Veterans and addiction

DEFINITION: Military veterans and active-duty service members are at an increased risk of developing substance use disorders (SUDs) compared to civilians because of the high-stress nature of their jobs. Combat-related stresses and traumas often result in depression, anxiety, or post-traumatic stress disorder (PTSD), which further increases the risk of substance abuse. Military and civilian mental health specialists continue seeking the best practices and implementing programs to support the mental health and SUD needs of veterans.

Combat-Related Stress Disorders

Substance abuse and SUDs resulting from combat trauma or PTSD are not unique to veterans of twenty-first-century wars and conflicts like Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Veterans of World Wars I and II, the Vietnam War, and earlier campaigns also presented classic symptoms of PTSD, though it was poorly understood. Researchers have studied the disorder for decades, and twenty-first-century data increasingly guide treatment and prevention programs and policies toward success.

In their 2008 book After the War Zone: A Practical Guide for Returning Troops and Their Families, Laurie B. Slone and Matthew J. Friedman recommend that military personnel with PTSD and a SUD be treated for both conditions concurrently. PTSD and SUDs were grossly underdiagnosed among military service members in the early 2000s, largely because both disorders carry a heavy stigma in the military. If either condition was reported on one’s medical record, the person faced restrictions from military school opportunities, their mission readiness was impacted, and they could be excluded from pursuing a future defense or law enforcement career. Further research confirmed Slone and Friedman's assertion that treating SUDs in combination with underlying mental health conditions is the most effective treatment option. Though the stigmas and barriers to mental health care continued to exist in the military decades later, services, education, and prevention measures improved exponentially.

Estimates vary, but up to 20 percent of US veterans experience some form of PTSD in a given year, and, according to the Addiction Center, two in ten veterans experiencing PTSD also have a SUD. In a 2009 Social Work journal article, specialists pointed out that 25 percent of the more than 100,000 veterans treated by the US Veterans Administration (VA) health services received a mental health disorder diagnosis. More than one-half of these veterans were diagnosed with both PTSD and a substance use disorder. In addition, an estimated 75 percent of veterans experiencing homelessness have a substance use disorder. As the stigma surrounding mental health treatment decreases, veteran mental health treatment has increased. The VA treated nearly 1.1 million veterans in 2016 and 1.7 million veterans in 2024 for mental health needs, primarily PTSD and SUDs.

Research indicates that between 14 and 30 percent of veterans of OIF and OEF developed a mental health condition at some point, such as PTSD or major depression, requiring treatment. Yet, less than 50 percent of these veterans received mental health treatment. These untreated conditions can influence problematic substance use. Additionally, veterans may experience chronic pain or other health issues related to their service that increase the risk of developing a substance use disorder. According to the American Addiction Centers, by the mid-2020s, 11 percent of all veterans treated by the VA presented with a substance use disorder; 80 percent of cases involved alcohol, 27 percent involved illegal drugs, and 7 percent involved both.

Substance Abuse Treatment

Service members who experience trauma, which may or may not lead to PTSD, often experience anxiety, anger, depression, and chronic nightmares. In an attempt to self-medicate, many begin or increase their use of alcohol, cigarettes, chewing tobacco, or illicit drugs. In the mid-2020s, alcohol was the primary substance used by 65 percent of veterans entering treatment facilities, which was double the rate of the civilian community.

In the first decades of the twenty-first century, mental health medicine researchers became increasingly convinced that addiction among veterans was directly related to the stresses of deployment and combat and that the treatment of SUDs among war veterans must occur in tandem with treatment for combat-related stress disorders like PTSD. Furthermore, specialists found that recovery strategies should involve psychological therapy, address spiritual issues, and focus on relaxation techniques and anger management. Because PTSD and substance abuse are chronic and dangerous disorders that are extremely difficult to treat, veterans, their family members, and care specialists should expect follow-up therapies, such as twelve-step programs and other support groups, to continue for several years following initial treatment.

Many service members and veterans experience a degree of distrust in relying on the government to treat mental health conditions. Some began seeking treatment at the community level rather than through the VA or a military hospital. Recognizing this shift, the VA began partnering with community organizations to create Veteran Community Partnerships (VCPs), such as the Veterans Community Care Program. These resources include support groups, impulse-control programs, and soldiers-helping-soldiers programs, in which soldiers are trained to help their peers handle combat-related stress.

Outlook

Through the first decades of the twenty-first century, research continued to emerge concerning the prevalence of SUDs in the military population. This research guided education and training, program development, and policy changes that increased and improved mental health and SUD treatment options for veterans and military members. In 2006, the Substance Abuse and Mental Health Services Administration (SAMHSA) and Treatment Communities of America held the National Behavioral Health Conference on Returning Veterans and Their Families to facilitate collaboration between VA services and mental health practitioners and specialists in the private sector. In July 2010, the US National Institutes of Health (NIH) announced the approval of $6 million in federal funding to support research by institutions in eleven US states specializing in SUDs among military personnel, veterans, and their families. The National Institute on Drug Abuse (NIDA) partnered with the VA to award grants earmarked for investigating the links between deployment and combat-related trauma with the prevalence of substance abuse, mainly among veterans returning from Iraq and Afghanistan. The VA's National Center for PTSD and NIDA continued to collaborate in subsequent years to research and address the intersection of military service, mental health, and SUDs.

Further research in the private and public sectors indicated that the most vulnerable individuals are in the military community. Younger female soldiers were most likely to be diagnosed with PTSD, while young male soldiers were more likely to be diagnosed with SUDs. However, one in three veterans who sought help for SUD in the late 2010s and early 2020s were diagnosed with PTSD upon examination. Similarly, one in five veterans who sought help for PTSD were diagnosed with a SUD upon examination. This data highlights the link between PTSD, SUDs, and military service and provides support for the combined treatment of these conditions.

Bibliography

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Slone, Laurie B., and Matthew J. Friedman. After the War Zone: A Practical Guide for Returning Troops and Their Families. Da Capo Lifelong Books, 2008.

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