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Rehab for Veterans

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Veterans frequently face a range of challenges as they readjust to civilian life after separation from the military. Substance use, mental health disorders, service-related injuries, and chronic pain are common among veterans.1 Veterans are at a higher risk for developing substance use disorders (SUDs).1 Veterans are also more likely to be diagnosed with a co-occurring mental health disorder, which is when an SUD occurs with another mental health disorder, such as depression or post-traumatic stress disorder (PTSD).1 Rehab facilities often have programs that are tailored to treat the unique needs of veterans.


Substance Abuse Among Veterans 

Nearly one-third of active-duty military personnel report binge drinking and even more show signs of dangerous drinking or potential alcohol use disorder.1 Substance use commonly increases after separating from the military.1 If a veteran also has mental health issues, they may be at greater risk for developing a problem with substances.1 They may be reluctant to seek help for substance abuse or mental illness for a variety of reasons, including stigma, insurance issues, or limited access to treatment.1

Veterans are more likely than the general population to struggle with substance use.1 Statistics show that:

  • More than 10% of veterans have an SUD.1,2
  • 63% of veterans who served recently in Afghanistan and Iraq who were diagnosed with an SUD also met criteria for PTSD.1
  • Almost 40% of veterans from Afghanistan and Iraq were likely to be abusing alcohol.3
  • About 3% of veterans from Afghanistan and Iraq were likely to be using drugs.3

There are several reasons why veterans use substances. Service-related injuries and chronic pain are often managed with pain medications, which can lead to opioid abuse.1,3 Veterans with mental health disorders may turn to alcohol or drugs to cope with symptoms or deal with the trauma that was experienced during service.1,3 The stress of readjusting to civilian life can also contribute to veteran substance abuse.1

The most common substance abused by veterans is alcohol, followed by opioids and other prescription medications, marijuana, and cocaine.1,3


Why Do Veterans Abuse Drugs and Alcohol?

A variety of factors can contribute to the development of an SUD, especially in veterans. Genetic factors can play a role; SUDs frequently run in families.4 And as they may be facing a genetic component, veterans are also often dealing with additional factors that contribute to substance abuse. Long periods of deployment, exposure to combat, and trauma are stressors common in military service that can increase the risk of developing an SUD.1,3,5 These issues can also contribute to the development of mental health disorders such as PTSD, depression, and anxiety, and veterans may use substances to manage symptoms and are also at higher risk for developing an SUD.1,3,6 Traumatic brain injuries (TBI) can increase the risk that a veteran will abuse alcohol or drugs by 2 to 5 times higher than veterans without TBIs.7

Veterans may find it difficult to readjust to civilian life after leaving the military, which can also contribute to SUDs.1,5 They may have difficulty connecting with family members and friends, especially if they have been deployed for an extended period.8 They may also find it hard to interact with civilians who don’t know what they’ve been through.8

Relationship issues can be exacerbated by mental illness symptoms.9 The family dynamic changes when a service member is deployed, and it can be difficult to adjust when a veteran returns home.9 More than half of married veterans experience marital problems, with similar numbers reporting some level of domestic violence.9 Marital problems and divorce can also be contributing factors to SUDs.


Mental Illness and Veterans

Co-occurring disorders may be especially likely in veterans.1,2,3,5 PTSD or depression diagnoses are 3-4 times more likely in veterans with SUDs.1,5 Anxiety disorders are also more likely to occur in veterans.1 Up to half of veterans from Afghanistan and Iraq are diagnosed with a mental illness of some kind, conditions that are strongly associated with SUDs.1,2 Estimates show that between 82-93% of veterans from Afghanistan and Iraq with an SUD have a co-occurring mental illness.5

Each disorder can influence the other and have an impact on the veteran’s functioning and treatment outcomes.1,5,7 Treatment can become more complicated because it needs to address each co-occurring disorder simultaneously.20

Veterans and PTSD

PTSD can occur after exposure to trauma such as combat.4,11 Symptoms last for at least 4 weeks, and may include:4,11

  • Agitation or irritability.
  • Avoiding things that are reminiscent of the trauma.
  • Difficulty feeling happiness or connection to others.
  • Excessive vigilance.
  • Feelings of guilt or blame.
  • Flashbacks.
  • Losing interest in hobbies or important activities.
  • Persistent and uncontrollable memories of trauma.
  • Recurring dreams about the trauma.
  • Severe and possibly long-lasting distress when exposed to triggers reminiscent of the trauma.
  • Sleep difficulties.
  • Trouble focusing.
  • Trouble remembering aspects of the trauma.

