Addressing PTSD and Substance Use Disorder in Veterans

Some veterans may turn to substance misuse as a way to cope with symptoms of PTSD. Fortunately, there are effective treatments available to address both addiction and PTSD simultaneously. 

When veterans transition to civilian life, they often grapple with various challenges stemming from their military service. A heightened risk of post-traumatic stress disorder (PTSD) is one of these challenges, which can further lead to substance misuse. The co-occurrence of PTSD and substance abuse is often a direct result of the impact of military service, but with comprehensive treatment, recovery is attainable.

Understanding PTSD

Post-Traumatic Stress Disorder (PTSD) is a mental health condition that develops after exposure to a traumatic event. It can arise from direct personal exposure to trauma, such as being threatened with a weapon, or from witnessing or hearing about traumatic events affecting others. Individuals with PTSD experience intrusion symptoms, including flashbacks of the traumatic event, unwanted memories related to it, nightmares, and intense psychological responses to reminders of the event.

PTSD also involves efforts to avoid memories or triggers associated with the trauma, alongside mood and behavior changes. Those with PTSD may persistently display negative emotions, feel responsible for the traumatic event, or withdraw from social interactions. For a person with PTSD, positive emotions such as happiness and satisfaction may be difficult to experience, and they may also exhibit sudden bursts of anger, engage in reckless behavior, and struggle with sleep.

Prevalence of PTSD and Substance Abuse in Veterans

Veterans experiencing PTSD are vulnerable to developing substance use disorders (SUD) or addictions. The coexistence of PTSD and substance use disorder is called co-occurring disorders. Research indicates that nearly 50% of individuals with PTSD have co-occurring substance use disorders. Furthermore, data from the Veterans Administration reveals that over 2 out of 10 veterans with PTSD also suffer from substance use disorder.

Alcohol Addiction and PTSD

For veterans grappling with PTSD, alcohol might serve as a temporary means to numb negative emotions or block painful memories. Regrettably, as alcohol’s effects wane due to tolerance, individuals may resort to consuming larger quantities to achieve the desired effects. Over time, untreated PTSD can heighten the risk of alcohol addiction, leading to deteriorating mental health. Studies suggest that up to two-thirds of veterans seeking treatment for alcohol addiction at the VA also have PTSD.

Substance Addiction and PTSD

Veterans affected by PTSD also face an increased risk of developing substance addictions. Research involving veterans from conflicts like Iraq and Afghanistan indicates that male veterans are prone to using drugs as a means to self-medicate PTSD symptoms. Among female veterans, drug abuse is linked to future PTSD symptoms, suggesting gender-specific differences in the interplay between drug addiction and PTSD. Combat-injured veterans are particularly susceptible to opioid addictions, given their potential dependence on prescription painkillers for chronic pain treatment.

Identifying PTSD Triggers and Symptoms in Veterans

Veterans living with PTSD frequently encounter triggers that activate symptoms. Triggers are events or memories that evoke PTSD symptoms. For instance, loud noises reminiscent of explosions or gunfire can prompt symptoms such as anger outbursts, heightened startle responses, or destructive behaviors like substance misuse. When PTSD symptoms manifest, they fall into the following categories:

Intrusion Symptoms

• Unwanted intrusive thoughts linked to the traumatic event
• Disturbing nightmares connected to the trauma
• Flashbacks, during which the trauma seems to recur
• Intense stress upon encountering reminders of the trauma
• Physiological reactions when reminded of the trauma (e.g., increased heart rate)

Avoidance Symptoms

• Efforts to evade reminders of the traumatic event
• Attempting to suppress distressing memories or thoughts related to the event

Negative Mood Alterations

• Inability to recall specific details of the trauma
• Distorted negative thoughts, like perceiving the world as unsafe
• Misplaced blame, either on oneself or others, for the event
• Consistent experience of negative emotions such as shame, guilt, anger, and fear
• Loss of interest in activities once enjoyed
• Emotional detachment from others
• Difficulty experiencing positive emotions like joy and happiness

