Military veterans are at a higher risk of developing post-traumatic stress disorder (PTSD) than the general population, since many in this group have experienced deployment to war zones or exposure to combat. PTSD is linked to an increased risk of substance use and abuse, a combination of conditions suited for what’s known as dual diagnosis treatment.1,2,3
Among veterans who served in Vietnam and later wars, 41.4% who had a substance use disorder (SUD) were also diagnosed with PTSD.2 In fact, research shows that more than 20% of veterans with PTSD also have an SUD, and one national study suggests that as many as 76% of veterans have these co-occurring disorders.4,5
Many people understand this connection, but it wasn’t always the case. The identification and understanding of PTSD has changed dramatically within the last century, as have the techniques that are used to effectively treat it.
For a long time, scientists did not make the connection between PTSD and substance abuse. One theory is that studies conducted in previous decades to determine if veterans suffered from PTSD or substance use employed self-reporting techniques, and trauma-related symptoms may have been less likely to be reported in the past.1 Also, veterans may not be willing to report issues or may be reluctant to seek treatment from the Veterans Administration (VA) for several reasons, such as:6,7
PTSD develops after exposure to a traumatic event that triggers feelings of terror, horror, or powerlessness, like those often found in war zones.2 The likelihood of veterans developing PTSD is increased relative to the severity of their exposure to warfare.2 And the changing nature of modern warfare, such as prolonged wars and unpredictable factors like improvised explosive devices, creates additional stressors that can place veterans of recent wars at an increased risk of developing PTSD and drug and alcohol abuse.3
This increased risk of developing PTSD among active military personnel can also be attributed, in part, to:3
Additional factors that contribute to their odds of getting PTSD include:3
Common symptoms of PTSD fall into 4 categories that include:3,8
Veterans with PTSD may also develop depression, anxiety, SUDs, or chronic pain. And, symptoms of PTSD can contribute to difficulty maintaining relationships or employment.8
Although symptoms of PTSD have been recognized since ancient times, it wasn’t until the 1980s that there was a scientifically accepted diagnosis.9
In the early 1950s, the American Psychiatric Association produced the first formalized diagnosis of PTSD, called “gross stress reaction,” which referred to normal people suffering from symptoms that resulted from trauma. This diagnosis was expected to resolve within 6 months or a different diagnosis would be issued.10 During and after the Vietnam War, nearly a quarter of veterans serving between 1964 and 1973 required psychological treatment.9
The term “Post Traumatic Stress Disorder” was introduced as a diagnosis by the American Psychological Association in 1980 after extensive research with Vietnam veterans, Holocaust survivors, and people who had experienced sexual trauma. Researchers were able to demonstrate a link between combat-related trauma and the reintegration into a civilian lifestyle (in the case of military members), along with a formalized description of PTSD symptoms.10
PTSD is currently recognized as varied in its manifestation, although most veterans experience a period of latency, in which symptoms do not appear until after the trauma has ended.9 The diagnosis cannot be made unless symptoms persist for at least one month and interfere with your daily functioning or cause you substantial distress.10 Once symptoms do present, PTSD most commonly will follow a chronic time-course and generally does not improve unless you receive treatment.9
Currently, the military recognizes the importance of screening veterans and active duty military personnel for PTSD and provides specialized treatment.10 The VA is committed to treating PTSD using highly effective, research-proven methods, often training treatment providers in the most up-to-date therapeutic approaches.6,10
While there are several theories surrounding the connection between PTSD and the development of SUDs in veterans, currently the widely accepted theory is that veterans use drugs or alcohol to self-medicate distressing symptoms.
Studies have demonstrated that the substance used is correlated with the type of symptoms most prominently experienced. For example, veterans suffering from symptoms of hyper arousal are more likely to abuse depressants like alcohol in an attempt to reduce those symptoms.2 And stimulants like cocaine may be used more by veterans with symptoms of depression like negative thoughts and lethargy.
