Veterans are at high risk of experiencing substance use and mental health issues for a number of reasons. Combat experience can lead to unique risk factors for addiction, including trauma and reintegration challenges, which may require specialist support. Various types of support and treatment are available for veterans across the United States.
- Veterans can be more likely than the general population to experience alcohol use disorder and post-traumatic stress disorder (PTSD).
- Unique risk factors, including exposure to combat, can increase the likelihood of these conditions.
- Various treatment options are available, including therapies, medications, support groups, and community support through veteran-focused organizations.
Why addiction is common among veterans
Substance use issues and addiction are common among veterans and military personnel. Various factors can contribute to this increased risk, in particular, mental health symptoms and chronic pain conditions. For example: [1][2]
- Exposure to traumatic events and combat, which can lead to self-medicating with alcohol and drugs.
- Emotional stress of reintegrating into civilian life following combat, which can lead to self-medicating.
- High rates of mental health problems known to co-occur with substance use, including anxiety, depression, and PTSD.
- Injuries incurred during combat that require chronic pain medication like opioids, which carry a high risk for abuse and dependence when used long term.
- Norms in military culture that reinforce heavy use of alcohol or other substances.
Statistics indicate that the prevalence of substance use disorder (SUD) diagnoses among veterans of all ages is around 1 in 10, although this figure is much higher among 18- to 25-year-olds, suggesting an age-related risk factor. [1]
It is also very common for veterans to have a diagnosis of, or meet diagnostic criteria for, co-occurring SUDs and mental illness, particularly post-traumatic stress disorder (PTSD), highlighting the link between mental illness and substance use among veterans. [2][3]
PTSD and substance use in veterans
PTSD is more common among military veterans than in the general population, reportedly affecting 15-17% of veterans returning from Iraq and Afghanistan compared to 6-8% of the general population. [2]
PTSD can increase the risk of SUDs, as it is common for people with PTSD to use substances as self-medication. [3] For example, people with PTSD may experience symptoms such as insomnia, aggression and violence, anxiety, depression, and flashbacks. Alcohol and drugs might be used to numb or avoid these symptoms, thereby increasing the risk of addiction. [2]
Research suggests that SUDs are 3-4.5 times more common among veterans with PTSD and depression than those without. [3] Additionally, veterans self-reported a link between SUD and PTSD symptoms, with 85.3% recognizing worsening PTSD symptoms with increased substance use, and 61.8% recognizing improved PTSD symptoms after a decrease in substance use. [2]
Common substances misused by veterans
The most commonly misused substance by veterans is alcohol. One report indicates that 65% of veterans entering a treatment program state that alcohol is their most prevalent substance use issue. Comparatively, alcohol use disorder (AUD) among the general population is around half as prevalent. [4]
Research also indicates that veterans with high levels of combat exposure are far more likely to engage in heavy and binge drinking (26.8% and 54.8%, respectively) compared to other military personnel (17% and 45%, respectively), indicating a strong risk factor. [1]
The prevalence of prescription drug use and misuse among veterans is increasing, with one study indicating a rise from 2001 to 2009 of 17% to 24% of veterans with an opioid prescription. [5] Opioid prescriptions are higher among those with PTSD (17.8%) than those with other mental health conditions (11.7%) and those with no mental health diagnosis (6.5%). [6]
Reportedly, illicit drug use is not higher among veterans than in the general population. [1]
Addiction treatment options for veterans
Veterans who experience SUDs can seek professional treatment. It may be necessary to seek professional help if substance use is increasing, causing a worsening of mental or physical well-being, impacting interpersonal relationships, or causing detrimental effects on financial or housing stability.
Various treatment options are available to veterans through the VA, which provides integrated care for both SUDs and mental health symptoms. The VA covers a full spectrum of treatment for addiction, including medical detox, inpatient rehab, intensive outpatient and outpatient therapy, and medication-assisted treatment. [7]
Preventative screening
The VA has implemented Screening, Brief Intervention, and Referral to Treatment (SBIRT) to help recognize and address the high rates of AUD among veterans. SBIRT screens the individual’s drinking behaviors, helping to identify those at high risk of developing AUD, so that intervention can be implemented as a preventive measure. [1]
Depending on the individual’s needs, brief intervention can be provided, or a referral to specialist services can be made for a more comprehensive treatment program.
