Alcoholism, Drug Dependence and Veterans

Explaining drug and alcohol problems in veterans

Increased stress, exposure to war and violence, trauma, and trouble adjusting to civilian life are all factors that may explain why veterans are at higher risk for substance use disorders and addiction. This is especially true when considering:^[1]

• Those with the greatest risk of developing a problem with drugs or alcohol are those who have served in multiple deployments and have direct combat exposure.
• Those with one if not all of a trio of co-occurring disorders, namely post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and some form of chronic pain commonly self-medicated with drugs and alcohol. 
• Troubles adjusting to civilian life also have links with addiction in veterans, including losing employment, financial problems, and relationships falling apart. 
• One-third of veterans seeking help for a substance use disorder also have a diagnosis of PTSD
• More than 20% of veterans with PTSD also report having problems with drug or alcohol use
• Veterans with PTSD are twice as likely to be smokers than veterans without PTSD
• Binge drinking and alcohol use are common in both active duty military members and military veterans
• Of returning veterans from Iraq and Afghanistan, 1 in 10 reported a drug or alcohol problem
• People who use drugs or alcohol to cope with stress or difficult emotions are more likely to develop an addiction than social or recreational users

Prescription drug abuse and veterans

The rates of illicit drug use such as heroin, cocaine, and marijuana have remained comparatively low among veterans; the abuse of prescription drugs such as opioid painkillers has seen a steep rise in recent years. The risk for prescription painkiller misuse is particularly high in veterans as many retire with chronic pain conditions and injuries. 

This, married with the wide availability of prescriptions makes the potential for abuse much higher. This puts veterans at a higher risk for accidental opioid painkiller overdoses. From 2001 to 2009, the percent of veterans in the VHA system receiving an opioid prescription increased from 17% to 24%.^[3] Similarly, the overall opioid overdose rates of veterans increased to 21% in 2016 from 14% in 2010.^[4]

Alcohol abuse and veterans

Alcohol use can have a tremendous impact on both active duty and retired military. Because of frequent drug testing, alcohol is one of the most commonly abused drugs among active military members and is a part of military culture. Binge drinking is especially common among active-duty military members and may help to establish a pattern of excessive alcohol use that continues even after they retire from active duty.^[1]

Sadly, far too few veterans get the help they deserve. Around half of the men and women who return home from deployments are in need of treatment for mental health conditions; however, only about 50 percent of those actually seek treatment. This may be partially due to the consequences they fear will come from seeking treatment, especially for active-duty members who can be forced out of service if they are diagnosed with any health or mental health condition, including an addictive disorder.^[10]

Related: living with an alcoholic

PTSD and substance abuse

Post-traumatic stress disorder, more commonly known as PTSD, is an underlying mental health condition often found in veterans and active-duty service members who have seen combat. PTSD is characterized by intense anxiety caused by trauma and stress from combat situations and manifests during times of rest and peace or if triggered by an event (arguments, moments of stress, etc.). 

For most, PTSD symptoms can include flashbacks of traumatic events and violence, intense nightmares, mood swings, and aggressive thoughts that are out of their control. As the reaction from PTSD can be so uncomfortable, many veterans and active-duty service people turn to abusing alcohol and drugs to dampen the effects and effectively self-medicate. Subsequently, veterans with PTSD are more likely to develop substance use disorders and other co-occurring disorders.^[1]

Many treatment centers are specialized in helping people with addiction and mental health disorders, such as PTSD. Treating co-occurring disorders can be difficult and getting help sooner rather than later is always advisable to ensure recovery from both conditions is possible.

Veterans and substance abuse statistics

• 22 percent of OEF and OIF veterans with post-traumatic stress disorder (PTSD) also have a substance use disorder.
• Deployment in the military is associated with starting smoking, unhealthy drinking, drug use, and risky behaviors.
• Rates of binge drinking in those who are deployed are rather high compared to the general population.
• In veterans, cannabis use disorders increased by more than 50% among those treated in the Veterans Health Administration (VHA) system between the years 2002 to 2009.
• Increased exposure to trauma, violence, and combat increases military personnel's risk of problematic drinking, and veterans diagnosed with PTSD and alcoholism are more likely to binge drink.
• The Substance Abuse and Mental Health Services Administration (SAMSHA) estimates that between 37 and 50 percent of Afghanistan and Iraq War veterans are diagnosed with some form of mental health condition.
• An average of 20 veterans die from suicide every day.
• About 8 out of 10 Vietnam veterans seeking PTSD treatment have issues with alcohol abuse.
• Suicide risk is higher for veterans, age 65 years or older, who are also diagnosed with an alcohol abuse disorder or mental illness, such as depression.

Seeking help

Finding help for addiction and substance abuse treatment is the most effective way of overcoming a drug or alcohol problem, especially if paired with a co-occurring disorder such as PTSD. According to the Army, only 40 percent of veterans who screen positive for serious emotional and substance use disorders seek help from a mental health professional. 

Stigma is a major barrier for veterans and according to SAMHSA service members frequently cite fear of personal embarrassment, disappointing comrades, losing the opportunity for career advancement, and dishonorable discharge as motivations to hide symptoms of mental illness and drug or alcohol problems from family, friends, and colleagues.^[10]

The Institute of Medicine (IOM) has recommended that insurance cover be broadened to include outpatient addiction treatment and better-equipped healthcare providers, as well as increasing the level of confidentiality for those seeking treatment.