It’s often said that military service is a tremendous act of sacrifice and service to our country. But, the sacrifice typically doesn’t end when the service is over. Veterans of the United States military face challenges while on tours of duty and when they return home and begin the new task of becoming a member of the community. However, military service is demanding and combat is, by nature, a danger to both your body and your mind. Injuries come with obvious difficulties, but mental health issues, because of trauma or head injuries, can be harder to notice. Mental issues, depression, injuries, and other adversities put veterans at a higher risk for substance abuse disorders (SUD).
How are Veterans Getting Addicted?
Alcoholism is the most common substance of abuse among veterans. It’s a major part of American culture and a quick option for immediate but temporary release from a wide range of mental illness symptoms. However, it ultimately makes these disorders much worse.
Veterans are much less likely to use illicit drugs than the general American population. However, combat-related injuries are often treated with opioids. If an individual has other addiction risk factors, they may develop a chemical dependence that leads to pill addiction and in some cases, heroin use.
The numbers show a disproportionate rate of drug and alcohol use disorders among U.S. veterans. One in 15 veterans had a substance abuse problem in 2013, accounting for 1.5 million people. Each military engagement affects its soldiers differently. Pre-Vietnam veterans experienced SUD rates of 3.7 percent. After Vietnam, the rates climbed, and after 2001, SUD rates were as high as 12.7 percent among veterans. The national average for people over the age of 17 with an SUD is about 8.6 percent.
These numbers show a significant problem for active military member, veterans, and their families. However, there are organizations working to provide solutions for military servicemen and women who are in need. The fight against addiction is complicated and difficult on all fronts, but the first step for you is to understand the problems and the solutions that are available. The following guide will discuss the problem of addiction among veterans and the solutions available to those who are seeking help for a substance abuse disorder.
Why Veterans and Addiction?
Drug and alcohol abuse is fairly low for active duty servicemen and women, but veterans who return home experience addiction at a high rate and veterans of the most recent wars in Iraq and Afghanistan have an SUD rate of about 10 percent. Alcohol and opioids are the most common sources of veteran addiction and the obstacles that they face can shed some light as to why.
Military personnel returning from active duty face a number of challenges, many of which contribute to alcoholism and addiction, including:
- Readjusting to civilian life
- Reconnecting with old friends and loved ones
- Adjusting to cultural norms outside the military
- Setting up VA benefits and services
- Finding a career path
- Dealing with sustained injuries or handicaps
- Addressing mental health issues due to trauma
- Treating mental issues due to head injury
- Dealing with long-term pain symptoms because of an injury
Substance abuse often begins as a coping mechanism that leads to physical or emotional dependence. The challenges associated with a return from military service in many cases, increase the risk factors for substance abuse.
Bad Coping Mechanisms
Like anyone struggling with major challenges in their day-to-day life, psychoactive substances seem like helpful coping options. They are often social, which allows you to connect with the people around you. Some drugs, including alcohol, can impair or suppress memories, allowing you to forget painful traumas, temporarily.
Plus, many drugs offer mood lifting or euphoric effects that can ease negative emotions. However, the effects are temporary and more dangerous in the long term.
Your coping response to bad feelings, negative circumstances, and adversity are closely tied to your overall mental health and the development of an addiction. In the cognitive behavioral model, relapse is said to start with a coping response. In mental illness, using alcohol or drugs as a coping mechanism can compound problems, leading to deeper psychological issues, health complications, and dual diagnosis.
Veterans and Opioids
When compared to the general U.S. population, veterans are less likely to use illicit drugs like cocaine and heroin. However, the opioid epidemic has affected the country and the world profoundly, because of a variety of factors. One factor is the use of powerful prescription opioids used to treat pain symptoms. Surgeries, injuries, and pain management are all treated with opiates like morphine and synthetic opioids like oxycodone. Recently, extremely powerful opioids like fentanyl have increased in medical and illicit use.
