Medication-Assisted Addiction Treatment for Veterans

Key Takeaways

• Veterans have a higher prevalence of Substance Use Disorders (SUDs) than civilians, often linked to PTSD and other mental health issues.
• 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.

Substance Abuse Among US Military Veterans

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. 

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.

How Veterans’ PTSD Influences Substance Abuse

The relationship between 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.

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.

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.

How Mental Health Disorders Exacerbate Substance Abuse in Veterans

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.

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.

Medication-Assisted Treatment for Substance Use Disorders

Medication-Assisted Treatment (MAT) is an evidence-based approach to treating SUDs, particularly opioid use disorders (OUDs). 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.

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.

Approved Medications for MAT

MAT employs FDA-approved medications to treat substance use disorders, particularly OUDs. 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 dependence 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.

How MAT Helps in Substance Abuse Recovery

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. 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.

MAT Adaptations for Veterans

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.

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.

Veterans Health Administration’s Role in MAT

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 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.

Challenges Preventing Veterans From Accessing MAT

Veterans seeking 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. 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.

The transition to community care has raised questions about cost and accessibility. Barriers to accessing MAT also include social factors, such as personal anxieties and cultural concerns, which can discourage veterans from seeking treatment. 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.

MAT: Veterans’ Pathways to Recovery

MAT has become a crucial component in the recovery journeys of many veterans facing substance use disorders. 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.

Recovery stories of veterans who have undergone MAT highlight the transformative impact of this treatment. 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 MAT: Veterans’ Success Stories

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. 

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.

Advancements in MAT for Veterans

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.

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.

Addiction Treatment Options for Veterans

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.