2020 Guide to Substance Abuse in Veterans
Table of Contents
- Veterans Substance Abuse Statistics
- Signs of a Substance Abuse Disorder
- When Is It Time to Get Help?
- Common Causes in Veterans
- Long-Term Risks for Substance Abuse
- PTSD and Substance Abuse
- Substance Abuse in Female Veterans
- Addiction Treatment for Veterans
- Detox for Veterans
- Traditional Therapies
- How to Find Help
- Help for Veterans with Substance Abuse
Substance Abuse in Veterans
According to an article in the journal Substance Abuse and Rehabilitation, an estimated 11 percent of people seeking first-time care in the Veterans Administration health system report having a substance abuse disorder.1 The Veterans Administration has determined that men are more likely than women to experience a substance abuse disorder. The other group with higher rates of substance abuse was veterans aged 25 or under.
Veteran Substance Abuse by the Numbers
There are approximately 23.5 million veterans in the US today and 2.3 million active military service members. It is estimated that 1.5 million veterans had a substance use disorder in 2014.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 1 in 15 veterans suffered from a substance abuse disorder in the past year.2 This number can be broken down by the years of service. This includes:
- July 1964 or earlier (pre-Vietnam era): 3.7% 3.7% 3.7%
- August 1964 to April 1975 (Vietnam era): 4.7% 4.7% 4.7%
- May 1975 to July 1990: 7.7% 7.7% 7.7%
- August 1990 to August 2001 (including Persian Gulf War): 6.6% 6.6% 6.6%
- September 2001 and later: 12.7% 12.7% 12.7%
Alcohol is the most prevalent substance abused in the military.3 People serving in the military may turn to alcohol as a means to relieve stress and to socialize with other military personnel. As a general rule, the more often a person has been exposed to combat, the more likely they are to engage in heavy or binge drinking.
Another substance commonly abused in the military are prescription painkillers. Opioid prescriptions increased in the Veterans Administration system from 17% to 24% between 2001 and 2009. An estimated 46.9% of the prescriptions were for oxycodone, 39.5% were for hydrocodone, and 6.8% were for codeine. If a person had a diagnosed mental illness (such as depression or anxiety), they were more likely to have an opioid prescription than those who didn’t.
Abuse of Illegal Drugs
In the past month, an estimated 3.5% of veterans reported using marijuana in the past month compared to 1.7% for other illegal drugs.
Signs of a Substance Abuse Disorder
Doctors usually diagnose a substance abuse disorder by certain using criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). There are 11 criteria listed in the DSM-V, and a person has to meet two or more of these criteria for a doctor to diagnose them with a substance abuse disorder. These include:
Using the substance more and more over time or over a longer time than the person intended.
Trying to quit using the substance but being unable to.
Spending a significant amout of time using, recovery from, or obtaining a particular substance.
Having frequent, strong cravings for a substance.
Substance abuse interfering with home, school, or work-life.
Continuing to use a particular substance even if friends, jobs, or other relationships have been lost as a result of substance abuse.
Ending particpiation in activities previously enjoyed due to substance abuse.
Engaging in substance abuse in situations where a person may be put in danger. Examples include drinking and driving.
Continuing to abuse substances regardless of physical or psychological problems.
Having to use more and more of a substance to achieve the same effect.
Experiencing withdrawals from a substance when use stops.
In addition to these symptoms, veterans struggling with a substance abuse disorder will often be in denial about their condition. It’s common for people struggling with substance use disorders to blame others for their particular situation. For example, if they lose a job, it’s because they have a terrible boss or their superiors “don’t know how to run a business.” Sometimes, a loved one may even blame close family members, saying that their family members drove them to drink.
Ultimately, a substance use disorder will cause a person to experience one or all of the following symptoms:
Cravings: Strong cravings for alcohol or drugs.
Loss of Control: Losing control over how much or how often they use.
Tolerance: Using more alcohol as a means to achieve the same high as before.
Withdrawal: Experiencing symptoms like shaking, nausea, anxiety, or other symptoms. The severity and type of symptoms depend upon the substance and length of time of abuse.
When Is It Time to Get Help?
Medical experts consider substance use disorders as a chroninc medical condition and should be in the same group as high blood pressure, asthma, or diabetes.4 People suffering from visable conditions are likely to seek medical treatment to help improve their health. Seeking treatment for a substance use disorder shouldn’t be thought of as any different.
