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Medication-Assisted Recovery Journeys for Veterans

Written by The Recovery Village

& Medically Reviewed by Dr. Kevin Wandler, MD

Medically Reviewed

Up to Date

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Updated 03/18/2024

Key Takeaways

  • Veterans have a higher prevalence of Substance Use Disorders (SUDs) than civilians, often linked to PTSD and other mental health issues.
  • PTSD and substance abuse are intricately linked in veterans, with those suffering from PTSD more likely to develop SUDs.
  • Mental health disorders and SUDs are interrelated, with conditions like depression and anxiety commonly co-occurring in veterans.
  • Medication-Assisted Treatment (MAT) is an effective approach for treating SUDs, combining FDA-approved medications with counseling and behavioral therapies.
  • The primary medications used in MAT include methadone, buprenorphine, naltrexone, and naloxone, each serving a unique purpose in treatment.
  • MAT has been shown to increase treatment retention, reduce illicit opioid use, and lower the risk of overdose and infectious disease transmission.
  • The Veterans Health Administration (VHA) implements MAT tailored for veterans, including the SCOUTT initiative to increase access to MAT.
  • Challenges for veterans accessing MAT include medical infrastructure, funding policies, and social barriers.
  • Veterans' recovery stories highlight the transformative impact of MAT when combined with peer support and mentorship.
  • Advancements in MAT for veterans include the VA's 2024 Equity Action Plan and expanded access to care for those exposed to toxic substances.

Substance Abuse Prevalence in the Veteran Population

Substance use disorders (SUDs) present a significant public health challenge among U.S. military veterans, with a range of substances being misused, including alcohol, prescription medications, and illicit drugs. The prevalence of SUDs is notably higher in veterans compared to civilian populations, with contributing factors such as post-traumatic stress disorder (PTSD), other mental health disorders, combat exposure, and the stress of reintegration into civilian life.

According to data from the National Survey on Drug Use and Health (NSDUH), approximately 11% of veterans visiting Department of Veterans Affairs (VA) medical facilities for the first time are diagnosed with an SUD. Alarmingly, the number of veterans diagnosed with opioid dependence has risen, and those with psychiatric conditions like PTSD are disproportionately affected. Research indicates that veterans from recent conflicts, such as Operation Iraqi Freedom and Operation Enduring Freedom, are particularly vulnerable to SUDs.

Alcohol misuse is common among both active-duty personnel and veterans, with binge drinking being a prevalent issue. The VA has observed an increase in the number of veterans treated for SUDs in outpatient settings, highlighting the growing need for effective treatment and support services. Additionally, veterans with SUDs are more likely to experience homelessness and are at an increased risk for suicide, underscoring the gravity of addressing substance abuse within this population.

Understanding the Link Between PTSD and Substance Abuse in Veterans

The relationship between post-traumatic stress disorder (PTSD) and substance abuse in veterans is both intricate and deeply concerning. Studies have shown that veterans with PTSD are significantly more likely to be prescribed opioids, often in higher doses, and are more prone to early refills and additional prescriptions for other sedatives. This pattern unfortunately increases the risk of developing opioid use disorders and experiencing adverse outcomes such as overdoses and violence-related injuries. Research indicates that veterans with mental health disorders, including PTSD, are more susceptible to substance abuse compared to those without such diagnoses.

Marijuana is the most commonly used illicit drug among veterans, and the prevalence of cannabis use disorders has risen sharply within the veteran community. Additionally, veterans are more likely to be smokers than their civilian counterparts, with smoking contributing significantly to cancer-related deaths among veterans. Studies suggest that combat exposure is a key risk factor for problematic alcohol use among veterans, with those exposed to high levels of combat more likely to engage in heavy and binge drinking.

