Substance Abuse

PTSD and Substance Abuse in Veterans

(Printed from PTSD: National Center for PTSD)

Download: Understanding PTSD and Substance Use Disorder Flyer (PDF)

Some people try to cope with their Posttraumatic Stress Disorder (PTSD) symptoms by drinking heavily, using drugs, or smoking too much. People with PTSD have more problems with drugs and alcohol both before and after getting PTSD. Also, even if someone does not have a problem with alcohol before a traumatic event, getting PTSD increases the risk that he or she will develop a drinking or drug problem.

Eventually, the overuse of these substances can develop into Substance Use Disorder (SUD), and treatment should be given for both PTSD and SUD to lead to successful recovery. The good news is that treatment of co-occurring (happening at the same time) PTSD and SUD works.

How common is co-occurring PTSD and SUD in Veterans?

Studies show that there is a strong relationship between PTSD and SUD, in both civilian and military populations, as well as for both men and women.

Specific to Veterans:

  • More than 2 of 10 Veterans with PTSD also have SUD.
  • War Veterans with PTSD and alcohol problems tend to be binge drinkers. Binges may be in response to bad memories of combat trauma.
  • Almost 1 out of every 3 Veterans seeking treatment for SUD also has PTSD.
  • The number of Veterans who smoke (nicotine) is almost double for those with PTSD (about 6 of 10) versus those without a PTSD diagnosis (3 of 10).
  • In the wars in Iraq and Afghanistan, about 1 in 10 returning soldiers seen in VA have a problem with alcohol or other drugs.

How can co-occurring PTSD and SUD create problems?

If someone has both PTSD and SUD, it is likely that he or she also has other health problems (such as physical pain), relationship problems (with family and/or friends), or problems in functioning (like keeping a job or staying in school). Using drugs and/or alcohol can make PTSD symptoms worse.

For example:

  • PTSD may create sleep problems (trouble falling asleep or waking up during the night). You might "medicate" yourself with alcohol or drugs because you think it helps your sleep, but drugs and alcohol change the quality of your sleep and make you feel less refreshed.
  • PTSD makes you feel "numb," like being cut off from others, angry and irritable, or depressed. PTSD also makes you feel like you are always "on guard." All of these feelings can get worse when you use drugs and alcohol.
  • Drug and alcohol use allows you to continue the cycle of "avoidance" found in PTSD. Avoiding bad memories and dreams or people and places can actually make PTSD last longer. You cannot make as much progress in treatment if you avoid your problems.
  • You may drink or use drugs because it distracts you from your problems for a short time, but drugs and alcohol make it harder to concentrate, be productive, and enjoy all parts of your life.

VA has made it easier to get help. It is important to know that treatment can help and you are not alone.

What treatments are offered for co-occurring PTSD and SUD?

Evidence shows that in general people have improved PTSD and SUD symptoms when they are provided treatment that addresses both conditions. This can involve any of the following (alone or together):

Talk with your provider about treatment for specific symptoms like pain, anger, or sleep problems.

What should I do if I think I have co-occurring PTSD and SUD?

The first step is to talk to a health professional and ask for more information about treatment options. Each VA medical center has an SUD-PTSD Specialist trained in treating both conditions to reach the best health outcomes. If there are signals you are at risk for both disorders, you will be encouraged to talk with a provider about how to best support your recovery. There are treatment resources at every VA medical center. The VA wants you to have the best possible care for co-occurring PTSD and SUD.

If you continue to be troubled or distracted by your experiences for more than three months or have questions about your drinking or drug use, learn more about treatment options. Life can be better! Talk to a VA or other health professional to discuss choices for getting started. 

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National Veteran Substance Abuse

the veteran

BY TOM BERGER, CHAIR

The Leadership Conference is over and initial reports indicate that it was a great success. The two PTSD seminars were well-attended and (according to the evaluations) they were very well received. Thanks to the Conference Planning Committee, VVA staff, Bill Messer and the Arizona State Council, the presenters (Fr. Phil Salois, Randy Barnes, Nancy Switzer, and Tony Catapano), and everyone who helped distribute the seminars’ handouts.