Questions to Ask Yourself
If you have some of the symptoms of substance abuse listed above, it’s time to seek help. If you still aren’t sure, ask yourself some of the following questions. If you answer yes to any, these could be a sign of a substance use disorder:
Has anyone ever told you that you should cut down on your drinking or drug abuse?
Have you ever tried to quit drinking or using drugs, but found you couldn’t?
Do you ever lie to other people about how much you are using or how often you use it?
Do you go through your prescription medications much faster than a doctor expects you should?
Have you ever felt ashamed or embarrassed about how your drinking or drug abuse?
Have you had problems with the law, your friends and family, or your job because of your drinking or drug abuse?
Have you ever blacked out due to your drinking or drug abuse?
If you answered yes to some of these questions, you could benefit from seeking help for a possible substance abuse problem.
Rock Bottom Misconception
A common misconception is that a person has to hit “rock bottom” before seeking treatment. This isn’t the case at all. If you’re starting to develop signs of a substance use disorder, it’s important to seek treatment as soon as possible. By seeking early treatment, it’s possible to reduce the risks for long-term physical and mental health problems related to substance abuse. You don’t have to lose everything before you decide it’s time to seek help.
Common Causes of Drug Use in Veterans
Several factors may contribute to a veteran developing a substance abuse disorder. Some of the biggest contributing factors include:
History of deployment
History of exposure to combat
History of pain from injuries sustained while in the military
Problems re-integrating into everyday society after leaving the military
History of interpersonal trauma, such as child physical or sexual abuse
Military personnel can experience many difficulties in re-integrating or returning to everyday life after service. Examples of these stresses include problems sleeping, chronic pain, violence in relationships, and traumatic brain injury.5 These stresses don’t only lead to substance abuse, they can also cause other mental health disorders.
Chronic pain is hard for veterans and their families to deal with. Some service members with chronic pain turn to drugs or alcohol to find some relief. However, substance abuse frequently leads to more problems, including divorce and the loss of other close relationships. Before leaving a veteran with chronic pain, spouses often exhaust themselves trying to provide care. Chronic pain is another injury that can be hard to see, making it harder to diagnose and treat.
Studies have shown that the rates of sleep problems in veterans are alarmingly high. In one study, 74% of veterans reported symptoms that would lead to a diagnosis of insomnia. Veterans with PTSD suffer even higher rates of insomnia.
Traumatic Brain Injury
Research from the Lone Survivor Foundation estimates that more than 300,000 veterans have suffered a traumatic brain injury.6 Most brain injuries of veterans fall into two categories, mild traumatic brain injury and post-concussive disorder. These injuries are not visible, so it is hard to see that the veteran is suffering. The symptoms of these brain injuries can be inconsistent, making the injuries hard to diagnose.
A 2009 report from the VA found that 81% of veterans with depression or PTSD engaged in one or more violent acts against their partner in the previous 12 months. The research also showed that half of the veterans with PTSD performed at least one severe act of violence in that time. That rate is more than 14 times higher than that in civilians. In 2005, the VA received almost 143 cases per week.7
Deployment Leads to Risky Behavior
Doctors associate a history of deployment with increased risks for problematic drinking, starting to smoke, engaging in risky behaviors, and using drugs.
Illegal Drug Use Increases After Active Duty
Doctors also know that rates of illegal drug use increase when a person leaves active duty. Of the veterans that admit to substance abuse treatment centers, an estimated 10% receive treatments for heroin addiction. An estimated 6% of treatment admissions are for cocaine use.
Zero-tolerance drug and alcohol policies deter veterans and military personnel from seeking treatment. Many veterans are afraid they may lose their jobs or healthcare coverage when they need help. This is a major roadblock to veterans getting the help they need.
VA Screening Tool
The Veterans Administration created a screening tool with questions that doctors are supposed to ask when a person seeks treatment. This tool is known as Screening, Brief Intervention, and Referral to Treatment.8 If the answers signal as alcohol use disorder, medical providers may give them a referral to a treatment specialist.
Trouble Getting Help
While there are known causes of increased risks for substance use disorders in veterans, there are also a lot of challenges that can sometimes prevent them from seeking the care they need. Examples of these challenges include lack of access to treatments (such as living far away from a Veterans Administration facility), fear of stigma or negative consequences for seeking treatment, lack of confidential services, and gaps in insurance coverage. While these concerns and fears are real, it’s important to realize that substance abuse can be deadly.
What Are the Long-Term Risks for Substance Abuse in Veterans?