Co-occurring mental health disorders such as depression and anxiety are common among veterans with substance use disorders (SUDs), compounding the challenges in treatment. A staggering 82%-93% of Operation Enduring Freedom and Operation Iraqi Freedom veterans diagnosed with an SUD also have a comorbid mental health disorder. The intersection of PTSD and substance abuse creates a vicious cycle, where each condition exacerbates the other, leading to poorer social functioning, increased suicide attempts, and less improvement during treatment. Effective treatments for this dual diagnosis are critical and must address both the PTSD and the substance abuse concurrently to improve outcomes.

Correlation Between Mental Health Disorders and Substance Abuse in Veterans

Mental health disorders among veterans are intricately linked with substance use disorders (SUDs), creating a complex web of interrelated issues that significantly impact their well-being. A study from the VA medical homes indicates that depression and severe mental illnesses are predictors of increased risk for hospitalization and mortality, highlighting the gravity of these co-occurring conditions in veterans [StatPearls – NCBI Bookshelf]. PTSD, in particular, has been consistently associated with substance abuse, with research showing that veterans with PTSD are more likely to be diagnosed with SUDs compared to those without PTSD.

Moreover, the presence of other mental health disorders such as anxiety, depression, and adjustment disorder often co-occur with SUDs. For instance, the National Health and Resilience in Veterans Study revealed that mental dysfunction, including emotional difficulties like anxiety and depression, was a significant predictor of health care utilization among veterans [Psychiatry Online]. This indicates a strong correlation between these mental health challenges and the increased need for medical intervention.

Furthermore, research underscores the prevalence of mental health disorders among female veterans, who exhibit higher rates of these conditions compared to their male counterparts, suggesting a gender-specific aspect to these issues [BMJ Military Health]. The RAND Corporation also emphasizes the importance of integrated treatments for veterans with co-occurring disorders, advocating for a patient-centered approach that addresses both substance use and mental health simultaneously [RAND].

Addressing the intertwined nature of mental health disorders and SUDs in veterans is paramount for effective treatment and recovery. It is clear that a multifaceted approach, considering the unique experiences and challenges faced by veterans, is essential for improving their health outcomes and quality of life.

Understanding Medication-Assisted Treatment for Substance Use Disorders

Medication-Assisted Treatment (MAT) is an evidence-based approach to treating substance use disorders (SUDs), particularly opioid use disorders (OUDs). MAT combines the use of FDA-approved medications with counseling and behavioral therapies to create a holistic treatment plan. The purpose of MAT is to support individuals in achieving and sustaining recovery, improving patient survival, and decreasing illicit opioid use and other criminal activities associated with substance abuse disorders. The U.S. Food and Drug Administration (FDA) has approved several medications for use in MAT programs, including buprenorphine, methadone, and naltrexone.

Recent initiatives, such as the distribution of grant funding by the Department of Health and Human Services (HHS) through the Substance Abuse and Mental Health Services Administration (SAMHSA), aim to expand access to MAT for individuals with OUD. These grants support the development of infrastructure and services to improve the continuum of care for substance use disorders. States have also taken action by establishing grant programs, requiring health insurers to cover MAT, and removing barriers such as prior authorization requirements for MAT medications, as evidenced by state policies and regulatory flexibilities.

MAT is not a one-size-fits-all solution; it requires careful consideration of individual patient needs to select the most appropriate treatment. As part of a comprehensive treatment strategy, MAT has been shown to increase treatment retention, reduce the risk of overdose, and help individuals lead more stable and productive lives.

Medications Utilized in Medication-Assisted Treatment (MAT)

Medication-Assisted Treatment (MAT) employs FDA-approved medications to treat substance use disorders, particularly opioid use disorder (OUD), and is combined with counseling and behavioral therapies for a comprehensive approach. The primary medications used in MAT include:

  • Methadone: An opioid agonist that reduces withdrawal symptoms and cravings, administered in a controlled setting.
  • Buprenorphine: A partial opioid agonist that diminishes the effects of physical dependency to opioids, available as a daily tablet or film, monthly injection, or six-month implant.
  • Naltrexone: An opioid antagonist that blocks the euphoric effects of opioids, offered as an oral medication or a monthly injection.
  • Naloxone: An opioid antagonist used to reverse opioid overdose, administered via intranasal spray or injection.