Narcotic painkillers have a long history of use in wartime, from the use of morphine in World War II to today’s field medicine. Soldiers need quick and effective pain medication and opioids are far and away the most effective. Unfortunately, they are also among the most addictive drugs. Still, it sees widespread use both at home and on the battlefronts. Military members are prescribed opioids three times as much as American civilians. In some cases, pain from injuries sustained during service continues when a soldier returns home. That, also, may be treated with opioids. In relation to the total number of people who are prescribed opioids, only a small percentage of people develop addictions. Of the 92 million people in the U.S. that were prescribed opioid pain medication,2 million developed a substance use disorder. While the percentage is low the numbers are high. The VA reports that around 68,000 veterans are addicted to opioid painkillers.
Opioids are highly addictive, and prescription abuse can sometimes lead to heroin use. Once you begin using heroin, you increase your risk of contracting infectious diseases and the risk of taking a lethal dose.
Veterans and Alcohol
Alcohol is a significant concern for military families, and the problem has slowly increased over the past few decades. It represents the most widely used psychoactive substance that’s abused by veterans. Part of the reason alcohol is such a significant problem for vets, is that alcohol use disorders are closely tied to depression and post-traumatic stress disorder. Alcohol is generally used in self-medication, which is the clinical name for using drugs or alcohol to relieve psychological symptoms as opposed to strictly for recreation. Self-medication is a form of negative coping that leads to more consequences than it solves.
Alcoholism and depression is a common dual diagnosis, and the two share causes, symptoms, and feed into each other. Alcohol is in the depressant category of drugs which can ultimately worsen depression symptoms. When euphoria and relaxing effects wear off, depression symptoms can return more severe than before.
Effects of Addiction Among Veterans
Substance abuse disorders can bleed into every aspect of your life. Depending on your drug of choice, it can have a serious impact on your health. Alcohol is the most commonly abused substance among veterans and it can lead to several serious diseases including liver disease, heart problems, and cancer. However, it can also impact your relationships, your job, and your socioeconomic status. Veterans who abuse drugs and alcohol are more likely to experience the following consequences:
- Long-term Negative Health Effects: Again, alcohol is linked to several serious medical complications. And, while veterans are less likely to abuse illicit drugs, those who do are at risk for contracting infectious diseases. Heroin and other drugs injected intravenously.
- Homeless: Sadly, homelessness has historically been a serious problem for the population of veterans in the U.S. This is, in part, because many are addicted, lose jobs, and become unable to support themselves. Organizations, including the Department of Veterans Affairs, have made significant strides in bring the homeless veteran population down by providing support to those in need. Still, there are around 40,000 homeless veterans on any given day.
- Challenges At Home: Addiction is often referred to as a family disease because of the way it radiates out to the loved ones in your life. If you develop a substance use disorder, there is a good chance that your drinking or drug use is going to bleed into your home life. Dealing with an addicted family member can be challenging to a family, especially one that has endured recent tours of military service and being away from one another.
- Suicide And Self-harm: When mental health disorders like PTSD and depression are mixed with alcoholism or drug addiction, suicide and self-harm is an extreme but common result. Alcohol, in particular, has been linked to an increased risk of suicide, especially when co-occurring psychological disorders are present. Many suicide prevention programs focus on limiting alcohol use for that reason.
Active Military Members and Addiction
Even active duty military members are susceptible to drug dependence and addiction. Plus, the military has a unique culture that can sometimes make detecting and treating addiction difficult. Addiction has a negative social stigma and illicit drug use is often under zero-tolerance policies, so people struggling with addiction often hide it for as long as possible. Plus, like veterans, active members that have seen combat or experienced injuries are at greater risk of developing an addiction.
Active Duty Substance Use Disorder Statistics
During active duty, it can be difficult to sustain or even get involved with illicit addictive drugs. According to statistics from the Department of Defense, only 1.2 percent of active military personnel used an illicit drug in 2011. In the same year, 24.9 percent of active service members used prescribed medications and 20 percent of those were pain relievers, which includes opioids. Only 1.3 percent reported misusing prescription drugs. Though only small percentages report substance use disorders and abuse, the majority of active duty personnel are tested for drugs, at almost 90 percent.
