The Problem of Substance Abuse Among Veterans
Between 2004 and 2006, approximately 7.1% of American veterans met criteria for a diagnosis of substance use disorder.1 For veterans ages 18 to 25, the rate was approximately 25%.2 A substance use disorder is a diagnosable condition that involves compulsive drug or alcohol use despite the harms that it causes (physically, socially, and psychologically).3
Prescription drug and alcohol abuse among service members is quite prevalent. Between 2002 and 2008, the number of active duty service members misusing prescription drugs increased from 2% to 11%.2 The majority of prescription drug abuse in the military involves opioid painkillers, including OxyContin (oxycodone) and Vicodin (hydrocodone).5
Alcohol poses another significant threat to the physical and mental health of veterans. In 2008, almost half of active duty service members reported binge drinking alcohol, and approximately 20% had binged on alcohol within the past month. Service members who had experienced more combat exposure reported binge drinking at greater rates.2
The experience of war is associated with mental health concerns for those returning home, which can lead to or worsen problems with substance abuse. Around 18.5% of soldiers returning from Iraq and Afghanistan suffer from post traumatic stress disorder (PTSD) or depression.1 Approximately 20% of veterans with PTSD also meet criteria for a substance use disorder.4 Almost 10% of soldiers returning from the Iraq and Afghanistan wars report problems with drugs and alcohol.4 Approximately 82%-93% of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans diagnosed with a substance use disorder also were diagnosed with a co-occurring mental health disorder.5
Why Are Veterans at Such High Risk?
A number of factors put veterans at high risk for developing addictions to drugs and alcohol:
- Exposure to trauma.1 Veterans with a history of multiple deployments and exposure to combat are at high risk of developing PTSD and other mental health issues. Some veterans with PTSD may turn to drugs and alcohol to deal with symptoms like intrusive thoughts, nightmares, and sleeping problems.
- Sexual trauma.6 Male and female veterans who have experienced sexual assault are at risk for mental health issues like anxiety, depression, and PTSD. Victims of sexual trauma may turn to drugs and alcohol to cope with the negative emotional impact of the trauma.
- Availability of prescription medications.2 Veterans may suffer from pain caused by combat-related injuries. In 2009, military doctors wrote around 3.8 million prescriptions for pain relievers. In some cases, veterans may become dependent on these highly addictive drugs.
- Homlessness.1,7 Veterans experience alarmingly high rates of homelessness. Approximately 10% of the homeless population is made up of veterans, and nearly 75% of homeless veterans experience mental health and/or substance abuse issues.7
- Barriers to treatment.2 Veterans who suffer from addiction problems may be reluctant to seek help despite the availability of resources and treatment programs. Some veterans may be deterred by the perceived stigma associated with seeking treatment.
The Link between PTSD and Substance Abuse
Posttraumatic stress disorder (PTSD) is a mental health condition that can develop after a person experiences or witnesses a traumatic event.3 Symptoms can include reliving the event, avoiding reminders of the trauma, negative thoughts and feelings, and increased emotional arousal (which might manifest as insomnia, angry outbursts, concentration difficulties, being easily startled, etc.). Veterans and active duty service members are at higher risk of developing PTSD because of their exposure to dangerous situations. People who develop PTSD following a traumatic event are also at risk for using drugs and alcohol to cope with their symptoms.4
Mental health conditions, including PTSD and depression, are closely linked to drug and alcohol use among both male and female veterans.4,8,9 Approximately 20% of veterans experience both PTSD and drug addiction, a situation known as a dual diagnosis.4
Veterans who are exposed to or witness death, injury, or violence are at risk for developing PTSD.3 Some people may also develop PTSD after learning that a close friend or relative has been exposed to trauma. In addition to experiencing or witnessing a traumatic event, symptoms of PTSD can include:
- Re-experiencing of the traumatic event. This may involve intrusive thoughts, nightmares, flashbacks, and physical and/or emotional distress after being exposed to reminders of the event.
- Avoidance of thoughts, feelings, or reminders of the trauma.
- Negative thoughts or feelings triggered or made worse by the trauma. This may include difficulty recalling aspects of the trauma, negative thoughts about self or others, blaming self or others for the trauma, sadness, decreased interest in activities, social isolation, and inability to feel positive emotions.