Each medication serves a unique purpose in MAT. Methadone and buprenorphine help manage withdrawal symptoms and reduce cravings, aiding individuals in their transition away from opioid dependence. Naltrexone and naloxone, on the other hand, are crucial for preventing relapse and treating overdoses, respectively. It is essential for healthcare providers to tailor MAT to the individual needs of each patient, offering access to all medication options where appropriate. The U.S. Food and Drug Administration (FDA) supports the use of these medications in combination with comprehensive therapy to effectively treat OUD and to help sustain recovery.

Efficacy of Medication-Assisted Treatment in Substance Abuse Recovery

Medication-Assisted Treatment (MAT) has been substantiated through various studies as an effective intervention for substance abuse, particularly opioid use disorder (OUD). MAT combines pharmacological therapy with counseling and behavioral strategies, aiming to treat the whole patient. The efficacy of MAT is reflected in its ability to increase treatment retention, reduce illicit opioid use, and lower the risk of infectious disease transmission among those who inject drugs. Research indicates that patients on MAT have better outcomes in terms of adherence to treatment and decreased substance use compared to non-pharmacological approaches.

For instance, a study published in JAMA Network Open found that long-term treatment exceeding 180 days with buprenorphine or methadone significantly reduced overdose incidents and serious opioid-related acute care use. This aligns with the understanding that prolonged engagement in MAT leads to better mortality outcomes. Studies also show that MAT is beneficial in reducing the need for mental health hospitalization and emergency department visits among alcohol-dependent adults with serious mental illness. Moreover, MAT is associated with improved mental health, quality of life, employability, and family relationships while decreasing criminal activity.

Despite its proven effectiveness, MAT's utilization remains low due to barriers such as limited access to treatment programs, lack of trained providers, and prevailing stigma. Addressing these challenges is crucial to expanding MAT's reach and enhancing patient outcomes in substance abuse recovery.

Medication-Assisted Treatment Adaptations for Veterans

Medication-Assisted Treatment (MAT) is an integral part of addressing substance use disorders among veterans, tailored to accommodate their unique needs. The Veterans Health Administration (VHA) has been at the forefront of implementing MAT for veterans, recognizing the complex interplay between substance use and mental health issues such as PTSD. MAT for veterans often includes medications like buprenorphine, methadone, and naltrexone, which are used to manage cravings and withdrawal symptoms, and are an essential component of a comprehensive treatment plan.

The VHA provides access to MAT alongside behavioral therapies, which is considered the most effective treatment for opioid use disorder. This approach is supported by the Stepped Care for Opioid Use Disorder Train-the-Trainer (SCOUTT) initiative, which aims to increase access to MAT in non-SUD care settings. Despite the initiative, challenges remain, such as ensuring consistent access to MAT across various healthcare settings, and integrating treatment into the broader spectrum of veteran care.

Innovative approaches, such as the incorporation of psychedelic-assisted therapy, are being explored to enhance mental health outcomes for veterans with PTSD and other serious mental health issues. Studies into the use of substances like MDMA and psilocybin are underway, with promising preliminary results. Regulatory changes, such as those implemented by the Substance Abuse and Mental Health Services Administration (SAMHSA), have also increased the flexibility of MAT delivery, including the use of telehealth and take-home medication doses.

It's clear that MAT for veterans requires a multifaceted approach that considers the unique challenges faced by this population, including the need for long-term care, the management of co-occurring disorders, and the integration of new and emerging therapies into existing treatment frameworks.

The Role of Veterans Health Administration in Medication-Assisted Treatment

The Veterans Health Administration (VHA) plays a crucial role in providing Medication-Assisted Treatment (MAT) to veterans dealing with substance use disorders. As part of its comprehensive care strategy, the VHA integrates MAT into the broader spectrum of services offered to veterans, including mental health support and other medical services. The VHA's involvement in MAT is part of its commitment to address the complex needs of veterans, especially those exposed to combat and other service-related stressors that may contribute to substance use and co-occurring mental health conditions.