Drinking is a much clearer problem in the military than illicit drug use. In 2011, military members reported that 39.6 percent of active drinkers engaged in binge drinking within a month of the survey. Marines represent the most common binge drinkers at 56.7 percent. Though daily duties demand sobriety, during leave and downtime, binge drinking is a significant risk.
Since your responsibilities in active duty are so demanding, drug addiction and alcoholism most commonly develop after active duty is completed. However, practices and experience that may contribute to an eventual substance use disorder may start during active duty. Employing SUD and mental health issue prevention practices may help service members avoid issues later in life. The Department of Defense has also developed addiction prevention strategies since the 1970s and they currently strongly discourage illicit drug use, tobacco use, and heavy drinking.
However, personal prevention strategies may be more effective than policy initiatives. Setting goals and limitations for yourself can help you avoid slipping into drug or alcohol abuse. It’s also important to pay attention to mental health to avoid self-medicating. If you notice a problem, taking action sooner rather than later can help avoid a serious problem. If you notice a problem, there are a number of people you might be able to reach out to, including:
- A Drug and Alcohol Program Advisor
- Your CO, XO, OIC, or another person in command.
- Your Chaplain
- DoD Medical Personnel
- A Family Support Center counselor
Addiction Treatment for Veterans
The U.S. Department of Veterans Affairs offers programs that can help with substance abuse disorders. Services are based on scientifically proven treatment options. Common options include group therapy, individual therapy, and medications. The VA even offers treatment options for tobacco addiction. VA benefits are a solid option for many who are looking for addiction recovery. However, veterans seeking help from the VA often encounter long wait times and a wall of bureaucracy that stand in the way of timely care.
The VA is one of the largest government agencies in the U.S., but it often fails to help the thousands of returning soldiers who need help dealing with mental health issues and substance use disorders. However, the VA isn’t the only option for people seeking addiction treatment. Today, most insurance companies cover addiction treatment at centers like the Palm Beach Institute, including most USAA policies. USAA is an insurance company that exclusively serves veterans, active duty military members, and their families and it comes with a number of benefits.
Post-Traumatic Stress Disorder and Addiction
Sleepless nights, frightening flashbacks, and reliving traumatic events can take its toll, especially when it lasts longer than three months. People who suffer from these symptoms may seek any relief they can find, even if it means using or abusing chemical substances that ultimately do more harm than good.
One of the most significant contributing factors to veteran substance abuse is post-traumatic stress disorder (PTSD). Over 200 million people in the United States have experienced trauma at some point in their lives, and 20 percent of those people develop PTSD, meaning that 31 million people have struggled with the disorder at some point in their life.
Combat veterans are more likely to experience both trauma and PTSD, with 10 to 30 percent developing the disorder at some point during their lifetime. Women in the military are at a higher risk of being affected by PTSD, and 71 percent of PTSD cases among women in the military are due to sexual assault.
PTSD has been linked to a number of health and behavioral issues including depression, insomnia, and substance abuse disorder. It’s closely tied to addiction and alcoholism in particular. Approximately 20 percent of veterans with PTSD also have a substance use disorder. The two disorders may feed off of each other, worsening symptoms, especially depression. Even if you don’t have a drinking or drug use disorder, your chances of developing one after suffering from post-traumatic stress disorder increase.
What is Post-Traumatic Stress Disorder?
PTSD is a mental illness that’s triggered by a traumatic event. Traumatic events can be shocking, scary, dangerous, painful, or horrifying to a degree that overwhelms you. Fear and shock is a natural response to potentially dangerous events, and it helps us kickstart our adrenaline, causing the fight-or-flight response.
This is designed to help us quickly escape or fight our way out of danger. However, in some circumstances, fear can cause lasting effects. Poor coping responses in the wake of a traumatic event can lead to mental health issues that last for years.
