According to the National Institute on Drug Abuse (NIDA), military personnel have lower substance abuse rates compared to civilians; however, this does not hold true for veterans.
In fact, a study of young veterans between 2004 and 2006 showed that approximately a quarter of veterans 18-25 years old met the criteria for a substance use disorder in the previous year. Older veterans also have high rates of substance abuse.
One contributing factor to substance abuse among veterans is post-traumatic stress disorder, or PTSD. Veterans who have seen active combat or otherwise experienced trauma on the job may develop this disorder, characterized by chronically reliving the trauma event through flashbacks or nightmares, exhibiting avoidance of places or situations that remind them of the event, and experiencing hypersensitivity to stressful situations for more than a month after the event. PTSD is a risk factor for developing substance abuse.
This prevalence of substance abuse and PTSD among veterans creates a special need for substance abuse treatment that can take into account the complicating factors of PTSD. It is important to fine-tune treatment to meet this need, as well as to manage the particular issues and stigma that surround these disorders in military veterans.
PTSD and Substance Abuse
People who have experienced a traumatic event and develop PTSD often also develop substance abuse issues. Many people who experience the fear and hypervigilance that arises during flashbacks, or the fluctuations in moods that can result from this disorder, use drugs or alcohol in an attempt to reduce or numb those feelings – a practice called self-medication. This abuse of substances can, in turn, lead to addiction.
One study from the European Journal of Psychotraumatology found that approximately 36.6 percent of people being treated for substance use disorders had co-occurring PTSD, as compared to only 10.2 percent among those who did not struggle with substance abuse. In fact, among those with substance use disorders, exposure to trauma affected more than 97 percent. This indicates that PTSD and other experiences of trauma are strongly correlated with substance abuse.
Veterans and Co-occurring PTSD with Substance Abuse
Because veterans are highly likely to have experienced traumatic events in combat, they are also likely to have PTSD. Given the above statistics, this would seem to indicate that veterans are also likely to have high levels of substance use disorders. Statistics presented by the U.S. Department of Veterans Affairs (VA) seem to confirm this: More than 2 in 10 veterans with PTSD also have substance use disorders, and almost 1 in 3 veterans who seek treatment for substance abuse have PTSD.
However, PTSD is not always the cause of substance abuse; sometimes, the reverse is true as well. For example, alcohol abuse can make it harder for a person to deal with stress or trauma, making a person who uses alcohol more likely to develop PTSD in response to trauma. Active military and veterans have higher rates of alcohol use than the general population, according to the VA, which could also contribute to the high rates of co-occurring substance abuse and PTSD among veterans.
Issues of substance abuse in veterans with PTSD become even more nuanced when it comes to gender. In general, women in the military have lower incidences of substance abuse than men. However, a number of studies, including a research review in the journal Epidemiologic Reviews, demonstrated that women veterans with PTSD or other trauma issues were more likely to have problems with substance abuse.
Other studies, such as one from the Journal of Traumatic Stress Disorders & Treatment, indicate that the risk factors and trauma types that result in PTSD in veterans are different for men and women, with men being more likely to experience trauma from combat circumstances, while trauma for women is focused more around sexual abuse. Because of this, there can be a need to provide treatment that can be customized based on gender.
Special Needs in Treatment
Personalities and concerns of those who live and work in a military environment can be different from those of the civilian population, creating special needs that may complicate treatment if they are not met. These include:
- Differences between female and male military personnel, as described above
- Higher stigma against PTSD and substance abuse in a military environment
- Fear of consequences from military leadership creating a need for confidentiality
- Challenges of reintegrating into civilian life adding further complications
- Prevalence of physical injury, including brain injury, among veterans with PTSD and substance abuse
There are a number of contributors to the need for specialized treatment for veterans.
As described by the Substance Abuse and Mental Health Services Administration, many of these issues that military personnel and veterans face are not well understood or recognized by civilians, making it harder for veterans to get the specialized care they need.
Types of Treatment
An article from Psychiatric Times emphasizes the need to take these considerations into account when dealing with treatment for veterans. For example, the article notes that many veterans will respond well to medical treatments for alcohol abuse, such as naltrexone and disulfiram; however, when PTSD is present, these medicines are not as effective. Similarly, medicines for PTSD do not seem to be helpful for substance abuse.
What does seem to work is to integrate treatment for PTSD and substance abuse, so that both disorders are treated at the same time. Because the disorders tend to feed into each other, it is much harder to recover from one if the other is not treated.
Treatments used for this population that can help manage symptoms of both PTSD and substance abuse include:
- Cognitive Behavioral Therapy
- Cognitive Processing Therapy
- Trauma-Focused Therapy
- Family or spouse therapy
- Group therapy
- Contingency Management treatment
These types of treatment have been shown to provide benefit for both reducing substance abuse and helping to manage PTSD symptoms. A program of treatments can be adjusted as needed to meet the individual’s specific needs.
Motivation to engage in treatment is one of the most important elements of recovery. For veterans, this may be particularly difficult for one particular reason: confidentiality. As described by NIDA, military culture has a strong stigma against substance abuse, as well as PTSD, which can make personnel and veterans hesitant to admit to problems. In order to engage these personnel in treatment, it is important to offer a high level of confidentiality that makes veterans struggling with substance abuse and PTSD more willing to pursue treatment.
Reputable substance abuse treatment centers are able to provide this level of confidentiality and privacy. Working with treatment center staff members can reassure veterans of this confidentiality, and provide the customized treatments and care that make it easier to achieve recovery. With evidence-based, personalized treatment, veterans can develop the tools they need to manage the symptoms of both PTSD and substance abuse, giving them a better chance at a productive future.