In line with the PACT Act, the VHA is expanding healthcare and benefits for veterans exposed to toxic substances, with an emphasis on early detection and treatment of health conditions that may include substance use disorders. The VHA's approach to MAT includes screening for toxic exposures, which is instrumental in understanding and addressing the underlying factors contributing to substance use. Furthermore, the VHA's role extends to providing grant funding aimed at supporting homeless veterans, among whom substance use issues are prevalent.

The VHA's efforts are supported by a substantial budget allocated for VA medical care, as highlighted in the Fiscal Responsibility Act of 2023, which ensures that essential health services are available to over 9.1 million veterans. This comprehensive support system underscores the VHA's pivotal role in delivering MAT as part of its mission to offer holistic care to veterans across the United States.

Understanding the Challenges and Barriers Veterans Face in Accessing MAT

Veterans seeking medication-assisted treatment (MAT) for substance use disorders face a range of challenges and barriers. A study by Knudsen et al. highlights that the lack of medical infrastructure and unsupportive funding policies significantly hinder the adoption of MAT in treatment programs. These issues are particularly acute in publicly funded programs, where the majority have not adopted MAT due to these systemic obstacles. The study underscores that without addressing the constraints related to medical personnel and funding, efforts to train counselors and disseminate information about MAT will not result in widespread implementation ( Knudsen et al., 2011 ).

Furthermore, the Veterans Health Administration's role in providing MAT is critical, yet the transition to community care has raised questions about cost and accessibility. The Veterans Choice and VA MISSION Acts aimed to increase flexibility for veterans to access care outside of VHA facilities, but this shift necessitates careful evaluation to ensure that veterans can indeed access the health care they need without facing prohibitive costs or restrictions ( RAND, 2022 ).

Barriers to accessing MAT also include social factors, such as personal anxieties and cultural concerns, which can discourage veterans from seeking treatment. RAND Corporation identifies these social barriers as significant impediments to care, highlighting the need for interventions that address both the psychological and logistical aspects of accessing MAT ( RAND Corporation ).

In addressing these challenges, it is essential to consider the comprehensive changes to VA Disability Law and the VA's Equity Action Plan, which aim to improve the lives of veterans by ensuring equitable access to health care and benefits. As these updates are implemented, it is crucial for veterans to stay informed and prepared to navigate the evolving landscape of VA services ( ).

Medication-Assisted Treatment: Veterans' Pathways to Recovery

Medication-Assisted Treatment (MAT) has become a crucial component in the recovery journeys of many veterans facing substance use disorders. With a focus on a holistic treatment plan, MAT combines medication management with therapy sessions to address both the physical and psychological facets of addiction. For veterans, this approach is often tailored to address the complex interplay between substance abuse and underlying issues such as PTSD and chronic pain resulting from service-related injuries.

Medications such as buprenorphine and methadone are commonly used to alleviate withdrawal symptoms and cravings associated with opioid use, while drugs like acamprosate, disulfiram, and naltrexone are prescribed for alcohol use disorders. These medications are administered within regulated medical environments to prevent potential abuse and to ensure the safety and efficacy of the treatment.

Recovery stories of veterans who have undergone MAT highlight the transformative impact of this treatment. The Veterans Health Administration plays a pivotal role in providing MAT, often covered by veterans' health insurance, whether through VA facilities or private centers. Veterans' testimonials often reflect the benefits of MAT in stabilizing their lives, managing cravings, and ultimately facilitating a return to a life of dignity and self-confidence.

Peer support, mentorship, and advocacy are also integral to the recovery process, providing veterans with a sense of fellowship and understanding that is unique to their shared experiences. Virtual recovery meetings and nature-based therapies have emerged as supportive resources, complementing traditional treatment methods and fostering a community of recovery among veterans.