PTSD can occur directly after an event or series of events, or years later. In some cases, it can last longer than three months and symptoms can cause extreme distress, disrupting multiple areas of your life. PTSD involves a number of disruptive psychological symptoms, which include:
- Reliving or re-experiencing the event through flashbacks and nightmares
- Restless sleep and sleep disturbances
- Avoiding visual, auditory, olfactory, and emotional triggers
- Negative shift in beliefs about yourself or others (i.e. distrusting)
- Feeling constant jitteriness or alertness
PTSD symptoms can cause extreme anxiety, depression, and paranoia, and may also begin to rule your life based on the fact that you are constantly looking out for or avoiding potential triggers. A trigger is a term used in both addiction and PTSD, which means a stimulus that causes symptoms to occur. In addiction, this can mean something that causes intense drug cravings and eventual use of the preferred substance.
In PTSD, it can be something that causes a flashback, anxiety, or other symptoms. If an SUD and PTSD are co-occurring disorders, the same trigger can cause both trauma symptoms and cravings to drink.
There are several types of events that can begin PTSD. Generally, they involve harm or the threat of harm. There is still a lot to be learned about what causes PTSD and what allows people who experience trauma to recover without developing a disorder. Events that trigger PTSD include:
- Auto accidents
- Serious injuries
- Sexual assault
- Physical assault
- Childhood Trauma
- Witnessing disaster and destruction
- Witnessing death
Any event that overwhelms you and initiates your fight-or-flight response has the potential to cause PTSD, especially if you don’t receive any kind of support after the event.
What Causes Post-Traumatic Stress Disorder?
Trauma isn’t rare for the average person. In fact, about 60 percent of men and 50 percent of women will experience a traumatic event at least one point during their life. Active servicemen and women may have a higher likelihood than that. However, only up to 8 percent of Americans develop PTSD at least once in their lives.
The numbers are higher for military members with 11 to 20 percent in Operation Iraqi Freedom and Enduring Freedom, 12 percent in the Gulf War, and 15 percent during the Vietnam War (30 percent of Vietnam Vets have experienced PTSD at some point in their lives.) If trauma is so common and trauma is what triggers PTSD, then why don’t more people have the disorder? Well, there are a number of factors in causing PTSD and not everyone experiences trauma in the same way.
Some have suggested that the circumstances surrounding a traumatic event have more to do with causing PTSD than the event itself. According to the American Journal of Public Health, African American soldiers in World War II were more likely to develop PTSD than other servicemen. The segregated battalions were isolated and receive limited support from the rest of the military, which may have contributed to lowered morale and PTSD after traumatic events. The circumstances surrounding civilian trauma can also be very different than combat trauma.
When someone is in a car accident, they will typically be treated by a paramedic or doctor, they may be given time off work, and are generally given time to process. Accidents have clear beginnings and ends. Combat can be ongoing. A traumatic event in a military engagement may not allow a soldier time to process before having to continue. Other common risk factors include:
- Getting injured in a traumatic event
- Witnessing a death (especially a love one)
- Early childhood trauma
- Feeling extreme fear/ horror during a traumatic event
- Having limited social support after the event
- Dealing with stress immediately following event (i.e., the grief of losing a loved one)
- A history of mental illness
- A history of substance abuse
There is still much we don’t know about post-traumatic stress disorder, but researchers continue to study the impact of the above factors and what can be done to avoid the effects of trauma.
Who Does Post-Traumatic Stress Disorder Affect?
Though veterans have a higher likelihood of developing PTSD, anyone can experience the disorder at any age. Children and teens are susceptible to PTSD but they typically respond differently than adults. They tend to react strongly and display different behaviors like bed wetting, talking less or not at all, or being clingy with parents. However, adults can still experience trauma at any point during their lifetime.
However, adults, especially veterans, are more likely to stigmatize mental illness following trauma, seeing PTSD as a sign of weakness. One study even reported that veterans avoided seeking treatment for fear of being labeled as dangerous or crazy. However, anyone who experiences the factors mentioned above is capable of developing PTSD. Avoiding a disorder after a traumatic event has less to do with mental fortitude (or toughness) and more to do with coping skills immediately following the event of trauma.
