Veterans are particularly at risk of developing substance use disorders. According to the American Psychological Association (APA), about 1.1 million veterans have some sort of substance use disorder. Of those, around 25% use illicit drugs, 80% use alcohol, and nearly 8% use both drugs and alcohol — all to the extent that they have a disorder.
Substance use disorders (SUDs) are characterized by a dependency on the substance and individuals with SUDs often have trouble with their physical and mental health, as well as their ability to function adaptively in society.
Although their alcohol use declined from 2018 to 2019, the prevalence of alcohol use disorder among veterans increased during that time. This mirrors a 6.5% increase in mental illness and/or substance use disorders, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Moreover, the APA found that veterans with substance use disorders are less likely to find employment through the Veterans Affairs (VA) vocational rehabilitation program.
This guide provides information to help veterans who are overcoming substance use disorders and seeking to lead healthy, fulfilling lives as civilians.
Why are veterans at a high risk of substance abuse?
After they spend years serving in the military, veterans are faced with the reality of returning to civilian life. They may have sustained injuries during their time in service or they may have difficulty adjusting to the civilian world. Their time in service may have contributed to the development of a mental illness such as post-traumatic stress disorder (PTSD), which affects up to 30% of veterans. For all these reasons and more, substance use disorders are common among veterans.
PTSD and substance abuse
PTSD is the repeated and often severe occurrence of anxiety in people who have experienced traumatic events. People with PTSD often experience flashbacks and panic attacks. For veterans, violent episodes and the inherent danger of wartime operations may lead to PTSD — but explosions and combat are not the only causes. According to the VA, sexual trauma also causes PTSD in veterans and about 23% of women report having been sexually assaulted when they were in the military.
Over 20% of veterans with PTSD have a co-occurring substance use disorder; nicotine use and binge drinking are especially prevalent for them. Among those who seek treatment for SUDs, about one-third are diagnosed with PTSD. Veterans with PTSD may turn to substances such as alcohol and nicotine to help them cope with anxiety and stress.
When substance use becomes a habit, it can lead to dependence and addiction. If you’re a veteran experiencing repeated anxiety, stress, and panic attacks due to PTSD, it seems only logical to return to a coping mechanism such as substance use. You may even abuse substances to preempt PTSD symptoms. Therefore, veterans with SUDs and PTSD typically need treatment for both issues.
What substances do veterans commonly abuse?
According to SAMHSA, veterans most often use alcohol, marijuana and psychotherapeutic drugs. Here are some statistics from SAMHSA’s National Survey on Drug Use and Health:
- Alcohol: 57%, or 11.5 million veterans, use alcohol; of those, 5% have alcohol use disorder.
- Marijuana: 12.8%, or 2.6 million veterans, use cannabis; of those, 0.5% have marijuana use disorder.
- Opioids: 2.9%, or 595,000 veterans, misuse opioids such as hydrocodone, oxycodone, and fentanyl; 0.7% have an opioid use disorder. Furthermore, the number of veterans who overdosed on opioids increased to 21% in 2016 from 14% in 2010.
- Prescription painkillers: 2.6%, or 531,000 veterans, misuse pain relievers.
Fewer veterans use heroin (0.3%), cocaine (1.1%), methamphetamine (0.5%), as well as LSD and other hallucinogens (1%). Additionally, over 21% of veterans have reported using nicotine, which comes with significant costs — in 2010, for example, the VA spent $2.7 billion on healthcare to lessen the negative impact of veterans’ cigarette use.
Signs and symptoms of substance use disorder
Substance use disorder can sneak up on you. It can be hard to know when to get help for something as common as alcohol use, for example, when having a drink now and then is simply part of your normal routine.
If you do use substances, it’s essential to know the signs of a disorder before you find yourself spiraling out of control. The physical, mental and behavioral signs of substance use disorder can differ depending on which substance you’re using, but some common symptoms of SUD include:
- Increased urge to drink or use drugs.
- Inability to stop drinking or using drugs.
- Drinking or using drugs in hazardous situations (for example, drinking and driving).
- Change in relationships due to drinking or drug use.
- Feeling depressed or anxious about your substance use.
- Feeling sick and experiencing withdrawal symptoms when drinking or drug use stops.
- Increased tolerance.
- Experiencing sudden weight loss or gain.
- Experiencing issues with sleep or appetite.
- Going through mood swings and manic periods.
- Feeling you need to keep your substance use a secret.
- Feeling a lack of motivation to do much besides drink or use drugs.
- Going through legal or financial problems caused by drug or alcohol use.
- Neglecting your responsibilities at home or work due to substance use.
- Continuing substance use despite harmful consequences such as blacking out or feeling depressed and paranoid.
If you’re a veteran who’s experiencing any of the above warning signs and symptoms, an addiction screening could potentially save your life. The screening will help you create a plan for change. What’s more, as the statistics we’ve mentioned show, you’re not alone, and there are professionals as well as rehabilitation resources to help you fully recover.