According to an article in the journal Substance Abuse and Rehabilitation, an estimated 30% of suicides in military veterans were in veterans who struggled with drug or alcohol abuse.9 Additionally, an estimated 20% of veteran deaths from high-risk behaviors were due to alcohol or drug use.
The same journal also reports on individual substances abused. The report showed that veterans who abuse alcohol are more likely to experience interpersonal violence, poor health, and greater risk for death due to alcohol abuse.
- An Estimated 30% of Suicides in Military Veterans Struggled with Drug or Alcohol Use 30% 30%
Veterans who struggle with a substance use disorder are also at greater risk for homelessness.10 An estimated 11% of all adults experiencing homelessness are veterans. An estimated 70% of veterans who are homeless have a substance use disorder. Of the veterans in substance abuse treatment programs, an estimated 20% are homeless.
The Veterans Administration has programs available for veterans experiencing homelessness that can help address concerns such as substance abuse treatment, case management, housing assistance, and other vital services that can help find a home and the help needed to recovery from substance abuse.
- An Estimated 70% of Veterans Who Are Homeless Have a Substance Use Disorder 70% 70%
Veterans in Prison
48% of veterans in prison are diagnosed with a mental disorder and 55% of veterans in jail have been told they have a mental disorder. Combat veterans were more likely than noncombat veterans to be diagnosed with a mental health condition. Veterans in prison and jail were diagnosed with PTSD at about half the rate of nonveterans. 11
PTSD and Substance Abuse
Post-traumatic stress disorder (PTSD) is a medical condition known to contribute to substance use disorders, according to an article in the journal Substance Abuse and Rehabilitation.12 A traumatic event such as combat or a terrorist attack can cause a person to experience flashbacks to traumatic experiences as well as feelings of anxiety and depression.13 People with PTSD often report feeling “numb” to life and unable to enjoy the activities they once used to.
Using Substances to Get Temporary Relief
Sometimes, those with PTSD will try to cope with their feelings and flashbacks by turning to drugs or drinking. While these may provide a temporary escape, if a person doesn’t deal with their emotions, using substances to escape isn’t a long-term solution and will eventually lead to additional health issues.
Veterans With PTSD And Substance Use Disorder
The rates of veterans with PTSD and a substance abuse problem aren’t fully known because there are probably lots of people out there who struggle with both and don’t seek treatment. According to the Veterans Administration, an estimated 1 out of 3 veterans who seek treatment for a substance abuse also have PTSD. The Veterans Administration estimates that one out of every four veterans who have PTSD also has a substance use disorder.
Using Opioids to Cope with PTSD
An estimated 17.8% of patients with PTSD had an opioid prescription from the Veterans Administration. Unfortunately, people who have a mental health disorder like PTSD are more likely to experience a substance use disorder or another bad health outcome, like accidents, overdoses, or violence-related injuries.
It’s very important for people who struggle with PTSD to seek treatment at a place that addresses both the substance abuse and PTSD. People who have PTSD who don’t seek treatment for their condition after substance use treatment are more likely to relapse. If a person can’t find a place that treats both, they can seek treatment for one condition, then the other.
Females and Substance Use Disorder in the Military
According to an article in the journal Substance Abuse and Rehabilitation, the rates of substance abuse among female veterans increased by 81% from 2005 to 2019. According to the Veterans Administration, women are twice as likely as men to develop post-traumatic stress disorder and twice as likely to experience serious psychological distress following their military service.14 An estimated one in five women who have served in the military also report experiencing some type of military sexual trauma. Each of these conditions can contribute to female veteran substance abuse.
Many female veterans reported they are uncomfortable in seeking care for their substance abuse disorder. This could be for many reasons, including that there are many more males in treatment settings, and that females may worry seeking treatment could interfere with their childcare duties.
Females who receive care geared toward them are more likely to benefit from treatment. Each Veterans Administration facility has a Women Veterans Program Manager that can help women seek the specific treatments they may need for PTSD, substance abuse or both.
Addiction Treatment for Veterans
Trauma-informed treatment provides veterans the best chance of recovering and staying sober. This type of treatment tries to increase a veteran’s sense of safety and prevent re-traumatization.
During trauma-informed treatment, a service member will:
Accept the traumatic events
Learn new, more helpful, thoughts
Increase their resilience to tolerate more stress
Eliminate suicidal thoughts
Therapies Used in Trauma-Informed Treatment
A therapist may use the following therapies to help the veteran:
DBT: dialectical behavior therapy
ACT: acceptance and commitment therapy
EMDR: eye movement desensitization and reprocessing
Psychotherapy or therapy is a common approach to treating substance use disorders. This treatment involves having a person identify thoughts and behaviors that are increasing the likelihood a person will abuse a particular substance. Then, a person learns behaviors that make them less likely to relapse. They practice things like saying no if a person asks them if they want a drink or use drugs again.