- Increased arousal and reactivity. This can include irritability or anger, engaging in dangerous behaviors, hypervigilance, heightened startle response, concentration problems, and sleeping difficulties.
Veterans may use substances in an attempt to alleviate their PTSD symptoms. Drugs and alcohol may serve as a distraction or a way of avoiding intrusive thoughts, memories, or nightmares of a previous trauma.4,9 While this behavior may ease short-term pain and discomfort, over time drug and alcohol use can actually intensify symptoms of PTSD. Drug and alcohol use can increase negative feelings and sleeping problems and make it more difficult to work through trauma in treatment.
Trying to quit drugs and alcohol while experiencing symptoms of PTSD can be difficult. Fortunately, treatment programs are available that specialize in treating people with dual diagnosis disorders. These programs work to simultaneously treat concurrent disorders which can aid in long-term recovery.
The Crisis of Prescription Drug Abuse in the Military
Prescription drug abuse is rampant among veteran and active service members.2 Members of the armed forces may turn to prescription drugs to cope with their experiences during deployment, including symptoms of PTSD. They may also begin to abuse them after getting prescriptions for injury-related pain.10 According to the VA, 50–60% of service members returning from deployment experience chronic pain.11
Veterans are also at risk for suffering from emotional issues like depression, anxiety, and PTSD. Because of the stigma associated with seeking mental health treatment, many veterans are more likely to seek help for their chronic pain, during which they are likely to receive prescriptions for potent, addictive painkillers. Veterans who take opioid medications for pain and also experience emotional issues like PTSD are more vulnerable to developing addictions to these drugs.
Consistent use of opioid medications can quickly lead to the development of physical dependence, a condition in which the user goes into withdrawal when they either cut back or stop using the drug.3 Tolerance also tends to develop quickly, and the veteran may find themselves turning to higher doses to achieve the relief they’re seeking. These two phenomena may contribute to a developing addiction.
Prescription opioid abuse is a serious concern. Opioid medications carry a high risk for overdose, especially when combined with other drugs and alcohol.10 According to the National Institutes of Health (NIH), the number of fatal overdoses by veterans was nearly 2x higher than the civilian overdose rate, with overdose rates driven largely by opioids.11
The VA is currently working to combat the prescription drug problem among service members. In 2010, the VA issued guidelines on prescribing medications, which helped decrease the number of opioid prescriptions given to veterans.11 The VA also developed the Integrative Health Coordinating Center (IHCC), which encourages alternative treatments for chronic pain, such as yoga and acupuncture.
The suicide rate among veterans is higher than the civilian suicide rate.7 Approximately 20% of suicides in the United States are committed by veterans, and up to 22 veterans die each day due to suicide. Between 2005 and 2009, more than 1,100 service members committed suicide1—29% of these suicides involved drug or alcohol use and approximately 1/3 of them involved prescription drug abuse.2 Nearly 60% of veterans who committed suicide had been previously diagnosed with a mental health condition.7
Several factors may increase the risk for suicide among veterans, including:12,13
- Exposure to trauma, such as combat trauma, military sexual trauma, and injuries suffered during service.
- Symptoms of PTSD, such as troubling memories, anger, and impulsivity.
- Combat-related guilt, where a person feels a significant burden of remorse and/or shame over actions they committed during service.
- Coping patterns that involve avoiding or suppressing emotions.
- Drug and alcohol use.
Drug and alcohol abuse plays a significant role in a veteran’s risk for suicide. Veterans who abuse substances are more than 2x as likely to die by suicide.13 The risk is higher for female veterans, who are more than 5x as likely to die by suicide. Abuse of prescription drugs like sedatives and opioids is associated with the highest risk of suicide.
Substance-abusing veterans may be at higher risk for suicide because drugs and alcohol can increase a person’s risk of making impulsive and poor decisions.14 Drugs and alcohol may also be used as a means to commit suicide, such as by intentionally overdosing on prescription pills or other drugs.
If you or someone you know is experiencing suicidal thoughts, contact the Veterans Crisis Line at 1-800-273-8255 (TALK). The lifeline provides free support 24 hours a day, 7 days a week.
Signs of Addiction
Veterans who are struggling with an inability to quit using drugs or alcohol may meet criteria for a substance use disorder. Signs of a substance use disorder can include:3
- Taking greater amounts of the drug or taking the drug for a longer duration of time than intended.
