Veterans and Addiction

Veterans often cope with stress after returning from multiple deployments. They may also suffer from illnesses and injuries that can contribute to a substance use disorder. Addiction delays an already complex social reintegration process and can have negative repercussions. However, the U.S. Department of Veterans Affairs offers treatment plans to support veterans as they recover from substance use disorders.

Many veterans wrestle with stress from deployments to combat zones. The stressful military life coupled with injuries and illnesses puts them at an increased risk for substance use disorders. A growing number of veterans turn to drugs to cope with the pressure of societal reintegration after the military.

With a 52.7 percent increase in outpatient veterans treated for substance abuse disorders from 1995 to 2013, it is undeniable that addiction is a major concern among the veteran community.

Between 2006 and 2009, the army reported that more than 45 percent of the 397 noncombat related deaths investigated were the result of an alcohol or drug overdose.

Drug Use After the Military

Readjusting to normal life is a difficult process for veterans. Out of the 23.4 million veterans in the United States, 7.1 percent met the criteria for a substance use disorder between 2004 and 2006.

Service members return from combat zones with a myriad of problems including post-traumatic stress disorder (PTSD), depression or traumatic brain injuries. While some of these injuries and mental illnesses require the use of opioid pain relievers, a portion of service members misuse them, leading to addiction.

Prescription Medications

VA records disclosed that the two most common prescription drugs veterans abuse after the military are opioid pain medications and benzodiazepines.

In an audit of 20 VA rehabilitation facilities, 10 percent of patients received more than a week’s supply of narcotics at one time to self-administer. Widespread availability and lax supervision from doctors are major contributors to increased drug abuse among veterans.

Pill bottle with capsule pills

Sixty-four percent of Iraq and Afghanistan veterans were prescribed at least one opioid in a one-year period. Of these veterans, four out of 10 had long-term opioid prescriptions. This is concerning because prescription holders are three times more likely to misuse prescription opioids than those without a prescription.

In 2011, the Journal of Pain and Symptom Management (JPSM) reported that 16.3 percent of veterans shared prescriptions to manage their pain, and 29 percent of veterans resorted to alcohol or street drugs to treat pain. Thirty-five percent of veterans used a combination of both. These dangerous practices increase the chances of an overdose.

Sixty-four percent of Iraq and Afghanistan veterans were prescribed at least one opioid in a one-year period.

Addiction

Veterans who abuse drugs blame their addiction on the horrors of war. To them, alcohol and drugs are an escape.

Researchers from the Washington University School of Medicine carried out a study on Vietnam War veterans and heroin use upon their return. The study, originally published in 1977, found that 35 percent of soldiers tried heroin while in Vietnam and 19 percent developed an addiction.

It is clear that combat exposure highly correlates to binge drinking among service members. In 2008, NIDA reported that 27 percent of active duty personnel who had been in combat engaged in weekly binge drinking.

Illicit drugs graphic

As they transition to life after the military, some former military members struggle with alcoholism. A 2007 study published in the Journal of the American Medical Association revealed that 12 to 15 percent of Iraq and Afghanistan veterans had an alcohol use problem in the three to six months following their release.

Numerous studies link addiction to traumatic stress from being at war.

35 percent of soldiers tried heroin while in Vietnam and 19 percent developed an addiction.
1 out of 10 Iraq or Afghanistan veterans has a substance use disorder.

Addiction and PTSD: A Vicious Circle

People with PTSD often resort to alcohol and other drugs as a coping mechanism. Often, the coping mechanism turns into an addiction. The VA reports that people who used drugs and alcohol before a PTSD diagnosis remained faithful users after. However, PTSD is a causational factor for a potential addiction.

The relationship between PTSD and addiction is clear. According to the VA, more than one in five veterans with PTSD have a substance use disorder and one out of three veterans who seek addiction treatment has PTSD.