In an August 8 article, USA Today reported that the House and Senate Appropriation Committees were poised to cut funding by half for traumatic brain injuries (TBI) caused by bomb blasts. The funding was to be used for research and treatment of war-related brain injuries as part of the 2007 Defense appropriation bill.

House and Senate versions of the 2007 Defense appropriation bill contain only $7 million for the Defense and Veterans Brain Injury Center—half of what the center received last fiscal year. The Brain Injury Center has received more money each year of the war—from $6.5 million in fiscal year 2001 to $14 million last year.

Spokespersons for the appropriations committees in both chambers said that the cuts were due to a tight budget this year. Seven military and Department of Veterans Affairs hospitals, including the center’s headquarters at Walter Reed Army Medical Center in Washington, and one civilian treatment site, all work on diagnosing and treating service members who suffer brain damage.

According to George Zitnay, co-founder of the center, “Traumatic brain injury is the signature injury of the war on terrorism.” As of January 2006, 20 percent of those injured in Iraq had TBI after suffering concussions during their tours. Scientists say that multiple concussions can cause permanent brain damage. Many experience headaches, disturbed sleep, memory loss, and behavior issues after coming home. The center has long urged the Pentagon to screen all troops returning from Iraq in order to treat the symptoms and create a database of brain-injury victims. So far the Pentagon has declined to conduct TBI screening and argues that more research is needed.

Sens. Tom Harkin (D-Iowa) and Charles Grassley (R-Iowa) have introduced legislation that calls for the VA to develop a better program to prevent suicides among veterans returning from Iraq. Under their bill, the VA would be required to provide suicide-prevention education for staff members, insure 24-hour access to mental health care for veterans deemed at risk of suicide, and create a family education program. At the time of this writing, Sens. Brownback (R-Kansas), DeWine (R-Ohio), Lautenberg (D-N.J.), Snowe (R-Maine), and Talent (R-Mo.) have signed on as co-sponsors.

The bill is named for Iowa Army reservist Joshua Omvig, who committed suicide in December 2005. According to an article in the Des Moines Register, Omvig suffered from untreated Post-traumatic Stress Disorder following an 11-month tour of duty in Iraq. On the House side, Rep. Leonard Boswell (D-Iowa) has introduced similar legislation.
It’s difficult to find accurate statistics on veteran suicides. The figure most commonly given for OEF and OIF veteran suicides is 79. However, that figure is misleading because the count started in 2003 and only includes those veterans receiving care within the VA healthcare system.

As many Vietnam veterans know, substance abuse often goes hand in hand with PTSD. Among Vietnam veterans seeking treatment for PTSD, 60 to 80 percent have alcohol-use disorders, according to the National Center for PTSD. And things are not looking much better for our current troops.

In the July 16 issue of Stars and Stripes, Col. Elspeth Ritchie, a psychiatry consultant to the Army surgeon general, noted: “The world is speculating that PTSD will be higher among troops who have been to Iraq more than once.”

Last November, an Army Mental Health Advisory Team finished looking at troops in their third Iraq rotations, but it has been eight months since the team returned, and it has yet to file a report. Ritchie said the information wasn’t in yet.

If mental health issues among troops from Iraq and Afghanistan are on the rise, programs such as the Army Substance Abuse Program will soon find themselves overwhelmed. In the same article, Robert McCollum, who runs the Army Substance Abuse Program for the Installation Management Agency-Europe, said the program’s offices across the continent already are feeling the pressure. “My people are busy. Their plates are full,” he said.

So, if substance abuse among Iraq and Afghanistan veterans with PTSD follows the course of Vietnam veterans, what does the future hold for our nation’s newest veterans?

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Substance Abuse among the Military, Veterans, and their Families (Click here for more information)            

The ongoing operations in Iraq (Operation Iraqi Freedom) and Afghanistan (Operation Enduring Freedom) continue to strain military personnel, returning veterans, and their families. Some have experienced long and multiple deployments, combat exposure, and physical injuries, as well as post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI).