PTSD is a risk factor for substance abuse.5,6,12 About 20% of veterans seeking treatment for PTSD have a co-occurring SUD.13,14 They may use substances to self-medicate and manage symptoms of PTSD such as insomnia, to relax, or as a distraction.12,13,14 Veterans with PTSD often get more prescriptions and higher doses of opioids than veterans without PTSD.5 However, SUD can worsen PTSD symptoms.12,14

Effective treatment requires addressing both disorders simultaneously.3,13 PTSD and SUDs are often connected because they affect the same areas of the brain and involve similar patterns of behavior, such as impulse control.12 SUDs can also lead to exposure to further trauma, creating a vicious cycle of worsening both disorders.6,12

Veterans and Traumatic Brain Injury

TBI can occur if a person suffers a head injury such as a concussion.12,15 Veterans are much more likely to experience TBI than civilians because they are more likely to be exposed to explosions, vehicle accidents, being hit with debris or shrapnel, or hitting a hard surface.12,15 TBI is known as “a signature wound” associated with veterans who served in Afghanistan and Iraq; about 20-30% returned with a possible TBI.7,15,16

TBIs can range in severity. Symptoms can involve memory loss, sensory changes, headaches, sleep disturbances, difficulty focusing, agitation, and seizures.12,15 Veterans with TBIs may also struggle with impulse control and develop mental health disorders such as PTSD, depression, or anxiety.12

Veterans with TBI are more likely to abuse substances. Rates increase in proportion to the severity of the TBI.7 Nearly half of all veterans with TBI complained of pain, which can make it more likely that they will receive opioid medications.7,17 Impulse control and impaired judgment can make veterans with TBI more likely to misuse substances.7,12 The presence of TBI can make SUD treatment more complex because both issues must be addressed for treatment to be effective.12

Veteran Depression and Anxiety

Depression, or major depressive disorder, is a cluster of symptoms that last more than 2 weeks and can make it difficult to function.4,18 Symptoms may include: 4,18

  • Changes in appetite and/or weight.
  • Feelings of guilt, hopelessness, or sadness.
  • Having no energy or feeling tired a lot of the time.
  • Isolating.
  • Lack of interest or enjoyment in activities.
  • Sleeping more or less than usual.

Anxiety is normal in certain situations, but for people who experience it frequently, anxiety may begin to interfere with their ability to function.19 People with anxiety may have symptoms including:4,19

  • Chest pain.
  • Difficulty breathing.
  • Feeling dizzy or about to faint.
  • Nausea or upset stomach.
  • Racing heart (palpitations).
  • Restlessness.
  • Sleep issues.
  • Trouble focusing.
  • Worrying excessively.

Both depression and anxiety have been linked to SUDs.3,4,17 Either issue can develop first, but each can complicate treatment for the other.5,7 Many veterans who display symptoms of depression or anxiety may use substances to change how they feel.20


Why Do Many Veterans Avoid Addiction Treatment?

Veterans avoid treatment for a number of reasons. Stigma is often one of the factors.1,3 Stigma is defined as “a mark of disgrace that sets a person apart from others.”21 Military culture can strongly influence this stigma and lead veterans to internalize this feeling, even after separating from the military.22,23

Some service members and veterans are less likely to seek treatment because of the military’s emphasis on being tough, strong, self-sufficient, reliable, and ready for service at all times.5,22,23,24 Getting help for a mental illness or SUD can feel contradictory to these values.22,23 Service members fear being judged as weak or less reliable. They don’t want to be treated differently or lose the respect of others.22,23,24

Veterans may also have concerns that seeking treatment will harm their career.25,26,27 Some veterans with PTSD may resist treatment to avoid talking or thinking about traumatic events.11


Addiction Rehab for Veterans

The following treatment options are available for veterans seeking help for SUDs and co-occurring disorders:

  • Inpatient care, which involves staying at a facility while receiving intensive group and individual counseling.10,28 Psychiatric care and detoxification services may also be provided and attendance at 12-step meetings or mutual help groups is commonly encouraged.10,28
  • Outpatient care, which offers similar treatment as inpatient, but is less intensive. Patients live at home and can maintain their usual routines, including work, school, and other responsibilities.10,28 Psychiatric care may be offered as well. Services are commonly offered on a continuum of intensity that is tailored to each patient’s needs.10,28
  • Medications, which can be highly effective, especially when paired with counseling.28 They can be prescribed to assist in detox, to support sobriety, and to manage symptoms of mental illness.10,28
  • Counseling, commonly offered in group and individual settings. It can help veterans learn to identify triggers, develop coping skills, prevent relapse, improve communication, cope with trauma, and manage mental health symptoms.10,28

The Department of Veterans Affairs (VA) operates medical centers around the country that are equipped to offer effective, high-quality treatment for veterans struggling with SUDs and mental health disorders.29 They offer treatment options such as:29

  • Detoxification services.
  • Individual, group, family, and marital counseling.
  • Inpatient services.
  • Medication-assisted treatment.
  • Outpatient services.
  • Treatment for co-occurring disorders.

The VA’s SUD locator allows veterans to find a VA treatment facility close to them anywhere in the country.