  • Three out of four Vietnam War veterans with PTSD meet the criteria for a substance use disorder.
  • One-third of veterans who seek drug addiction treatment meet the criteria for PTSD.
Compared with other Iraq and Afghanistan war veterans, those with PTSD exhibited higher-risk of opioid use and adverse clinical outcomes, including injuries and overdose.

Seal, K.H. et al., Journal of the American Medical Association, 2012

Repercussions of Addiction in Members Suffering from PTSD

Combined with a substance use disorder, PTSD can spiral into a series of problems including:

  • Health problems such as physical pain
  • Relationship trouble with family and peers
  • Job retention difficulty
  • Challenging societal integration

Several veterans who suffer from PTSD resort to drugs and alcohol to self-medicate, but self-medication causes symptoms to worsen in the long run. In cases where the person suffers from insomnia, substance use alters the quality of sleep, and the user feels groggy and restless.

Some PTSD symptoms include a surge of emotions, paranoia and a feeling of alienation from others. The intake of drugs and alcohol magnifies these symptoms, making these feeling worse.

Drugs and alcohol are not helpful for people with PTSD. The substances cause them to avoid the traumatic memories associated with their time in the military, which delays treatment.

The Link Between PTSD and Overdose

Numerous studies have shown that extensive use of prescription opioids and antidepressants puts veterans at a high risk for fatal overdose.

According to a 2012 study by the Journal of the American Medical Association (JAMA), veterans diagnosed with PTSD-associated mental illness were more likely to receive opioid prescriptions. The authors further remarked that the veterans were prone to alcohol and drug use disorders, received higher and more frequent doses of opioids and had prolonged opioid use.

The research linked prescription opioids to adverse clinical outcomes such as injuries, central nervous system depression and overdose in veterans returning from Iraq and Afghanistan.

Veterans with PTSD were more likely to be prescribed a benzodiazepine with more than one opioid at the same time. The mix of prescription pills heightens the risk of overdose in veterans.

Another study published in the American Journal of Psychiatry observed a correlation between accidental overdose and co-occurring disorders in veterans receiving care from the Veterans Health Administration. The researchers also found that the rate of accidental overdose doubled for VHA patients compared to the regular U.S. population.

29 to 42 percent of Afghanistan and Iraq veterans experienced difficulties reintegrating with their friends and family.

Aftermath of Veteran Drug Abuse

Mental and substance use disorders were the primary cause of hospitalization among U.S. troops in 2009. Aside from the plethora of health consequences from alcohol and drug abuse, substance use disorders bring a number of other issues to veterans’ lives.

US Marine Soldier Coming Home
Drunk Homeless Veteran in Landfill
Man in prison cell looking sad and wanting to get out

Social Reintegration

Veterans who return with mental and substance abuse issues are more likely to face difficulties in their personal and professional lives. Veterans who use substances cause distress to their immediate families with their change in behavior.

Securing employment after service is difficult for veterans. A report funded by VA Health Services Research and Development pointed out that 30 percent of young veterans faced unemployment issues after their release from the military in 2011.

The study revealed that nine percent of Iraq and Afghanistan veterans have been arrested since returning home. Alcohol, drug misuse and high levels of anger caused by PTSD contributed to the arrests. Criminal records related to drug misuse make it even more difficult to acquire a job.

Homelessness

Veterans account for 11 percent of the homeless population. With PTSD and substance use disorders making it difficult to find employment, veterans often do not have the financial resources to afford a home.

According to a survey carried out by the 100,000 Campaign, three out of four homeless veterans reported having a substance use disorder. A 2014 report by the Substance Abuse and Mental Health Services Administration stated that homelessness among veterans who abuse substances makes treatment difficult.

  • One out of five veterans in addiction treatment was homeless, according to a 2014 report.
  • 27.3 percent of homeless veterans suffered from mental illness, physical illness and a substance use disorder.