Another common approach is called contingency management. This approach involves giving people rewards or incentives to stay sober. Examples include gift cards, movie tickets, or other benefits that may encourage a person to continue their sobriety.
Because veterans who struggle with substance abuse are more likely to be younger, they are also less likely to seek treatment at a traditional medical facility. For this reason, the Veterans Administration may use other approaches to help a person receive treatment. Examples include using Facebook or other Internet-based approaches to help a person participate in counseling. These approaches may help to reduce embarrassment from seeking treatment for a substance abuse disorder.
Psychotherapy is very important for a person who struggles with a substance use disorder, especially because it isn’t likely that it is their only medical condition. Many veterans who struggle with substance abuse also have a mental health disorder, such as PTSD or depression. Doctors can use psychotherapy approaches to help them treat both conditions.
The U.S. Food and Drug Administration (FDA) has approved certain medications to help reduce the likelihood a person who suffers from a substance use disorder will return to previous behaviors. The FDA has approved medicines for people who struggle with substance abuse. These include:
Acamprosate: This medication helps to reduce cravings for alcohol and the severity of alcohol withdrawal symptoms. Doctors think it works by stabilizing certain neurotransmitters in the brain.
Disulfiram: Also known as Antabuse, this medication causes a person to experience symptoms like nausea, vomiting, and flushing if they try to drink alcohol.
Naltrexone: This medication may help reduce cravings for alcohol. Some doctors also use this medicine to reduce cravings for opiates.
The FDA has also approved medications to treat opioid abuse. This includes addiction to medications like painkillers as well as heroin. Examples include:
Buprenorphine: This medication can help block receptors that make a person feel high when they use opiates.
Methadone: This is a painkilling medication that works on different opioid receptors to reduce pain but also doesn’t give off the same effect as heroin or other narcotics. Doctors have prescribed it for decades to help people stop abusing drugs. However, it is very long-lasting. As a result, a person must enter a methadone monitoring program to ensure the medication isn’t building up in the body.
Naltrexone and extended-release injectable naltrexone: These medications may help to reduce cravings for opiates while also reducing the likelihood that a person would feel high if they use opiates again.
Although the FDA hasn’t approved medications to treat other addictions like marijuana, cocaine, or methamphetamine, they are researching different approaches.
While medications designed to help reduce cravings and risks for relapse are available, studies indicate doctors prescribe these medications to fewer than 35 percent of patients in the Veterans Health Administration who report an addiction to opioid medications.15
Substance abuse is a chronic disease. Even if a person may not be using a substance, the potential for relapse is always there. That’s why doctors recommend continuous engagement in aftercare programs. These programs help keep sobriety as the main focus in life and overall health.
Some things may come up after participation in a rehabilitation program that a person doesn’t anticipate. Maybe one day they pass by a bar they frequented or see an old friend they used to do drugs with. Even a certain song or smell may trigger them to feel strong cravings to return to substance abuse. That’s why aftercare programs are so important – they provide a support network and medical professional to call if they find themselves struggling after achieving sobriety.
Even if a veteran doesn’t have access to a nearby Veterans Administration Medical Center, they may often have access to other resources and meetings. These include those for Alcoholics Anonymous or Narcotics Anonymous. These are free support groups that many people utilize to continue sobriety.
Access to VA Service
VA programs offer evening and weekend hours. Live-in options are in place for veterans who live too far from a VA clinic, suffer from unstable housing, or are currently homeless. There are specific programs for different types of veterans, like female veterans, veterans with a disability, and veterans experiencing homelessness.
Where Does the VA Provide Substance Abuse Care?
There are three main locations where the VA provides substance use disorder treatment,
Inpatient programs – full-time help in a hospital or medical facility
Residential treatment house – full-time help with less medical care provided
Intensive outpatient programs – part-time help while you live in your house
Detox for Veterans with Substance Use Disorder
One of the first steps to treating a substance use disorder is to go through detox. This is when a person stops using less of a particular substance or slowly tapers the substance off until they stop using it altogether. A treatment center’s staff can help the person determine what approach is best for them.
Detox Could Trigger Flashbacks
Because many veterans have experiences with PTSD, sometimes the detox process can trigger flashbacks, hallucinations, or otherwise painful memories. When this is the case, a doctor may recommend detoxing at an inpatient treatment facility. There, a person can receive around-the-clock care and support from staff members. They may also wish to take medications that make the withdrawal process less severe.