- Attempting to cut down but being unable to do so.
- Spending a long time getting, using, or recovering from the drug.
- Having cravings or strong urges to use a drug.
- Difficulty carrying out responsibilities at home, work, or school because of drug use.
- Experiencing social or relationship problems as a result of drug use.
- Spending less time participating in activities you once enjoyed because of drug use.
- Using the drug in situations that may cause harm.
- Continuing to use the drug even though drug use causes or worsens physical or psychological problems.
- Needing greater amounts of the drug to feel the desired effects.
- Going through withdrawal after lowering the dose of or stopping use of the drug.
Friends and family members may also notice certain behaviors that may indicate that their loved one is struggling with addiction. Other signs of addiction include:
- Emotional changes, such as anger, depression, anxiety, or erratic mood shifts.
- Changes in appearance, such as weight loss, pupil changes (appearing dilated or constricted), poor hygiene, sores on the skin, or track marks.
- Blackouts or difficulty remembering periods of time.
- Isolation from family and friends.
- Financial problems.
- Participation in criminal activity, such as stealing.
- Possession of drugs and drug paraphernalia (pipes, needles, etc.).
Drug Addiction Treatment for Veterans
A significant number of veterans throughout the United States are struggling with addictions to drugs and alcohol. At the same time, many veterans are also experiencing mental health issues like PTSD, homelessness, and the stress related to returning from deployment and adjusting to civilian life. Because of their past experiences, veterans may benefit from specialized treatment programs that can help address their unique needs.
The Veterans Administration (VA) provides evidence-based addiction treatment for all eligible veterans.15 The VA offers a variety of treatment options, including individual and group therapy, as well as medications. The goals of addiction treatment include:
- Increasing a veteran’s motivation to change negative behaviors.
- Teaching skills to deal with triggers and prevent a relapse.
- Improving understanding of addiction and communication among family members.
- Becoming connected with support groups like Alcoholics Anonymous and Narcotics Anonymous.
Veterans may also participate in addiction treatment outside of the VA. Private, non-profit, and government-funded programs are available throughout the United States.
Veterans seeking addiction treatment through the VA or other treatment programs may benefit from different levels of care:
- Detoxification usually takes place prior to ongoing addiction treatment and is a process wherein the body clears itself of drugs and alcohol, often (but not always) with medical oversight and/or intervention. In a medical detox program, doctors and other medical professionals closely monitor a person’s withdrawal symptoms and administer medications to alleviate symptoms. In a non-medical, or social, detox, recovering individuals will receive emotional support but no medications. Medical detox is usually recommended in the case of alcohol, sedative, and opioid withdrawal.
- Inpatient/residential rehab programs offer live-in treatment with therapy sessions and recovery meetings that are focused on understanding and coping with addiction. These programs offer 100% drug-free environments and social support.
- Outpatient substance abuse treatment programs offer a set number of therapy sessions each week that the patient will visit the treatment facility to attend. The frequency and intensity of outpatient treatment depend upon the particular program. Participants do not stay in the treatment facility and often reside in their own homes or sober living facilities.
Only half of military service members who need treatment end up receiving it.
Dual diagnosis programs offer the opportunity to treat addiction and mental health issues at the same time. Veterans with both addiction and PTSD show the greatest improvements when both conditions are effectively addressed.4 There are several therapies to treat dual diagnosis issues like PTSD and addiction:
- Cognitive behavioral therapy helps people understand the relationship between their thoughts, feelings, and behaviors and develop healthy coping strategies to manage stress.
- Cognitive processing therapy aims to modify negative thoughts related to past trauma.
- Prolonged exposure focuses on gaining control over negative thoughts by talking about and facing reminders of previous traumatic events.
Addiction and dual diagnosis treatment may involve group, individual, and family or couples therapy. In some cases, medications may also be prescribed to treat symptoms of PTSD and addiction. The VA recommends the use of opioid agonists, such as methadone or buprenorphine, for opioid addiction.10 These medications can help relieve cravings and prevent withdrawal, which can help reduce the likelihood of a relapse.
Despite the availability of addiction treatment through the VA and other treatment centers, many veterans go without the help that they need. Only half of military service members who need treatment end up receiving it and an even smaller number receive adequate care.2 Veterans and active duty service members may avoid seeking treatment because of the perception that getting help is a sign of weakness or concern that they will experience discrimination.
