PTSD & Substance Use Disorder in Veterans

Last Updated: February 14, 2024

Editorial Policy | Research Policy

Some veterans may develop an addiction to cope with their PTSD. Luckily, there is treatment available to address these conditions together. 

When veterans return to civilian life, they may face a number of negative effects from their time in the service. Veterans are at increased risk of developing post-traumatic stress disorder (PTSD). They may also face other challenges related to PTSD, such as substance misuse. PTSD and substance abuse in veterans can be a direct consequence of the effects of serving, but with quality treatment, recovery is possible. 

What Is PTSD?

PTSD is a mental health condition that occurs after exposure to a traumatic event. In some cases, it occurs because of direct exposure to trauma, such as being threatened with a weapon, but it can also occur after witnessing or hearing about a traumatic event happening to others. When people develop PTSD, they experience intrusion symptoms, which include flashbacks of the traumatic event, unwanted memories related to the event, nightmares about the event and intense psychological reactions to reminders of the event. 

PTSD also involves attempts to avoid memories or reminders of the event, as well as changes in mood and behavior. A person with PTSD may consistently show negative moods, believe that they are to blame for the traumatic event or detach from others. They are likely to have a hard time experiencing positive moods like happiness and satisfaction. They may also have angry outbursts with little warning, engage in reckless behavior and have a hard time sleeping. 

PTSD & Substance Abuse in Veterans: How Common Is It?

Veterans with PTSD are at risk of developing substance use disorders (SUD) or addictions. When a veteran has both PTSD and a substance use disorder, they are said to have co-occurring disorders. According to research, nearly 50% of people with PTSD have a co-occurring substance use disorder. Furthermore, the Veterans Administration reports that over 2 out of 10 veterans with PTSD also have a substance use disorder. 

Alcohol Addiction & PTSD

For veterans with PTSD, alcohol may serve as a way to temporarily numb negative emotions or block out painful memories. Unfortunately, as the effects of alcohol wear off with tolerance, a person will need to use larger and larger amounts to achieve the same desired effects. Over time, as PTSD goes untreated, a person is at risk of developing an alcohol addiction and experiencing worsening mental health functioning in the process. Research has shown that up to two-thirds of veterans who seek care for alcohol addiction from the VA also have PTSD. 

Drug Addiction & PTSD

Veterans with PTSD are also at risk of developing drug addictions. According to research with veterans of the Iraq and Afghanistan conflicts, male veterans are at risk of using drugs to self-medicate PTSD symptoms. For female veterans, drug abuse is associated with future PTSD symptoms, suggesting that men and women are affected differently by drug addiction and PTSD. Combat-wounded veterans may be especially at risk of developing addictions to opioids, as they can become dependent upon prescription painkillers used in the treatment of chronic pain. 

Triggers & Symptoms of PTSD in Veterans

Veterans with PTSD are likely to experience triggers for symptoms. These are events or memories that cause PTSD symptoms to appear. For instance, loud noises that activate memories of explosions or gunfire can trigger PTSD symptoms such as outbursts of anger, activation of the startle reflex or destructive behavior like substance misuse. 

When someone with PTSD experiences symptoms, they fall into the following categories:

Intrusion Symptoms

  • Intrusive thoughts related to the traumatic event
  • Upsetting nightmares related to the trauma
  • Flashbacks, during which it feels as if the trauma is happening again
  • Extreme stress when exposed to reminders of the traumatic event
  • Physiological reactivity when reminded of the trauma (e.g., elevated heart rate)

Avoidance Symptoms

  • Trying to avoid reminders of the event
  • Attempting to block out distressing thoughts or memories of the event

Negative Alterations in Mood

  • Being unable to remember details of the traumatic event
  • Distorted negative thoughts, such as believing that the entire world is unsafe 
  • Inappropriately blaming oneself or others for the event
  • Consistently experiencing negative emotions, including shame, guilt, anger and fear
  • Lacking interest in usual activities
  • Feeling detached from other people
  • Being unable to experience joy, happiness and other positive emotions

Alterations in Arousal and Reactivity

  • Outbursts of anger with no warning
  • Engaging in self-destructive behavior
  • Being hypervigilant of surroundings 
  • Startling easily
  • Having a hard time concentrating
  • Experiencing disrupted sleep 

