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Veterans: PTSD and Addiction

Readjusting to civilian life after deployment is hard, and even more so when a veteran has been exposed to trauma leading to PTSD. Too often, veterans turn to alcohol or drugs to cope with symptoms of PTSD. The U.S. Department of Veterans Affairs now offers treatment to vets suffering from co-occurring addiction and PTSD, so hope and recovery are more available than ever.

Line of people in fatigues

PTSD in the Armed Forces

Veterans can have substance use disorders both before and after their deployments. However, research has shown a clear link between PTSD and addiction. Even if a military member doesn’t have a substance use disorder before deployment, experiencing PTSD greatly increases the risk of developing one after returning home.

According to the Department of Veterans Affairs, post-traumatic stress disorder (PTSD) can develop after any traumatic event, including terror attacks and combat. Symptoms of PTSD include:

  • Re-living the event through flashbacks, nightmares or triggers
  • Avoiding situations that remind you of the event
  • Negative changes in beliefs or feelings related to the event
  • Hyperarousal, or feeling “keyed up” all the time, evidenced by insomnia, trouble concentrating, anxiety, being easily startled, etc.

Sometimes PTSD appears immediately after the event, but it’s possible that weeks, months or even years can go by without symptoms of PTSD surfacing. Often, symptoms start affecting daily life for veterans, including work, family and school. That’s when it’s important to seek treatment.

Some veterans also have co-occurring mental health disorders that have gone untreated and unaddressed until PTSD became an issue. Depression, anxiety and suicidal thoughts or actions all can contribute to or exacerbate the symptoms of PTSD. In some veterans, these can also lead to or worsen new or existing problems with alcohol or drugs.

The Link between PTSD and Addiction in Veterans

Many servicemen and women enter the armed forces with a substance use disorder already. According to the Drug Policy Alliance, approximately 11 percent of current combat veterans have been diagnosed with a substance use disorder. In general, military personnel and combat veterans have a higher instance than the general population of substance use disorders.

Some veterans may try coping with their PTSD symptoms with drugs or alcohol before they seek treatment. In fact, 27 percent of veterans diagnosed with PTSD also have a substance use disorder, according to the Department of Veteran’s Affairs.

The most widely accepted reason for the link between PTSD and addiction is the “self-medication hypothesis.” This states that individuals use the sedating, tranquilizing and otherwise mind-altering properties of drugs and alcohol to forget about the traumatic event or to numb the symptoms of PTSD caused by the event.

Societal reintegration of combat veterans is difficult, and often, veterans are expected to adjust quickly and without much supervision or guidance. This can make the symptoms of mental health disorders, including PTSD, much more acute, as former service members navigate the civilian world.

Addiction is a major concern in the veteran community. With a 52.7 percent increase in outpatient veterans treated for substance use disorders between 1995 and 2012, the challenge is undeniable.

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Problems Associated with PTSD and Addiction

The symptoms of PTSD can reach far and wide. It can be hard for veterans to hold a steady job, to connect with their significant other, or to adjust to paying bills and conforming to social mores when they’re under such emotional and mental distress.

The memories surrounding the event that triggered PTSD can be overwhelming. When speaking to the Montreal Gazette in 2011, Alain Brunet, a researcher at McGill University who specializes in PTSD treatment said that most memories “are not generally active but some carry a huge, powerful emotional charge.”

There are specific problems related to daily life that affect veterans with PTSD and addiction. Whether it’s at home or at work, PTSD and addiction can combine to equal disaster if not treated properly.


PERMANENT INJURY AND CHRONIC PAIN

One of the results of combat is injury to service members. From lost limbs to chronic headaches and back pain, the list of ailments from veterans returning from war zones is significant.

One of the most common ways doctors treat this pain is with prescription opioids. While opioids such as OxyContin and Vicodin have proven successful in treating pain, they are highly addictive, and veterans are at particular risk for developing an addiction to them.

Dr. Gavin West, a physician who heads the Opioid Safety Initiative at the Department of Veterans Affairs, told National Public Radio in 2014 that there has been a significant increase in prescriptions for narcotics to treat pain in the military and in the civilian world, but it’s worse for combat veterans because they have more pain to manage.