In veterans with PTSD who also use substances, drug or alcohol cravings may increase as PTSD symptoms increase, providing more evidence to support the self-medicating theory.2 Additionally, certain symptoms of withdrawal can mimic some of the symptoms of PTSD, leading some people to use again to alleviate the discomfort these symptoms cause.4
Veterans with both an alcohol use disorder and PTSD are also more likely to binge drink, possibly in periodic attempts to block out traumatic battle memories or flashbacks. Counter productively, substance use may actually prolong the duration of PTSD by providing an escape from the trauma, which cannot be treated successfully if the person is actively avoiding it.4
Substance use alters a person’s ability to perform well physically and mentally, and it can impair a soldier’s ability to do their duty or even lead to legal sanctions if they are using illegal drugs or driving under the influence.
Medical, social, financial, and legal consequences are commonly associated with substance abuse, in general, and in the military, there is a zero-tolerance policy for substance use, with active soldiers frequently drug tested.2,4,11 Positive drug tests in the armed forces may lead to criminal charges and dishonorable discharge.11
Veterans with PTSD who abuse substances often experience an exacerbation of physical health issues or cognitive impairment in their day-to-day civilian lives.2,11 These veterans are at increased risk of other issues, too, including domestic violence, sleep disturbances, and severe depression.11 Suicide rates are higher for active duty military and veterans than it is for the civilian population.11 In 2014, more than 20% of the countries suicides were veterans.11
Those who bravely served in the military sacrifice so much for all of us, and it is imperative that you not sacrifice your mental and physical health any longer. PTSD and substance abuse are mountains that you can climb, and we are here to help. Call our admissions navigators at 1-888-509-8965 Who Answers? so they can assist you in finding the treatment you need to live the life you deserve.
During the Vietnam era, forward treatment, which is when soldiers were treated near the combat zones to allow for social support from their military peers while focusing on returning to battle as soon as possible, was used to treat soldiers with symptoms of what is now known as PTSD.9 Levels of substance use were also high among service personnel during this time, and as veterans returned home, they were drug tested and sent for rehabilitation as needed.9,11
As the knowledge surrounding PTSD and substance use expanded, the VA began to focus on treating both disorders at the same time.2,4,5 This is known as the integrated model of treatment and has been shown to be effective due to the complex interaction between PTSD and substance abuse.2,4,5 As of 2010, the VA has shown a commitment to making the most effective treatments available to veterans with PTSD and substance abuse.5
Integrated treatment uses:2,4,5
These treatments all focus on helping veterans learn positive coping skills to manage their symptoms and emotions surrounding the trauma that contributed to the development of their PTSD.2
Treating veterans comes with unique challenges, and the VA has invested a large amount of resources into educating and training for clinicians to treat veterans in the most effective way possible.2,4,5 Discussing the traumatic experiences associated with combat can be difficult to address in groups with civilians, and there is a unique culture and need among veterans for treatment with providers who understand this lifestyle.7
The first step in seeking PTSD and substance use treatment for many people is attending a detoxification facility. Substance use has the effect of numbing or avoiding trauma, which cannot be addressed until the substance use has stopped.4 Detox services are available through the VA, in civilian facilities, or on an outpatient basis in some cases. It is important receive supervision in one of these settings, since withdrawal may worsen the symptoms of PTSD and increase cravings. The staff at detox programs can provide support and medications to ease the discomfort associated with the withdrawal process.
Remember, detox is only the first step on the road toward recovery. Once detox is complete, behavioral techniques and medications can be used to further recovery from both issues in extended treatment options. For veterans who need a more structured setting to recover from substance use and PTSD, the VA offers residential treatment programs or transitional programs to ease the reintegration into a sober, civilian lifestyle.6
Recovery is possible with the right treatment and support, and the VA has actively worked to reduce the stigma surrounding substance use and mental health issues and to improve confidentiality to better serve our country’s veterans.11