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Confronting PTSD and Substance Use Among Veterans

Written by Melissa Carmona

& Medically Reviewed by Jenni Jacobsen, LSW

Medically Reviewed

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As veterans transition back to civilian life, some find solace in substance use as a means of coping with PTSD. However, a glimmer of hope emerges – there exists effective treatment to address both addiction and PTSD in tandem. 

The transition from military to civilian life comes with its share of hurdles, especially considering the lingering effects of military experiences. This often translates to a heightened susceptibility to post-traumatic stress disorder (PTSD), which, in turn, can fuel substance misuse. But the journey towards recovery is marked by the availability of comprehensive treatment options.

Unpacking the Layers of PTSD

Post-Traumatic Stress Disorder (PTSD) emerges as a mental health condition subsequent to exposure to a traumatic event. This can arise from direct engagement with trauma, such as facing a life-threatening situation, like assault with a weapon. However, it can also stem from the indirect experience of witnessing or hearing about traumatic events involving others. In the realm of PTSD, individuals may grapple with intrusion symptoms. These symptoms encompass flashbacks, intrusive memories tied to the trauma, nightmares, and intense psychological reactions elicited by triggers reminiscent of the event.

PTSD also ushers in a tendency to avoid stimuli associated with the trauma. Alterations in mood and behavior become evident. Individuals may consistently exhibit negative emotions, attribute blame to themselves for the traumatic event, or exhibit social detachment. Experiencing positive emotions like happiness can become an uphill battle, while abrupt outbursts of anger, impulsive behaviors, and sleep disturbances might manifest.

The Prevalence of PTSD and Substance Abuse in Veterans

Veterans grappling with PTSD are at an elevated risk of developing substance use disorders (SUD) or addictions. In cases where both PTSD and substance use disorders coexist, they’re described as co-occurring disorders. Research underscores that nearly half of individuals with PTSD also contend with co-occurring substance use disorders. Additionally, insights from the Veterans Administration reveal that more than 2 out of 10 veterans with PTSD simultaneously battle a substance use disorder.

The Nexus of Alcohol Addiction and PTSD

For veterans navigating the complexities of PTSD, alcohol often presents itself as a temporary refuge from distressing emotions or haunting memories. However, as time progresses, an escalating amount of alcohol is needed to achieve the same relief due to increased tolerance. In the absence of proper intervention, unaddressed PTSD can pave the way for alcohol addiction. Research illustrates that up to two-thirds of veterans seeking help for alcohol addiction concurrently experience PTSD.

Unveiling Drug Addiction and PTSD

Veterans grappling with PTSD are equally susceptible to developing drug addictions. Studies involving veterans from conflicts like Iraq and Afghanistan illuminate that male veterans may resort to drug use as a mechanism for managing PTSD symptoms. On the other hand, female veterans may find that drug use exacerbates future PTSD symptoms. This dichotomy underscores the nuanced relationship between drug addiction and PTSD among men and women. Furthermore, veterans wounded in combat may find themselves vulnerable to dependence on prescription painkillers used to alleviate chronic pain.

Decoding PTSD Triggers and Symptoms in Veterans

Veterans grappling with PTSD often confront triggers that instigate episodes of symptoms. Triggers can take the form of stimuli that evoke memories of the trauma. For instance, loud noises reminiscent of explosions or gunfire might trigger outbursts of anger, heightened startle responses, or behaviors such as substance misuse. When PTSD symptoms manifest, they generally fall within these categories:

Intrusion Symptoms

  • Persistent thoughts about the traumatic event
  • Troubling nightmares tied to the trauma
  • Flashbacks resembling the traumatic incident
  • Heightened stress when reminded of the trauma
  • Physical reactions in response to trauma triggers (e.g., elevated heart rate)

Avoidance Symptoms

  • Efforts to distance oneself from trauma reminders
  • Attempts to suppress distressing memories or thoughts linked to the trauma

Shifts in Mood

  • Difficulty recalling specific details of the trauma
  • Negative thoughts, such as perceiving the world as unsafe
  • Self-blame or attributing blame to others for the event
  • Consistently experiencing negative emotions like guilt, anger, and fear
  • Diminished interest in activities once enjoyed
  • Emotional detachment from others
  • Inability to experience happiness or joy

Behavioral Changes

  • Abrupt outbursts of anger without warning
  • Engaging in behaviors that harm oneself
  • Heightened vigilance towards surroundings
  • Easily startled reactions
  • Difficulty concentrating
  • Sleep disturbances