Withdrawal Symptoms Vary by Substance
Detox symptoms can vary based on the particular substance a person abuses. For example, in some people, alcohol withdrawals can trigger a condition called delirium tremens or DTs. While this is a rare occurrence, it’s more likely to happen in people who have been through detox before. Symptoms of DTs include seizures, extremely high body temperatures, and hallucinations. Because doctors know this condition can happen when a person withdrawals from alcohol, they’ll usually recommend a person goes through withdrawal at a medical facility.
Addiction to benzodiazepines like Valium, Xanax, or Ativan can also cause seizures. Some people take these medications to reduce the risks they’ll have seizures. When a person stops taking them, their body may go into overdrive and trigger a seizure. For this reason, most doctors recommend a tapering program or monitoring at a medical facility when a person goes through detox.
While most other substances don’t have life-threatening withdrawal symptoms, this doesn’t take away from the fact that withdrawal can make a person feel horrible and sick.
Detox is Only the First Step
Detox is just the first step toward sobriety, but it’s an important one. After detox, doctors will usually recommend participating in traditional therapies and relapse prevention programs as a means to reduce their risks for returning to substance abuse.
Whether a person seeks treatment at a Veterans Administration facility or a separate facility, there are lots of services a rehabilitation facility offers as a means to help end drug and alcohol abuse. Examples of these services include:
Group and Individual Counseling
These sessions focus on helping a person learn about how their behaviors can prevent drug abuse or how changing behaviors can keep them drug-free.
Education about a particular substance or the long-term effects of a substance use disorder can be very eye-opening for some people. Education can often help start the motivation needed to commit to a sober lifestyle.
Sober Life Skills
These therapies focus on helping how to rebuild a life that is free from drug and alcohol abuse. Examples can even include a new job, money management, and stress management training.
When a person struggles with substance abuse, they usually aren’t the only ones affected. A person’s family may also experience strong feelings of hurt and trauma. Family counseling can help a family identify how they can rebuild trust and communication.
Payment Assistance For Veterans
VA health benefits generally fully cover addiction treatment services if they are performed in a VA medical facility. The VA will pay for addiction treatment in a private facility if the veteran is unable to reach a VA facility. This is known as the Community Care program.
The VA may require the veteran to pay for a portion of the treatment if it finds that the need for addiction treatment didn’t directly result from military service. In practice, this is very rare.
Non-profit organizations can help some veterans pay for addiction treatment. Some examples are:
VFW Unmet Needs Program – www.vfw.org/assistance/financial-grants
Veterans Resource Centers of America – www.vetsresource.org/
Rebuild Hope – www.rebuildhope.org/eligibiity/
Operation Homefront – www.operationhomefront.net
U.S. Soldiers Foundation – www.saluteheroes.org/get-help/eligibility/
Veterans Healing Initiative – www.vetshealing.org/
USA Cares – www.usacares.org/application
Operation First Response – www.operationfirstresponse.org/military-family-assistance-program/
How to Find Help for Addiction
There are many resources available to veterans and the general public that can help find the resources needed when they struggle with a substance use disorder. Examples include:
VA– The Veterans Administration has a general hotline at 1-800-827-1000 that can help a person establish where they first need to go for help. Speaking with a VA doctor or healthcare provider or contacting a local Vet Center is also a great to identify where to get help. It’s possible to find a list of Veterans Administration facilities at VA.gov. There is also a Veterans Crisis Line available by calling 1-800-273-8255.
SAMHSA – The Substance Abuse and Mental Health Services Administration offers several resources to help a person find help. Examples include the website findtreatment.samhsa.gov and their national helpline at 1-800-662-HELP (4357).
AA – Alcoholics Anonymous, whose website is aa.org.
SMART Recovery – SMART recovery is a secular program similar to AA. Its website is www.smartrecovery.org
Help for Veterans Struggling with Substance Abuse
Those who have served their country can often struggle with post-traumatic stress and other feelings that may lead them to substance abuse as a means to escape. Help is available, both through the Veterans Administration and through other programs designed to help those struggling with substance abuse. Treatment for substance abuse and addiction can and does work. Treatment helps to reduce the rates of suicide and mental health disorders that tear families apart and cause a person to suffer needlessly. If you or someone you love is a veteran, who may need professional help, reach out to the many resources available. Today could be the first day towards a new life free from drug and alcohol abuse.