Dependence on and addiction to prescription opioids is linked to homelessness and suicide among veterans as well. While the VA has piloted pain-management programs that don’t include prescription opioids, treatment for addiction is the best option available.


CRIMINAL AND LEGAL CHALLENGES

Increased incarceration rates in veterans are linked to every major war since World War II and are closely related to instances of PTSD and addiction. About 34 percent of new admissions to 11 U.S. prisons between 1946 and 1949 were combat veterans.

Former service members who have returned home between the Vietnam War and today’s conflicts are at an even greater risk for incarceration because of the war on drugs, which was declared in 1971. As a consequence, 21 percent of men in all state prisons and 23 percent of men in federal prisons were combat veterans.

According to the Drug Policy Alliance, the National Vietnam Veterans Readjustment Study, which was completed in 1988, found that nearly half of male Vietnam combat veterans afflicted with PTSD had been arrested or incarcerated one or more times. Also, 11 percent had been convicted of a felony. Researchers predict a continued trend as today’s combat veterans return home and attempt to readjust to daily life as civilians.


DOMESTIC PROBLEMS

Post-traumatic stress disorder and addiction can cause problems with trust, closeness, communication and problem solving in relationships. Often, a partner doesn’t know how to respond to the other, and vice versa, causing a cycle that can eventually destroy relationships and families. According to the VA, 5 to 10 percent of veterans with PTSD have lasting relationship problems at least partly in response to symptoms of PTSD.

The memories, flashbacks, mood swings, aggression and isolation associated with PTSD can combine with the symptoms of drug addiction — many of which they share — and can amplify dysfunction. Partners, friends and family members may feel hurt or distanced from the effect of the trauma on their loved one. Addiction just furthers the distance between loved ones and increases feelings of isolation and depression for those struggling with PTSD.


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HOMELESSNESS

A 2013 feature story published in the American Psychological Association publication Monitor on Psychology reported that homeless Iraq and Afghanistan veterans are more likely to be “haunted by PTSD” than homeless vets of previous eras. About two-thirds of homeless Iraq and Afghanistan vets tested positive for PTSD, much higher than homeless veterans from previous wars, who tested at about 8 to 13 percent.

According to a survey by the 100,000 Homes Campaign, three of four homeless veterans reported having a substance use disorder. One in five veterans in addiction treatment was homeless, according to a 2014 report by the Substance Abuse and Mental Health Services Administration.

Treatment for Co-Occurring PTSD and Addiction

It’s imperative that veterans who suffer from PTSD and a co-occurring substance use disorder receive treatment for both concurrently. Treatment can be in an in inpatient rehab center, outpatient therapy program, or combine medical and psychological treatment on the person’s own schedule.

The most frequently used techniques for treating PTSD and substance use disorders are:

  • Cognitive behavioral treatments, including exposure therapy
  • Group therapy and 12-step programs
  • Behavioral couples’ therapy
  • Medication-assisted treatment (MAT)

In the past, it was believed that PTSD treatment should not commence until the individuals achieved lasting sobriety from alcohol or drugs. A 2012 study conducted by the National Drug and Alcohol Research Center in Sydney, Australia, refuted this theory.

Now, doctors and therapists know that concurrent treatment is the best option. The study found that exposure therapy, which involves exposing an individual to memories and reminders of the traumatic experience, can successfully reduce the symptoms of PTSD, even when the individual continues using drugs or alcohol.

Resources for Veterans with PTSD and Addiction

If you or a loved one may be struggling with PTSD and a co-occurring substance use disorder, the first thing you should do is talk to an addiction specialist that also has experience treating PTSD.

The Department of Veterans Affairs has a directory of providers that specifically help veterans deal with these issues. Additionally, each VA medical center has an in-house specialist trained in treating these concurrent disorders.

The Substance Abuse and Mental Health Services Administration also sponsors a help line especially for veterans. You can reach them at 1-800-273-8255, and press option 1. The Veterans Crisis Line website can also provide information about where to find treatment in your area.