Treatment for Veterans with Co-Occurring PTSD & SUD

PTSD and substance abuse in veterans are best treated with integrated modalities that simultaneously address PTSD and addiction. Some common modalities used to treat these conditions include:

  • Therapies: Talk therapy is often used to treat co-occurring PTSD and SUD in veterans. Two specific forms of cognitive behavioral therapy (CBT), called cognitive processing therapy (CPT) and prolonged exposure (PE), are particularly beneficial for veterans. 
  • Medication: Some veterans may benefit from taking medication to manage symptoms of PTSD and addiction. Antidepressant drugs can be helpful in treating PTSD symptoms. Veterans can also take medications to manage drug and alcohol withdrawal and cravings. 
  • Group treatment: Group therapy is also a key component of treatment programs for veterans. Some treatment centers offer groups specifically designed for individuals with trauma, and some centers may even offer veteran-only groups. 
  • Inpatient rehab: In some cases, veterans may benefit from beginning their recovery journey with inpatient rehab. These programs allow veterans to live on-site at a treatment facility, so they are removed from triggers in everyday life while they undergo treatment. 

How to Help a Veteran with Co-Occurring PTSD & SUD

If a veteran in your life struggles with PTSD and addiction, they need your support. Here’s how you can help:

  • Learn about their symptoms and triggers: Learning about a person’s symptoms and triggers is helpful. If you’re able to identify when symptoms are worsening, you can offer additional support. Knowing a person’s triggers gives you insight into situations that may be distressing for them, so you can help them avoid these situations. 
  • Be patient with them: A veteran who lives with PTSD is likely to show changes in behavior and mood. For instance, they may not want to participate in their usual activities, and they may have outbursts of anger. Remember not to take this behavior personally; it’s a manifestation of their mental health state and not an indication of anything you’ve done wrong. Patience and understanding will go a long way. 
  • Encourage them to seek treatment: Veterans with PTSD and SUD experience the best outcomes when they engage in treatment. Encourage your loved one to reach out for professional intervention and keep their appointments. You might even consider helping them schedule an appointment or driving them to their appointments. 

Other Helpful Resources for Veterans

Below are some additional resources for veterans with PTSD: 

  • VA Benefits Hotline: This toll-free number is available Monday through Friday from 8:00 a.m. to 9:00 p.m. ET at 800-827-1000. 
  • The VA Mental Health Page: The VA offers a mental health page on its website, where you can access information about VA programs and treatment options.
  • National Center for PTSD: Access research publications and information about PTSD treatment at this website.

Afterdeployment.org: This webpage provides expert information related to mental health treatment after deployment, including advice regarding when it’s time to reach out for help.

Sources

Mann, Sukhmanjeet & Marwaha, Raman. “Posttraumatic Stress Disorder.” National Library of Medicine, January 30, 2023. Accessed June 29, 2023.

McCauley, Jenna; Killeen, Therese; Gros, Daniel; Brady, Kathleen; & Back, Sudie. “Posttraumatic Stress Disorder and Co-Occurring Substance Use Disorders: Advances in Assessment and Treatment.” Clinical Psychology (New York), 2012. Accessed June 29, 2023. 

U.S. Department of Veterans Affairs. “PTSD and Substance Abuse in Veterans.” Accessed June 29, 2023. 

Straus, Elizabeth; Norman, Sonya; Haller, Moira; Southwick, Steven; Hamblen, Jessica; & Peitrzak, Robert. “Differences in protective factors among U.S. Veterans with posttraumatic stress disorder, alcohol use disorder, and their comorbidity: Results from the National Health and Resilience in Veterans Study.” Drug and Alcohol Dependence, January 2019. Accessed June 29, 2023. 

Livingston, Nicholas, et al. “Longitudinal assessment of PTSD and illicit drug use among male and female OEF-OIF veterans.” Addictive Behaviors, July 2021. Accessed June 29, 2023. 

Dembek, Zygmunt & Chekol, Tesema. “The Opioid Epidemic: Challenge to Military Medicine and National Security.” Military Medicine, 2020. Accessed June 29, 2023. 

National Center for PTSD. “Effective Treatments for PTSD: Consider Cognitive Behavioral Therapy (CBT) as First Line Treatment.” January 2015. Accessed June 29, 2023.

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