Although less common, substance abuse is also a key concern. While the 2008 Department of Defense Health Behavior Survey reveals general reductions over time in tobacco use and illicit drug use, it reported increases in other areas, such as prescription drug abuse and heavy alcohol use. In fact, prescription drug abuse doubled among U.S. military personnel from 2002 to 2005 and almost tripled between 2005 and 2008.

Alcohol abuse is the most prevalent problem and one which poses a significant health risk. A study of Army soldiers screened 3 to 4 months after returning from deployment to Iraq showed that 27 percent met criteria for alcohol abuse and were at increased risk for related harmful behaviors (e.g., drinking and driving, using illicit drugs). And although soldiers frequently report alcohol concerns, few are referred to alcohol treatment. Research findings highlight the need to improve screening and access to care for alcohol-related problems among service members returning from combat deployments.

Mental illness among military personnel is also a major concern. In another study of returning soldiers, clinicians identified 20 percent of active and 42 percent of reserve component soldiers as requiring mental health treatment. Drug or alcohol use frequently accompanies mental health problems and was involved in 30 percent of the Army's suicide deaths from 2003 to 2009 and in more than 45 percent of non-fatal suicide attempts from 2005 to 2009.

Drug Abuse Research and Military Personnel

To gain a fuller understanding of these issues, the Millennium Cohort Study—the largest prospective study in military history—is following a representative sample of U.S. military personnel from 2001 to 2022. Findings from this study suggest that Reserve and National Guard personnel and younger service members who deploy with reported combat exposures are at increased risk of new-onset heavy weekly drinking, binge drinking, and other alcohol-related problems. Results also suggest an increase in smoking initiation and relapse among those deployed, highlighting the importance of prevention strategies before, during, and after deployment. To meet this need, a host of government agencies, researchers, public health entities, and others are working together to adapt and test proven prevention and treatment interventions for potential use with military and veteran populations and their families.

To address the social problems both caused by and contributing to drug use, NIDA-supported researchers are developing and testing novel treatment approaches with veterans. In one project, researchers are using smart phones and wearable wireless sensors to record real-time responses to stress among veterans suffering from addiction and trauma. The data will be compiled and analyzed to detect patterns of responding that predict relapse. Included on the research team are psychologists working to create interventions that can be delivered by smart phones to help deter patient drug use as a response to stress.

NIDA-supported research is also working to improve veterans' access to drug treatment, including adapting currently available Internet-based interventions and studying the use of drug courts. Drug courts have demonstrated effectiveness in addressing nonviolent crimes committed by drug abusers, ushering them into needed treatment instead of prison. Because the criminal justice system is a frequent treatment referral source for veterans, specialized drug courts for this population may give them the opportunity to access services and support they may not otherwise receive. While New York pioneered the concept of a court devoted exclusively to handling nonviolent crimes committed by veterans, this concept has spread quickly, with 65 courts now in 20 states.

Advancing the Research

Along with the studies mentioned above, NIDA—in collaboration with the U.S. Department of Veterans Affairs and other Institutes within the National Institutes of Health—awarded $6 million in 2010 federal funding to 14 principal investigators to support research on substance abuse and associated problems among U.S. military personnel, veterans, and their families.

The purpose of the initiative was to enhance and accelerate research on the epidemiology/etiology, identification, prevention, and treatment of alcohol, tobacco, and other drug use and abuse, including illicit and prescription drugs, and associated mental health problems among active-duty or recently separated military troops and their families. Most of the research funded under this initiative is focused on substance abuse and related conditions experienced by veterans returning from wars in Iraq and Afghanistan.

These 14 projects will explore a range of topics, including the following:

  • therapies for co-occurring disorders, such as depression and substance abuse;
  • the effectiveness of early interventions for recently returning soldiers;
  • the high rates of smoking among returning military personnel; and
  • the impact of a youth substance abuse prevention intervention designed for parents returning from deployment.

By supporting research initiatives like those mentioned here and collaborating with other stakeholders, NIDA intends to contribute to the design and implementation of effective prevention and treatment interventions that can help safeguard the health and well-being of those who protect and serve our Nation.

Wisconsin Veteran Substance Abuse

Wisconsin information being developed.


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