Veteran Substance Abuse: Resources and Strategies for Treatment

The scope of veteran substance abuse and mental illness is startling: 3.9 million veterans suffer from addiction or mental illness, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Among this population, nearly 27% struggle with drug abuse, and more than 80% abuse alcohol.

The connection between substance abuse and suicide has also been firmly established. The suicide rate is higher in veterans than in the general population and is rising. According to RAND, the suicide rate for veterans was 32 per 100,000 in 2018; for the civilian population, it was 17 per 100,000.

The causes of substance abuse in veterans are complex and resistant to treatment. Counselors who specialize in treating veterans must have an in-depth understanding of what causes addiction and mental illness in former soldiers.

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The Causes of Veteran Substance Abuse

Understanding the causes of veteran substance abuse is integral to effective treatment. It’s quite common for veterans to suffer from more than one cause of disorder. In that case, treatment can be more challenging.
The common causes of veterans substance abuse include the following:

  • Post-traumatic stress disorder. One of the most significant causes of substance abuse among veterans is PTSD. Called shell shock during World War I and battle fatigue during World War II, PTSD causes mental and emotional stress due to a traumatic experience. It causes various symptoms, such as reliving the experience (flashbacks), disturbed sleep, and physical pain. PTSD is linked to opioid use disorder and thoughts of suicide. Combat and other traumatic experiences can cause PTSD.
  • Shame and guilt. Veterans may also be burdened with emotions of shame and guilt, often as part of PTSD. Survivor’s guilt, in which soldiers survive a battle in which their comrades were killed, is a common cause of mental and emotional trauma. Shame, which makes people feel like bad people for their actions or inactions, can cause veterans to feel they deserve their mental and emotional illness. Shame can worsen their thoughts of suicide.
  • Traumatic brain injury. Veterans who suffered a traumatic brain injury, such as from an explosive device, can experience numerous symptoms: cognitive impairment, slower brain processing, and mental illness. They may also become more easily angered or frustrated. Repetitive TBI increases alcohol use among male combat veterans, according to researchers.
  • Physical injury. Soldiers deployed to Iraq or Afghanistan suffered various combat injuries. Besides gun or artillery fire, combat injuries included burns, broken bones, spinal injuries, shrapnel wounds, limb loss, and loss of sight and hearing. All of these injuries could have a permanent impact on veterans. Chronic pain can lead to overuse and subsequent addiction to painkillers.
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    Commonly Abused Substances

    Commonly abused substances by veterans can be legal (alcohol, tobacco, prescription medications) or illegal (heroin, methamphetamines, other illicit drugs). They may also fall into legal limbo (marijuana) as laws vary. However, substance abuse doesn’t discriminate between legal and illegal drugs.
    The ramifications for veterans and their families can be stark. Substance abuse can impair a veteran’s ability to find and keep a job, potentially causing homelessness. It can also drastically impact mental and physical health.
    Common substance abuse disorders include the following:

  • Opioid use disorder. Opioids are a class of drugs that include the painkiller oxycodone and the illicit drugs fentanyl and heroin. Veterans prescribed opioids such as oxycodone to manage pain may become addicted. If their prescription can’t be refilled, they may turn to other drugs, such as fentanyl or heroin. This can put them at risk of an accidental overdose.
  • Marijuana use disorder. Marijuana is the most widely used substance after alcohol and nicotine. Although it’s legal in some states, it can still be abused, as can alcohol and nicotine. It can worsen the symptoms of depression, social anxiety, and schizophrenia.
  • Nicotine use disorder. Most commonly found in tobacco, nicotine has many physical effects. Smoking or chewing tobacco can cause lung cancer, mouth cancer, heart disease, and stroke. Although legal, nicotine can be abused and can be one of the hardest substances to quit.
  • Alcohol use disorder. Alcohol use disorder can cause compulsive alcohol use and damage to the heart, liver, and immune system. The military has a culture of alcohol use. According to the CDC, 1 in 3 active service members reports binge drinking, compared with 1 in 6 civilians. Additionally, combat exposure increases the risk of alcohol abuse. Just like their active duty counterparts, veterans are more likely to binge drink.
  • Barriers to Treatment for Veterans