Resources for Veterans
Transition to Civilian Life
- Real Warriors offers help for active duty service members and veterans. Information includes how to cope before, after, and during deployment, managing symptoms of PTSD and stress, and tips for returning to school and finding civilian employment.
- Make the Connection provides information on conditions like PTSD and addiction, common reactions to retirement, available resources, and stories from other veterans who have transitioned from active duty to civilian life.
- After Deployment offers information on various topics facing military families, including PTSD, drug and alcohol use, military sexual trauma, and suicide prevention. The site includes videos as teaching tools and assessments that can help identify issues like depression, anxiety, and substance use.
- The Veterans Crisis Line provides free, confidential support for veterans and their loved ones who are feeling suicidal or experiencing a crisis. The hotline can be reached by calling 1-800-273-8255 and pressing 1, sending a text message to 838255, or accessing the online chat. Support staff can connect you with responders through the VA. The Crisis Line is available 24 hours a day, 7 days a week.
- The Department of Veterans Affairs aims to help connect homeless and at-risk veterans with housing, employment, and healthcare services. You can access the Homeless Veterans Chat, an online resource managed by the VA that provides free and confidential support 24 hours a day, 7 days a week.
- The United States Department of Housing and Urban Development-VA Supportive Housing offers housing vouchers and rental assistance for homeless veterans. Program participants work with case managers who help veterans connect with medical care, addiction treatment, and mental health treatment. For more information and to see if you are eligible, contact the National Call Center for Homeless Veterans at 1-877-4AID-VET.
Finding Addiction Treatment:
- The Department of Veterans Affairs offers evidence-based addiction treatment for veterans at local VA offices. Treatment may also address other issues, such as PTSD, depression, chronic pain, sleeping problems, and family conflict. For more information about addiction treatment through the VA, you can contact your local VA healthcare provider, the OEF/OIF coordinator at the local VA medical center, your local Vet Center, or by calling the VA’s information hotline at 1-800-827-1000. You can also access the VA’s Substance Use Disorder Program Locator and PTSD Program Locator online.
Get Help Now
Veterans who are struggling with addiction and other mental health issues should know that there is hope. Treatment may help veterans quit using drugs and alcohol, reduce the likelihood of a relapse, adjust to life outside of the military, and cope with previous trauma and other emotional issues. If you are a veteran struggling with addiction, consider taking the first step in recovery and seeking help. We are available any time of day or night to discuss your treatment options.
- Substance Abuse and Mental Health Services Administration. (2017). Veterans and military families.
- National Institute on Drug Abuse. (2013). Substance abuse in the military.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- U.S. Department of Veterans Affairs. (2015). PTSD and substance abuse in veterans.
- 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.
- Kimerling, R., Street, A. E., Pavao, J., Smith, M. W., Cronkite, R. C., Holmes, T. H., & Frayne, S. M. (2010). Military-related sexual trauma among Veterans Health Administration patients returning from Afghanistan and Iraq. American Journal of Public Health, 100(8), 1409-1412.
- Substance Abuse and Mental Health Services Administration. (2017). Critical issues facing veterans and military families.
- Miller, M. W., Reardon, A. F., Wolf, E. J., Prince, L. B., & Hein, C. L. (2013). Alcohol and drug abuse among US veterans: Comparing associations with intimate partner substance abuse and veteran psychopathology. Journal of Traumatic Stress, 26(1), 71-76.
- United States Department of Veterans Affairs. (2015). PTSD and problems with alcohol use.
- National Institute on Drug Abuse. (2017). Medications to treat opioid addiction.
- University of Pennsylvania Center for Ethics and Rule of Law. (2017). The intersection of opioid overuse and veteran mental health challenges.
- Hudenko, W. & Homaifar, B. (2017). The relationship between PTSD and suicide. United States Department of Veterans Affairs.
- Bohnert, K. M., Ilgen, M. A., Louzon, S., McCarthy, J. F., & Katz, I. R. (2017). Substance use disorders and the risk of suicide mortality among men and women in the US Veterans Health Administration. Addiction, 112(7), 1193-1201.
- National Institute on Drug Abuse. (2014). Drugs, brains, and behavior: The science of addiction.
- United States Department of Veterans Affairs. (2015). Treatment programs for substance use problems.