Where to find treatment for substance use disorder
When it comes to SUD recovery, your treatment options are as extensive or minimal as you want them to be. You’re in control and this is a mission you can accomplish with all the resources at your disposal. The fact that you’re reading this signals awareness, which is the first, and perhaps the most important, step to recovery. Here’s where you can go to get started:
- Rehabilitation facilities: At a substance abuse treatment center, you can access outpatient or residential care from a licensed team of practitioners. You’ll attend group and one-on-one therapy in a structured environment, where you’ll get to know others who are going through the same things you are. These facilities emphasize structure, which is ideal for veterans.
- Veterans Alcohol and Drug Dependence Rehabilitation Program: This program from the VA offers a variety of treatment options to eligible veterans, including detoxification, rehabilitation and psychiatric care. You’ll find this program at your state’s VA medical centers and clinics. Eligibility is based on whether you are enrolled in the VA healthcare system.
- Primary care physician: A primary care provider (PCP) can provide various treatment services, such as diagnosis, prescriptions, referrals to therapists and substance abuse rehab facilities in your area, as well as recommendations for your course of treatment. A primary care physician is often the first and last source of care for those recovering from substance abuse. Quality PCPs pride themselves in doing everything in their power to help their patients.
- Psychologist: A licensed psychologist is an essential part of your recovery. Once you decide to seek treatment, a psychologist will give you an assessment and treatment plan with concrete steps and goals to empower your success.
- Psychiatrist: As part of your treatment team, a psychiatrist can provide a substance use disorder diagnosis and a co-occurring disorder diagnosis, provide therapy, prescribe medications as needed, and partner with a therapist who provides more frequent counseling.
- Therapist: A therapist provides counseling as well as various kinds of therapies and treatments based on your needs.
Once you begin treatment, you’ll have a team of professionals working in your corner, which may also include a vocational rehabilitation specialist, a peer support specialist, a community-based rehabilitation specialist, and a social worker.
Rehabilitation options for substance abuse
As we indicated earlier, there are multiple rehab options for veterans overcoming substance abuse.
- Detoxification programs: A detox center helps veterans recovering from substance abuse transition into a rehabilitative program. Since sudden, “cold turkey” detoxification from some substances such as alcohol or opioids can be dangerous, detox centers help mitigate the effects of detox through managed withdrawal. This includes medications, medical interventions and therapies. By the time you’re done with detox, the substance should no longer be in your system.
- Inpatient or residential rehabilitation: Depending on the severity of the addiction, a patient may need to transition to an inpatient rehab center after detox. There, you enter a structured setting where you learn to replace your dependence on a substance with psychological resiliency and new habits for a better life.
- Intensive outpatient programs: Unlike an inpatient program, outpatient rehab allows you to live at home while you take part in therapy and activities at the rehab center. Patients who do residential rehab often transition to an intensive outpatient program. Or, you may go straight to an outpatient program if a psychiatrist deems your addiction to be less severe and your social supports are strong enough.
- Partial hospitalization programs: A partial hospitalization program allows veterans to maintain their home life even as they benefit from the rigor and treatment modalities of inpatient rehab. Compared with an intensive outpatient program, patients spend more time in partial hospitalization, where they can receive medical and psychiatric care, which is not normally included in an outpatient program.
The treatment modalities rehab programs use are based on evidence that therapeutic treatment is beneficial in reducing substance use. Find out more about the therapy types for veterans with substance use disorder below.
Therapy programs for substance abuse
There are many types of therapy that can show positive results for veterans who are conquering substance abuse. The therapy you’ll receive will vary based on your needs. Here are some of the common types:
Group therapy
According to SAMHSA, 93% of substance use disorder treatment facilities provide group counseling, and 22% of groups are for veterans. You’ll meet with one or two therapists and up to 12 other patients. The counselor(s) guide the group in various therapeutic approaches; SAMHSA notes that these include:
- Motivational interviewing;
- Stages-of-change interventions;
- Psychoeducation;
- Supportive approaches;
- Skill development.
In group therapy, you’ll find community, a sense of belonging, and a forum of mutual support. Through the sharing of experiences and education on positive coping skills, group therapy empowers you to move ahead without depending on substances to do so.
Motivational interviewing (MI)
According to SAMHSA, research shows motivational interviewing is effective for the treatment of substance use disorder. In an individual or group setting, a therapist finds out what drives you and where you want to go. Empathizing with your past experiences and what put you in your current position, the therapist helps you see your strengths. You get a clear-eyed view of the discrepancy between substance dependency and your goals. Through MI, you come to your own understanding of how you can use your strengths to live a life free of substance abuse.
Eye movement desensitization and reprocessing (EMDR)
As a kind of somatic therapy, EMDR can be an effective treatment for PTSD. In one study, 90% of participants whose trauma was due to a single event experienced a total cessation of PTSD symptoms after three EMDR sessions. Similarly, EMDR is showing positive results for the treatment of substance use disorder. For veterans whose substance use is co-occurring with PTSD, EMDR may be a highly effective therapy.
