natural opioid receptors and cause euphoria, pain relief, sedation, and relaxation. Opioids are highly addictive and habit-forming, leading people to develop a tolerance and uncomfortable withdrawal symptoms if they try to stop taking them.
Anti-Anxiety Medications (Benzodiazepines)
Veterans are also often prescribed anti-anxiety medications such as benzodiazepines (“benzos”). These drugs work by acting on the gamma-aminobutyric acid (GABA) system in the brain and controlling the neurotransmitters that contribute to anxiety and stress. This results in a general sense of calm and relaxation.
However, benzos are also addictive, especially if they are taken for a long period. And, like opioids and alcohol, benzos cause uncomfortable withdrawal symptoms if they are discontinued. This means medical detox is often needed for Veterans who become addicted to these medications.
How to Help
If you or someone you know is struggling with substance abuse following their service in the military, there are a few things you can do.
Find a Support Network
Going through PTSD and alcohol or drug addiction can feel lonely and isolating. Being able to reach out can also be difficult, which is why it’s important to develop a strong support network. Whether it’s family, friends, other Veterans, or individuals who have recovered from PTSD and substance abuse, surrounding yourself with people who care can make a world of difference. Remember, it’s ok to feel what you’re feeling and to ask others for help.
One of the best ways of managing your conditions is to educate yourself about Veterans and substance abuse. The Veteran population has its own unique needs and challenges, so it’s important to learn from others who have gone through similar experiences.
It’s also worth learning more about what substance abuse and PTSD are, and what symptoms they produce. By better understanding these conditions, you can know that what you’re experiencing is normal. You may also want to educate yourself about the different treatment options available, whether it’s counseling, rehab centers, or support groups like Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and 12-Step groups.
Treatment Programs for Veterans
There are many treatment options for veterans who are struggling with PTSD and substance abuse. These include programs like:
- Residential or inpatient treatment
- Partial hospitalization programs (PHP)
- Intensive outpatient programs (IOP)
- Regular outpatient programs
- Sober living residences
There are also specific therapies that are known to be effective for conditions like PTSD and substance abuse. These include:
Eye Movement Desensitization and Reprocessing (EMDR)
Trauma-informed treatments such as EMDR are led by a therapist who guides an individual through a series of rapid eye movements to redirect negative or traumatic memories. This therapy can be especially helpful for Veterans who need assistance with managing troubling flashbacks and recurring memories.
Cognitive-Behavioral Therapy (CBT)
Cognitive-behavioral therapy (CBT) is one of the hallmark therapies for substance abuse and mental health conditions. This type of therapy can help Veterans change negative cycles of thinking into more positive and affirming ones. This includes recognizing “automatic thoughts” and dysfunctional thinking patterns and being able to re-frame substance use triggers. CBT can also teach Veterans how to develop a greater sense of self-understanding and confidence.
Somatic Experiencing (SE)
Somatic Experiencing is a revolutionary new body-oriented therapeutic model for releasing trauma. Developed by Dr. Peter Levine, this type of therapy addresses the physiological fight or flight system that remains active in traumatized individuals. It works by treating the central nervous system and teaching people how to get in touch with the bodily sensations that arise with memories of traumatic events.
Family Systems Theory
This type of therapy focuses on the family as an emotional unit and helps Veterans find their place within this unit after they’ve retired from service.
TRICARE Insurance and Rehabilitation Coverage
TRICARE is a healthcare program for active and retired military service members and their families. Previously known as the Civilian Health and Medical Program of the Uniformed Services, TRICARE includes coverage for individuals of the U.S. Air Force, Army, Navy, Marine Corps, Coast Guard, Commission Core, U.S. Public Health Service, and Commission Core of the National Oceanic and Atmospheric Association.
Since 2017, TRICARE also provides coverage for addiction treatment and mental health. This includes treatment for opioid abuse and substance abuse issues.
While individual circumstances vary, TRICARE may cover the following services:
- Intervention programs
- Inpatient services
- Residential treatment
- Partial hospitalization programs (PHP)
- Intensive outpatient programs
- Medication-assisted treatment (MAT)
- Family therapeutic services
Support Programs and Organizations
For additional information and resources, below are a few organizations and hotlines that can help:
- National Suicide Prevention Lifeline: 1-800-273-8255
- Veterans Crisis Line: 1-800-273-8255, then press 1
- Women Veterans Call Center: 1-855-829-6636
- Help for Homeless Veterans: 877-424-3838
- Caregiver Support: 855-260-3274
- Make the Connection: this is a campaign run by the U.S. Department of Veterans Affairs’ campaign which connects Veterans to the resources and services they need.
- Wounded Warrior Project (WWP): this is a non-profit project that connects veterans with peer support groups and programs.
- Iraq and Afghanistan Veterans of America (IAVA): this organization provides information and resources for veterans and their families about mental health.
If you or a loved one are struggling with substance abuse, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.
You can also find a list of treatment centers near you on our website to help get you on the path to recovery.
Linscott, A. (2016). PTSD & Vietnam Veterans Part 2 – Substance Abuse. Hillandponton.com. https://www.hillandponton.com/ptsd-vietnam-veterans-part-2-substance-abuse.
National Institute on Drug Abuse (NIDA). (2019). Substance Use and Military Life DrugFacts. Drugabuse.gov. https://www.drugabuse.gov/publications/drugfacts/substance-use-military-life#ref.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2015). Veteran’s Primary Substance of Abuse is Alcohol in Treatment Admissions. The CBHSQ Report. https://www.samhsa.gov/data/sites/default/files/report_2111/Spotlight-2111.html.
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. doi:10.2147/SAR.S116720.
U.S. Department of Veterans Affairs. (n.d.). PTSD and Substance Abuse in Veterans. Ptsd.va.gov. https://www.ptsd.va.gov/understand/related/substance_abuse_vet.asp.
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