While the VA provides quality care to many veterans, there are certain situations where they cannot offer a particular treatment because of limited accessibility or availability. For those situations, a community care provider such as American Addiction Centers (AAC) may be an option.

AAC has partnered with the VA to offer private treatment to veterans at its Recovery First and Desert Hope facilities. Both facilities have a carefully cultivated program called Salute to Recovery, a service for veterans who are dealing with substance abuse and mental health disorders. Salute to Recovery allows veterans to receive treatment, often from other veterans, in a safe environment where they are surrounded by other veterans. The shared experiences of both patients and staff give veterans the opportunity to feel comfortable and understood while they address their issues.


Sources

  1. National Institute on Drug Abuse. (2019). Substance use and military life.
  2. U.S. Department of Veterans Affairs. (2019). Spotlight on substance use disorder.
  3. National Veterans Foundation. (2016). What statistics show about veteran substance abuse and why proper treatment is important.
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th). Arlington, VA: American Psychiatric Publishing.
  5. Teeters, J.B., Lancaster, C.L., Brown, D.G., & Back, S.E. (2017). Substance use disorders in military veterans: Prevalence and treatment challenges. Substance Abuse and Rehabilitation, 8, 69-77.
  6. Schmied, E.A., Larson, G.E., Highfill-McRoy, R.M., & Thomsen, C.J. (2016). Reciprocal relationships between stressors and mental health problems in military veterans. Journal of Social and Clinical Psychology, 35(9), 705-721.
  7. Saxon, A.J. (2011). Returning veterans with addictions. Psychiatric Times, 28(7).
  8. U.S. Department of Veterans Affairs. Common challenges during re-adjustment.
  9. Sayers, S.L., Farrow, V.A., Ross, J., & Oslin, D.W. (2009). Family problems among recently returned military veterans referred for a mental health evaluation. The Journal of Clinical Psychiatry, e1-e8.
  10. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (Third edition).
  11. U.S. Department of Veterans Affairs. (2020). PTSD basics.
  12. Brady, K.T., Tuerk, P., Back, S.E., Saladin, M.E., Waldrop, A.E., & Myrick, H. (2009). Combat posttraumatic stress disorder, substance use disorders, and traumatic brain injury. Journal of Addiction Medicine, 3(4), 179-188.
  13. U.S. Department of Veterans Affairs. (2018). Understanding the link between PTSD and substance use disorders in veterans.
  14. U.S. Department of Veterans Affairs. (2019). PTSD and substance abuse in veterans.
  15. U.S. Department of Veterans Affairs. (2019). Traumatic brain injury (TBI).
  16. American Psychological Association. The mental health needs of veterans, service members and their families.
  17. U.S. Department of Veterans Affairs. (2018). VA research on substance use disorders.
  18. U.S. Department of Veterans Affairs. (2020). Depression.
  19. U.S. Department of Veterans Affairs. (2019). Anxiety.
  20. U.S. Department of Veterans Affairs. (2016). VA research on depression.
  21. Government of Western Australia, Department of Health. (2009). Stigma, discrimination, and mental illness.
  22. Sharp, M.L., Fear, N.T., Rona, R.J., Wessely, S., Greenberg, N., Jones, N., & Goodwin, L. (2015). Stigma as a barrier to seeking health care among military personnel with mental health problems. Epidemiologic Reviews, 37(1), 144-162.
  23. Acosta, J.D., Becker, A., Cerully, J., Fisher, M.P., Martin, L.T., Vardavas, R., … & Schell, T.L. (2014). Mental health stigma in the military. RAND Corporation.
  24. Kulesza, M., Pedersen, E., Corrigan, P., & Marshall, G. (2015). Help-seeking stigma and mental health treatment seeking among young adult veterans. Military Behavioral Health, 3(4), 230-239.
  25. Tanielian, T., Jaycox, L.H., Schell, T.L., Marshall, G.N., Burnam, M.A., Eibner, C., …Vaiana, M.E. (2008). Invisible wounds: Mental health and cognitive care needs of America’s returning veterans.
  26. Kime, P. (2015). Panel: Stigma is obstacle to mental health care. Military Times.
  27. Dingfelder, S.F. (2009). The military’s war on stigma. American Psychological Association.
  28. National Institute of Drug Abuse. (2019). Treatment approaches for drug abuse.
  29. U.S. Department of Veterans Affairs. (2019). Treatment programs for substance use problems.
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NREMT
Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series of in-depth articles on Community Paramedicine programs across the country that go beyond transporting patients to emergency rooms and connects specific patients, such as repeat system users, the homeless and others with behavioral health issues and substance use disorders, to definitive long-term care and treatment. In his current capacity as Medical Editor for American Addiction Centers, Ryan works to provide accurate, authoritative information to those seeking help for substance abuse and behavioral health issues.
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