Triumphs in Medication-Assisted Treatment: Veterans' Success Stories

Medication-Assisted Treatment (MAT) has been a pivotal component in the recovery journeys of many veterans who have faced substance abuse challenges. The integration of medications with counseling and behavioral therapies effectively addresses the full spectrum of addiction, providing a holistic approach to treatment and recovery. Veterans' success stories serve not only as a testament to the effectiveness of MAT but also as an inspiration for others grappling with similar issues.

One such story is that of Dave, a military veteran whose life was transformed by the Veterans Treatment Court (VTC). Through the VTC's tailored resources, including mental health services and substance abuse treatment, Dave was able to reclaim control over his life. The support offered by the VTC and its mentorship programs exemplifies the transformational impact that specialized court programs can have on veterans' lives.

These narratives of success are crucial in highlighting the potential for positive change and the importance of accessible, veteran-focused treatment options. The Veterans Health Administration's role in facilitating MAT, coupled with community-based support systems, underscores the collective effort required to assist veterans in their recovery. As we honor the service of our nation's heroes, it is imperative to recognize and support their journey to wellness through effective treatment modalities like MAT.

Insights from Veterans' Experiences with Medication-Assisted Treatment

Veterans' journeys through Medication-Assisted Treatment (MAT) are marked by both transformative experiences and significant challenges. The complexity of navigating mental health care, as highlighted by resources from RAND and PhillyVoice, points to the intricate system of providers and treatments that veterans must manage. This complexity is compounded by the need for tailored approaches to address the unique mental health symptoms stemming from service-related stressors and trauma.

Efforts by the Veterans Health Administration to enhance equity and access to care, including MAT, are crucial in addressing the systemic barriers that veterans face. The importance of adequate brain energy for mental health, as discussed in Psychology Today, underscores the need for holistic treatment models that consider the veteran's overall well-being.

Furthermore, veterans' treatment courts, as depicted by U.S. Veterans Magazine, offer a glimpse into the supportive structures that can facilitate successful MAT journeys. These courts exemplify how legal and health systems can work collaboratively to provide veterans with the comprehensive support they require. Such initiatives are critical in ensuring that veterans do not have to navigate their recovery alone, but rather have a community and a system that stands behind them, ready to offer assistance and recognition of their service.

Advancements in Medication-Assisted Treatment for Veterans

The future of Medication-Assisted Treatment (MAT) for veterans looks promising with several key developments aimed at enhancing the accessibility and effectiveness of care. The Department of Veterans Affairs (VA) has undertaken initiatives to expand the scope of MAT as part of its 2024 Equity Action Plan. This includes proactive outreach to transitioning service members, updates to the Transition Assistance Program curriculum, and direct engagement with Veteran Service Organizations (VSOs) to support veterans, particularly those from underserved communities.

Furthermore, the VA has proposed a rule to extend presumed areas of exposure to Agent Orange, simplifying the process for affected veterans to receive their benefits, which could include MAT services. The VA's budget for 2024 also emphasizes the importance of mental health services, supporting the Commander John Scott Hannon Veterans Mental Health Care Improvement Act, and backing clinical trials and studies on risk and prevention factors relevant to veterans' health.

These efforts signify a concerted move towards a more inclusive and comprehensive approach to MAT for veterans, ensuring that all veterans, regardless of background, receive the health care and benefits they have earned.

The Recovery Village at Baptist Health is an industry-leading treatment provider for addiction and co-occurring mental health disorders. Our clinicians are specially trained in trauma-informed care, military culture and treating veteran-specific addiction and mental health needs. We're also proud members of the VA Community Care Network, so we can accept VA health benefits as payment at no cost to the veteran.

If you’re a veteran struggling with alcohol or drug addiction, our physician-led, private rehab program could be your path to recovery. Call us today and request a specialized Veteran Advocate to assist you.