During EMDR, a therapist uses bilateral stimulation — they give you a sensory stimulus such as a buzzer that alternates side to side. Simultaneously, they ask you questions so you can recall your trauma or any early memories of substance abuse. With subsequent sessions, you dive deeper into memories and thoughts that drive you towards using substances. The safe setting and the counselor help you reprogram your brain so that certain feelings and thoughts no longer trigger you to use substances.
Rational emotive behavior therapy (REBT)
With REBT, a therapist helps you remember what led you to begin using substances. Next, you identify your irrational beliefs or assumptions tied to the state of affairs that caused you to start using substances. Then, you’ll examine how your belief makes you feel — you’ll come to understand the emotions triggered by your belief. Further therapy sessions will help you change your irrational beliefs or assumptions so that you are no longer triggered.
Cognitive behavioral therapy (CBT)
Similarly to REBT, cognitive behavioral therapy helps you identify the thought distortions and irrational beliefs that lead you to use substances. You also come to a firm understanding of your triggers toward substance use.
Through repeated sessions, you challenge your beliefs, build new ones, and develop coping skills for times when you’re triggered. The therapist will help you carry CBT into the real world, often by giving you exercises to do at home, and they may assign a peer support specialist to help you process the therapy on your own.
Dialectical behavioral therapy (DBT)
“DBT is basically CBT with mindfulness, acceptance and validation woven in,” says Grace Dowd, a licensed clinical social worker and therapist. According to Addiction Science and Clinical Practice, DBT for substance use disorder takes place via individual therapy, group skills training and telehealth. ASCP notes randomized trials have shown DBT is effective in treating substance use disorder and co-occurring disorders, such as borderline personality disorder.
Through DBT, you examine your emotions without judging them, accepting yourself and removing guilt but simultaneously committing to abstinence from substances. DBT is consistent with the Serenity Prayer, popularized by 12-step programs such as Alcoholics Anonymous: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” Abstinence commitments continued to be renewed after patients reach each goal, with a focus on anticipating triggers and planning out coping methods in advance.
Contingency management (CM)
Contingency management involves rewarding patients for abstinence. According to The Psychiatrist, “Contingency management has a great deal of evidence supporting its efficacy.” In one study, participants who received CM therapy were four times more likely to abstain from stimulants compared with those assigned to standard care. Although CM has been shown effective in reducing alcohol, opioid, marijuana, and benzodiazepine use across a wide variety of populations, it hasn’t caught on as a widespread treatment.
Paying for substance abuse treatment
Since substance use disorder may lead to unemployment and substance abuse drains wallets, it can be tough to afford treatment. However, you have many options at your disposal when it comes to paying for therapy. Here are veterans’ options when it comes to paying for treatment:
- Veterans Affairs: The VA provides free readjustment counseling and related mental health services, as well as free care for any issues related to combat service. So, if you have combat-related PTSD or another mental health issue co-occurring with substance use disorder, the VA should be able to provide you with free or low-cost mental health care. You can also receive a free substance abuse assessment and referral at a Vet Center. Whether you need to pay a copay for SUD treatment depends on your disability rating, income level, military service record and your VA healthcare priority group.
- Medicare: If you’re disabled or aged 65 or older, you may be eligible for Medicare. If your SUD treatment is not covered by VA because it’s deemed non-combat related, Medicare may be able to cover the treatment costs of inpatient care at a non-VA facility, or therapy costs at a private provider.
- Medicaid: If your income needs qualify you for Medicaid, this state-administered insurance program may pay for SUD treatment. Contact your VA social worker or state Medicaid office to see if you qualify, or visit the Medicaid website.
- TRICARE: If you’re a retired service member, you’re eligible for TRICARE, which provides coverage for medically and psychologically necessary mental health and substance use disorder care.
- Private insurance: If you’re not eligible for any of the above healthcare options, you can get private insurance to cover SUD treatment through the Health Insurance Marketplace. Depending on your income and household size, you may be eligible for low-cost premiums or low out-of-pocket costs.
Veterans advocacy groups
The following advocacy groups can help you receive care for substance use:
- Give an Hour: A nonprofit that links veterans with free mental health care from a network of volunteer mental health professionals.
- Homecoming for Veterans: Offers veterans free neurofeedback treatment for PTSD and substance abuse.
- Veterans Recovery Resources: Offers substance abuse and mental wellness services to all veterans, even those who only served for a day. Offers charity care and financial assistance to those who are underinsured, uninsured, or ineligible for VA healthcare.
Additional substance abuse resources
There are even more resources that can help veterans overcome substance use:
- NAMI: With over 600 state organizations and affiliates, the National Alliance on Mental Illness can connect veterans to substance use disorder therapy. Additionally, NAMI Homefront is an educational program and resource hub that you, as well as families of veterans, can use to address substance abuse head-on.
- SAMHSA National Helpline: This free, confidential service can connect you to information and referrals 24/7, 365 days a year.
- Alcoholics Anonymous: The original 12-step program for those with alcohol use disorder, AA helps to guide you through recovery through a community of people going through the same things you are.
- Narcotics Anonymous: NA takes the 12-step model and applies it to drug use recovery.
As a veteran, you’re well equipped to overcome substance abuse with help from these resources and the information at hand.