How Post-Traumatic Stress Disorder is Prevented
With trauma being so common, it might be an unavoidable part of life for some people. However, preventing PTSD doesn’t necessarily mean avoiding the events that trigger the disorder. Instead, it can be prevented by addressing the issue properly after the event occurs. With a proper coping response, you are more likely to get through trauma without developing PTSD. Effective post-trauma coping strategies include:
- Seeking out support from family and friends after an event. Talking through a traumatic event with someone you trust can help you vent stress and process your experience.
- Seek help with responsibilities following the event. Many traumatic events also give you extra responsibilities. If you are in an auto accident, you have to talk to police to fill out a report, talk to insurance companies, and find a new or temporary method of transportation. And that’s just if you didn’t sustain any serious injuries. Military engagements come with their own set of post-event responsibilities. Recruiting help with these responsibilities can give you time to process and recuperate.
- Find a support group for people who have gone through trauma. Talking with friends and family is great. But talking to people who have gone through similar situations can give you a unique feeling of being understood.
- Accepting and feeling good about your own actions during the event. Sometimes guilt is a source of PTSD. Negative feelings about your reactions during the event can cause you psychological pain. However, in the majority of cases, people couldn’t have reacted any differently without having to see the future. Trauma by nature is surprising and beating yourself up about your role only hurts you.
These strategies increase your resilience, or your ability to withstand trauma without long-lasting effects on your psychological health. However, when you feel like you are struggling to overcome a particular trauma, it’s important to seek help. Letting the problem grow or self-medicating with drugs or alcohol will only intensify the problem.
Post-Traumatic Stress and Substance Use Disorders
Self-medicating with drugs and alcohol as a way to find relief from PTSD symptoms is a common negative coping strategy. Unfortunately, it’s one that adds to your problems and ultimately worsens your symptoms.
Plus, alcohol is a depressant and when your brain becomes dependent on is, it can cause or worsen symptoms of depression. Finally, alcohol abuse is associated with a number of health complications. Even withdrawal symptoms can be fatal. Still, SUDs and PTSD are closely related and can quickly grow out of control. If you have PTSD and you feel like your developing a substance use disorder, it’s important to seek help as soon as possible.
How is Post-Traumatic Stress Disorder Treated?
PTSD can be treated with a number of therapies, some of which are often used in or alongside of addiction treatment. If you have a dual diagnosis of PTSD and an SUD, many addiction treatment facilities offer programs that address both simultaneously. Trauma is often an underlying issue in addiction, and addressing one and not the other might produce limited, temporary effects.
Eye movement desensitization and reprocessing therapy (EMDR) is a common treatment option in drug rehab facilities, including the Palm Beach Institute. It specifically addresses trauma with the goal of reprocessing painful or frightening memories. EMDR originally started with a therapist who would facilitate a discussion about the traumatic event in your past while having you focus on his or her finger while they moved it back and forth. While this may sound like hypnotism, the purpose isn’t to lull you into a catatonic or sleep-like-state. Instead, the idea is to have you focus on secondary stimuli while talking about a traumatic event.
It was at first thought that moving your eyes back and forth had a calming effect that took away some of the intensity of a painful memory, allowing you to talk about it and reprocess it in your mind. However, the therapy has also been performed with other secondary stimuli like tapping a finger. The specific biological reason EMDR is successful is currently unclear. Some believe that it works on your working memory while you access memories of the event. Another theory is that it engages the orienting reflex, which is a response to a change that is not strong enough to trigger a startling reflex.
One of the most common and most recommended treatments in addiction recovery is cognitive behavioral therapy (CBT). However, it can also be used to treat people with PTSD. CBT operates under the idea that thoughts, behavior, and feelings all influence each other. For instance, bad feelings can lead to negative thoughts which can lead to negative behavior like using drinking or drugs to cope. In CBT, you can learn to identify problematic thoughts and feelings and correct them.
In PTSD, CBT can be used to confront traumatic memories or even individual triggers. By reviewing what you think and feel, you can identify faulty thinking that leads to bad feelings and actions.
Treating Addiction in Veterans
Military service and combat put veterans at heightened risk for PTSD, alcoholism, and drug use disorders. When these issues start to take over your life, it’s important to call in help from the experts. Treatment is available that can help you get your life back.