Incarceration

Veterans are victims of the ripple effects of war. They return with injuries and illnesses that can lead to addiction if left unattended. When drug abuse conflicts with the law, the result is incarceration. Sixteen percent of veterans are in prison for drug-related infractions.

According to a 2012 report by the Drug Policy Alliance, more than 140,000 veterans were in prisons or county jails in 2004. There is concern that these figures will magnify in coming years because of discharge rates and an increasing number of veterans.

Studies show that substance misuse and addiction are major contributing factors to veteran incarceration. Nine percent of Iraq and Afghanistan veterans reported being arrested, according to a national survey.

Veterans with substance use disorders need the appropriate level of treatment after they get out of prison. Many of them are susceptible to death by drug overdose after their release. Unfortunately, they face a number of obstacles that limit their access to services and resources.

  • 46 percent of veterans in federal prisons are there because of drug law infractions.
  • 38 percent of veterans in state prison received a less than honorable discharge, which may disqualify them for VA benefits.
  • 61 percent of imprisoned veterans met the criteria for substance use disorders.
As one of the largest providers of mental health care, the VA provides treatment for more than 1.1 million patients possessing a mental illness or substance use disorder

Treatment

Treatment is crucial to veterans if they wish to resume a normal life where they can thrive without substance abuse. Luckily, a combination of medication-assisted treatment and therapy has proven to be effective in helping veterans recover.

The VA offers different levels of treatment to cater to veterans afflicted with a substance use disorder. They also offer different options where veterans can seek treatment in case VA Care Centers are not available.

Veterans Affairs Assistance

As one of the largest providers of mental health care, the VA provides treatment for more than 1.1 million patients possessing a mental illness or substance use disorder. The VA offers comprehensive services regardless of the duration of treatment.

What the VA treats:

  • Alcohol dependence — treated with medication and counseling
  • Tobacco cessation — treated with medication or patches
  • Opioid addiction — treated with medication and therapy
  • Co-occurring disorders such as PTSD and depression
  • Relationship or interpersonal communication issues
United States Department of Veterans Affairs patch

Counseling and Therapy

The VA also provides veterans with a list of resources to help them achieve a substance-free life. For the treatment of substance use disorders, VA centers are equipped with psychologists specialized in cognitive behavioral therapy, motivational interviewing, and motivational enhancement therapy.

Cognitive behavioral therapy teaches veterans to recognize negative behavior associated with substance use and work on changing their attitude to improve their lives. CBT encourages positive thinking in veterans and helps them shape their future. The veteran will meet a therapist once a week for 12 weeks.

Motivational Interviewing helps veterans find motivation to change substance using behaviors and focus on practices that are more constructive. MI is a conversation between the therapist and the veteran highlighting the reasons he or she wishes to make a change and the potential benefits that come with the change.

Motivational enhancement therapy is a structured approach that helps veterans stay away from alcohol and substance use. MET is useful as a stepping-stone to a level of care. The therapist will help the veteran determine the extent of his or her addiction issue.

Psychologist and despair soldier
The VA diagnosed 375,000 patients with a substance use disorder in 2007.

Levels of Treatment

To ensure that veterans have the substance abuse treatment they need, the VA provides flexible treatment options during the evening and on weekends. The organization has residential treatment options for veterans who live far from a VA facility or do not have fixed housing. The VA also has special programs designed to help women, current conflict veterans and homeless veterans.

Levels of care provided by the VA include:

Other Treatment Options

Treatment at VA facilities is not always readily available because of the increasing number of veterans and dependents requiring care. However, veterans have several options in case they need timely treatment:

  • Emergency cases allow veterans to use the nearest hospitals.
  • Pre-approved medical care allows veterans to receive routine outpatient services and some inpatient services through community providers.
  • Patient-Centered Community Care (PC3) is a network of providers that offer comprehensive services including mental health care.

Veterans with dishonorable discharges are not eligible for VA care; however, they can receive treatment at regular facilities treating substance use disorders.

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