    Veterans face many roadblocks to treatment for substance abuse, such as a shortage of resources, the complexity of their disorders, and even their own unwillingness to ask for help. Common barriers to treatment include the following:

    • Getting help. Veterans may be reluctant to seek treatment. This may be due to various contextual factors. Veterans often come from a military culture of strength and stoicism. Some veterans suffering from guilt or shame may not feel that they deserve treatment. They may worry about letting down their loved ones. All these issues can prevent veterans from reaching out.
    • Workplace stigma. Despite legal protections and a better understanding of veterans’ PTSD and other mental health disorders, there is still a stigma against veterans in the workplace. As a result, veterans may be reluctant to seek treatment. The U.S. Department of Veterans Affairs (VA) offers information to employers that want to encourage veterans (and all their employees) to use health benefits.
    • Access to treatment. Veterans suffering from several disorders require integrated treatment. This can make treatment expensive and prolonged. They may live an hour or more away from VA treatment facilities, even if a non-VA site is closer.
    • Denied claims. The VA hasn’t always handled soldiers’ PTSD claims correctly, denying many claims that should’ve been approved. However, the VA and the U.S. Department of Defense have initiated many programs to treat soldiers and veterans for PTSD, TBI, and other mental illnesses.

    Counseling Veterans With Substance Abuse Issues

    The VA provides guidance for counselors on treatment techniques for veteran substance abuse disorders and PTSD. Since veterans are often diagnosed with various related disorders (for example, PTSD and alcohol abuse), these techniques can help veterans with many symptoms.
    The first step to treating veterans is screening. The VA has numerous screening tools, or questionnaires, that it uses to identify patients with PTSD. Counselors use this initial screening to further investigate a veteran’s symptoms. Counselors may confirm PTSD or a combination of disorders.
    Treatments for veterans follow evidence-based care principles. These principles have proven effective in helping veterans overcome substance abuse and PTSD. The most common include the following:

    • Cognitive behavioral therapy. CBT helps veterans reframe behaviors surrounding their substance abuse. It helps them identify triggers and look for other ways to prevent use.
    • Eye movement desensitization and reprocessing. EMDR helps patients process trauma while moving their eyes to follow light or sound. This engages both parts of the brain and helps the patient stop focusing on the pain.
    • Prolonged exposure. PE, also known as exposure therapy, helps patients face their fears or trauma, and gradually get used to the pain and fear. In time, the negative feelings lessen.

    Resources for Counselors

    The following resources are aimed at counselors treating veterans with substance abuse disorders:

    Resources for Veterans

    Veteran substance abuse is a complex problem that has no easy answers. Veterans may suffer from several disorders, requiring integrated treatment. Long wait times for a VA facility or the lack of financial resources can create barriers to care. Additionally, counseling can be expensive and lengthy, because substance abuse disorders are difficult to treat and require inpatient or outpatient care.
    As a result, help for substance abuse can feel like a daunting task for veterans. However, resources are out there. They range from the VA and other government agencies as well as counseling centers that specialize in the particular needs of veterans.
    The following resources may help veterans and their families identify the care they need:

    • Help for Service Members and Their Families. Current and former members of the military can find various mental health resources from the U.S. Department of Health and Human Services.
    • About Us. The goal of Justice For Vets is to reform how the justice system treats veterans who’ve committed crimes. The organization has formed veteran treatment courts to help veterans get the treatment they need and keep veterans out of jail or prison.
    • Military and Veterans Issues. GoodTherapy provides an overview of the emotional and mental health issues that soldiers and veterans face.
    • PTSD Treatment Works. The National Center for PTSD provides information on treatment, providers, and other resources for veterans and active members of the military.
    • Substance Use Disorder Program. The VA offers a guide to its facilities in all states and territories. The VA also has outpatient mental health clinics to help veterans with substance use disorders.
    • Substance Use. The VA provides a guide to help active members of the military and veterans identify behaviors that indicate a substance use disorder.
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