Changes in Arousal and Reactivity

• Sudden anger outbursts without warning
• Engagement in self-destructive behaviors
• Heightened vigilance of surroundings
• Easily startled responses
• Difficulty concentrating
• Disrupted sleep patterns

Effective Treatment for Veterans with Co-Occurring PTSD and SUD

Addressing PTSD and substance abuse in veterans necessitates integrated approaches that simultaneously tackle both conditions. Several modalities prove effective in treating these conditions:

• Therapies: Talk therapy, particularly cognitive processing therapy (CPT) and prolonged exposure (PE), are valuable for veterans facing co-occurring PTSD and SUD. These cognitive behavioral therapies (CBT) offer substantial benefits.
• Medication: Medications can aid veterans in managing PTSD and addiction symptoms. For example, antidepressants prove useful in alleviating PTSD symptoms. Additionally, medications can assist in mitigating drug and alcohol withdrawal and cravings.
• Group Therapy: Group therapy plays a pivotal role in treatment programs for veterans. Some treatment centers provide groups tailored for trauma survivors, including veteran-only groups.
• Inpatient Rehabilitation: In specific instances, veterans may find inpatient rehab beneficial as they embark on their recovery journey. These programs allow veterans to reside within a treatment facility, effectively isolating them from everyday triggers while they receive treatment.

Supporting Veterans with Co-Occurring PTSD and SUD

For veterans living with both PTSD and addiction, your support can make a significant difference. Here’s how you can help:

• Educate Yourself: Learn about their symptoms and triggers. This knowledge empowers you to provide additional support when symptoms worsen and helps you identify distressing situations to assist them in avoiding triggers.
• Practice Patience: Recognize that living with PTSD might result in changes in behavior and mood. Offer patience and understanding, as these changes stem from the person’s mental health condition, not any actions on your part.
• Encourage Treatment: Encourage veterans to seek professional intervention. Optimal outcomes occur when individuals engage in treatment. Supporting them in scheduling appointments and attending them can be immensely helpful.

Additional Resources for Veterans

For veterans seeking additional resources related to PTSD, consider the following:

• VA Benefits Hotline: Reach out to the toll-free number 855-586-2889 available from Monday to Friday, 8:00 a.m. to 9:00 p.m. ET.
• The VA Mental Health Page: Access valuable information about VA programs and treatment options on the VA’s mental health page.
• National Center for PTSD: Gain insights into PTSD treatment options and research publications through the National Center for PTSD’s website.
• Afterdeployment.org: Explore expert information about mental health treatment after deployment on the Afterdeployment.org website. This resource offers advice on recognizing the need for help.

Veteran Recovery Is Our Mission

The Recovery Village is an industry-leading treatment provider for addiction and co-occurring mental health disorders. 

• Experienced clinicians: Our clinicians are specially trained in trauma-informed care, military culture and treating veteran-specific addiction and mental health needs.
• Dual diagnosis: We treat addiction and mental health disorders like PTSD, anxiety or depression simultaneously for a better recovery.  
• EMDR: A revolutionary treatment available at several facilities, EMDR therapy alleviates mental pain and emotional recession from trauma, which can lead to better outcomes for your addiction.
• FORTITUDE: Our specialty track for veterans and first responders at select facilities puts you in exclusive group therapy sessions with your peers. 

If you’re a veteran struggling with alcohol or drug addiction, our Veteran Advocates can help you navigate your VA health insurance and get you the help you need.

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Editor – Melissa Carmona

Melissa Carmona puts years of writing and editing experience to work helping people understand substance abuse, addiction and mental health disorders. Read more

Medically Reviewed By – Jenni Jacobsen, LSW

Dr. Jenni Jacobsen is a licensed social worker through the Ohio Counselor, Social Worker and Marriage and Family Therapist Board. She has over seven years working in the social work field, working with clients with addiction-related and mental health diagnoses. Read more