Empowering Veterans through Effective Treatment

Veterans grappling with co-occurring PTSD and SUD can find their path to recovery illuminated by comprehensive treatment modalities:

  • Therapies: Cognitive processing therapy (CPT) and prolonged exposure (PE) – both forms of cognitive behavioral therapy – play pivotal roles in addressing co-occurring PTSD and SUD in veterans.
  • Medications: Medications play a supporting role in assisting veterans to manage symptoms of both PTSD and addiction. Antidepressants aid in alleviating PTSD symptoms, while medications also assist in addressing drug and alcohol withdrawal and cravings.
  • Group Therapy: Group therapy emerges as a cornerstone of treatment for veterans. Certain treatment centers offer specialized groups tailored to trauma survivors, including those exclusively designed for veterans.
  • Inpatient Rehabilitation: Under specific circumstances, veterans may discover that their journey towards recovery is best initiated through inpatient rehabilitation. These programs create a controlled environment, reducing exposure to triggers during treatment.

Extending a Hand to Veterans in Need

For those providing support to veterans dealing with PTSD and addiction, these steps can pave the way for positive impact:

  • Enhance Your Understanding: Acquire insights into their symptoms and triggers. This knowledge equips you to provide additional support during challenging times and aids in recognizing situations that might evoke distress.
  • Exercise Patience: Veterans contending with PTSD might display altered behavior or experience sadness and anger. Remember, these reactions are tied to their mental health and not a reflection of your actions. Kindness and patience can be incredibly helpful
  • Encourage Seeking Help: The journey to recovery for veterans with co-occurring PTSD and SUD gains momentum through professional intervention. Encourage them to seek assistance and offer your aid by helping with setting up appointments and accompanying them to appointments.

Additional Resources for Veterans

Veterans seeking further information on PTSD can explore these valuable resources:

  • VA Benefits Hotline: Reach out at 855-586-2889, Monday to Friday, between 8:00 a.m. and 9:00 p.m. ET.
  • The VA Mental Health Page: Delve into the VA’s mental health page for insights into programs and treatment alternatives.
  • National Center for PTSD: Access research and treatment resources focused on PTSD through this platform.
  • Afterdeployment.org: Gain access to expert advice concerning mental health treatment post-deployment at this website.

Veteran Recovery Is Our Mission

Our facilities have helped thousands of veterans overcome a drug or alcohol addiction. At The Recovery Village at Baptist Health, our treatment programs offer veterans:

  • Veteran Advocates who can navigate the VA on your behalf to enter treatment faster
  • Experienced clinicians trained in military culture and trauma-informed care
  • Dual diagnosis to treat addiction and mental health disorders together  
  • EMDR, a revolutionary treatment that alleviates trauma symptoms

View Sources

Mann, Sukhmanjeet & Marwaha, Raman. “Posttraumatic Stress Disorder.” National Library of Medicine, January 30, 2023. Accessed September 6, 2023.

McCauley, Jenna; Killeen, Therese; Gros, Daniel; Brady, Kathleen; & Back, Sudie. “Posttraumatic Stress Disorder and Co-Occurring Substance Use Disorders: Advances in Assessment and Treatment.” Clinical Psychology (New York), 2012. Accessed September 6, 2023.

U.S. Department of Veterans Affairs. “PTSD and Substance Abuse in Veterans.” Accessed September 6, 2023.

Straus, Elizabeth; Norman, Sonya; Haller, Moira; Southwick, Steven; Hamblen, Jessica; & Peitrzak, Robert. “Differences in protective factors among U.S. Veterans with posttraumatic stress disorder, alcohol use disorder, and their comorbidity: Results from the National Health and Resilience in Veterans Study.” Drug and Alcohol Dependence, January 2019. Accessed September 6, 2023. 

Livingston, Nicholas, et al. “Longitudinal assessment of PTSD and illicit drug use among male and female OEF-OIF veterans.” Addictive Behaviors, July 2021. Accessed September 6, 2023.

Dembek, Zygmunt & Chekol, Tesema. “The Opioid Epidemic: Challenge to Military Medicine and National Security.” Military Medicine, 2020. Accessed September 6, 2023.

National Center for PTSD. “Effective Treatments for PTSD: Consider Cognitive Behavioral Therapy (CBT) as First Line Treatment.” January 2015. Accessed September 6, 2023.