Behavioral and psychological interventions
Various therapies can be provided for veterans with SUDs, which can also be used to address co-occurring mental health conditions, such as PTSD and depression. Depending on the severity of the substance use disorder, treatment may be provided in an inpatient, intensive outpatient, or outpatient setting. Some of the more common types of therapy used to treat veterans with substance use disorders include: [1][7]
- Cognitive behavioral therapy (CBT): CBT can help veterans recognize and adapt harmful behaviors and thoughts, learn coping strategies to manage mental health and substance use symptoms, and develop tools to manage signs of relapse.
- Contingency management (CM): CM provides incentives to reach and maintain recovery goals and abstinence, which can be beneficial for veterans with SUDs.
- Motivational interviewing (MI): MI helps veterans recognize their personal motivations and goals, helping to strengthen their desire to change.
- Trauma-focused therapies: Trauma-focused therapies involve exposure-based techniques, during which the individual revisits their trauma memory with professional guidance and support in order to gradually reduce and overcome its impact.
Pharmacological interventions
Medications can be a crucial part of SUD treatment for veterans and might include: [7]
- Alcohol use disorder medications, such as disulfiram, topiramate, acamprosate, and naltrexone, which can help minimize cravings and withdrawals.
- Opioid use disorder medications, such as buprenorphine, methadone, and naltrexone, which prevent withdrawals and relapse.
- Tobacco use disorder medications, such as nicotine replacement therapy (NRT) and bupropion.
Inpatient or residential programs
Residential programs, or inpatient care, can be beneficial to veterans with SUD or dual SUD and mental health diagnoses. These programs might be suited to people with very severe symptoms who require extensive support, particularly if supported withdrawal is required. Veteran-centered residential programs are available across the country.
Support groups
Veterans can find local support groups that meet their needs. For example, some support groups, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), can be used to support substance use recovery without a veteran focus.
Alternatively, veteran-specific support groups are available across the US, which may be preferable, particularly to those with combat-related trauma or other mental health symptoms. There are many available, although they may vary by area, including Wounded Warrior Project and The American Legion, as well as VA-run groups.
VA addiction treatment services eligibility
Veterans who are not yet utilizing VA health care can sign up online to apply for VA healthcare benefits. Eligibility requirements for this include all of the following:
- Military, naval, or air service, including the National Guard or Reserve.
- Did not receive a dishonorable discharge.
- Meet at least one of the following service requirements:
- At least 24 months of continuous service or a complete active-duty period.
- Discharge related to a service-related disability.
- Discharge related to a hardship or “early out”.
- Served prior to September 7, 1980.
Veterans can also find their nearest VA medical center, where they can speak with a community care provider about available options in their area, or can search the VA directory for SUD programs. They can also contact their primary care provider to make a referral to these services.
Private and community-based rehab options
In some cases, veterans may prefer to access private or community-based rehab options. These options may incur higher costs, whereas VA services are often free or low-cost, although they tend to offer:
- Faster access to treatment.
- More luxury facilities with more privacy.
- Specialized care, with additional therapies including holistic therapies.
Sometimes, VA provides care through these services if VA providers are unavailable. In these instances, VA will pay for these services.
Barriers to treatment in military and veteran populations
Veteran and military populations may experience barriers to treatment, including: [8]
- Difficulty accessing VA services due to issues such as limited availability of providers, particularly among those living in rural areas.
- Fear of stigma from others or self-stigma.
- Concerns about the impact on employment after seeking treatment.
- Financial concerns.
- Reluctance to seek help or denial of the severity of symptoms.
- Concerns about consequences and ability to serve for active duty personnel.
How families can support veterans in recovery
Families can support veterans in recovery by learning more about the specific symptoms and conditions that their loved one might be experiencing and by attending family support groups, such as Al-Anon or Nar-Anon, which offer support and guidance for friends and family of people with SUDs.
They may also wish to be involved with Caregiver Support Programs offered by the VA, which family members of VA-enrolled veterans can access. These programs provide education, skills training, coaching, self-care, mentoring, and other forms of support for individuals in a caregiving role.
If veterans or their families are worried about a veteran and require urgent assistance, call 911 or the Veterans Crisis Line at 1-800-273-8255.
