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Veterans’ Struggles: Addressing PTSD and Substance Use

Written by Melissa Carmona

& Medically Reviewed by Jenni Jacobsen, LSW

Medically Reviewed

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This article was reviewed by a medical professional to guarantee the delivery of accurate and up-to- date information. View our research policy.
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In the aftermath of military service, some veterans find solace in addiction as a way to cope with their PTSD symptoms. Fortunately, treatments that address both PTSD and addiction simultaneously are available. 

Transitioning to civilian life can be accompanied by a range of challenges stemming from military experiences. Perhaps one of the most significant challenges is the heightened risk of post-traumatic stress disorder (PTSD), which often triggers substance misuse. The coexistence of PTSD and substance abuse is a natural outcome of military service, but effective treatment offers hope for recovery.

Understanding PTSD

Post-Traumatic Stress Disorder (PTSD) is a mental health condition triggered by exposure to a traumatic event. It may arise from direct exposure to trauma, such as being threatened with a weapon, or from witnessing or hearing about traumatic events affecting others. Individuals with PTSD experience intrusion symptoms, including flashbacks, unwanted memories linked to the trauma, nightmares, and intense psychological reactions triggered by reminders of the event.

PTSD involves efforts to avoid memories or triggers tied to the trauma, as well as changes in mood and behavior. Individuals with PTSD may consistently exhibit negative emotions, blame themselves for the traumatic event, or withdraw from social interactions. Experiencing positive emotions such as happiness becomes a challenge, and sudden outbursts of anger, risky behavior, and sleep disturbances can emerge.

The Intersection of PTSD and Substance Abuse in Veterans

Veterans contending with PTSD face an elevated risk of developing substance use disorders (SUD) or addictions. When PTSD and substance use disorder coexist, it’s termed as co-occurring disorders. Research suggests that nearly 50% of individuals with PTSD have co-occurring substance use disorders. Additionally, data from the Veterans Administration reveals that over 2 out of 10 veterans with PTSD also meet diagnostic criteria for substance use disorder.

The Link Between Alcohol Addiction and PTSD

For veterans dealing with PTSD, alcohol may serve as a temporary escape from negative emotions or distressing memories. However, as tolerance develops and the effects of alcohol diminish, individuals may require larger amounts to achieve the same effects. Over time, untreated PTSD increases the risk of alcohol addiction and contributes to declining mental health. Research indicates that as many as two-thirds of veterans seeking help for alcohol addiction at the VA also suffer from PTSD.

Exploring Drug Addiction and PTSD

Veterans grappling with PTSD are also at risk of falling into drug addictions. Research involving veterans from conflicts such as Iraq and Afghanistan suggests that male veterans are susceptible to using drugs to self-medicate PTSD symptoms. In the case of female veterans, drug abuse is tied to future PTSD symptoms, indicating gender-specific differences in the relationship between drug addiction and PTSD. Combat-wounded veterans may be especially prone to opioid addictions due to potential dependence on prescription painkillers for managing chronic pain.

Identifying Triggers and Symptoms of PTSD in Veterans

Veterans diagnosed with PTSD often face triggers that activate their symptoms. Triggers can be events or memories that evoke the onset of PTSD symptoms. For example, loud noises reminiscent of explosions or gunfire can trigger symptoms like anger outbursts, heightened startle responses, or behaviors such as substance misuse. When PTSD symptoms arise, they usually fall into the following categories:

Intrusion Symptoms

  • Intrusive thoughts related to the traumatic event
  • Disturbing nightmares tied to the trauma
  • Flashbacks that recreate the traumatic event
  • Intense stress triggered by reminders of the trauma
  • Physiological reactions upon encountering reminders of the trauma (e.g., elevated heart rate)

Avoidance Symptoms

  • Attempts to avoid triggers associated with the traumatic event
  • Efforts to suppress distressing memories or thoughts about the event

Negative Mood Changes

  • Inability to recall specific details of the traumatic event
  • Distorted negative thoughts, such as viewing the world as unsafe
  • Placing blame on oneself or others for the event
  • Consistently experiencing negative emotions like shame, guilt, anger, and fear
  • Loss of interest in once-enjoyed activities
  • Feeling emotionally disconnected from others
  • Inability to experience joy, happiness, or other positive emotions

Changes in Arousal and Reactivity

  • Sudden bursts of anger without warning
  • Engaging in self-destructive behaviors
  • Hyper-vigilance towards surroundings
  • Heightened startle responses
  • Difficulty concentrating
  • Disrupted sleep patterns

Effective Approaches for Veterans with Co-Occurring PTSD and SUD

Effective management of PTSD and substance abuse in veterans requires comprehensive approaches addressing both conditions together. Several effective strategies are employed to treat these conditions:

  • Therapies: Talk therapy, including cognitive processing therapy (CPT) and prolonged exposure (PE), plays a crucial role in treating co-occurring PTSD and SUD in veterans. These forms of cognitive behavioral therapy (CBT) offer substantial benefits.
  • Medications: Medications can help veterans manage symptoms of both PTSD and addiction. Antidepressants are commonly prescribed to alleviate PTSD symptoms. Medications can also aid in managing withdrawal symptoms and cravings for drugs and alcohol.
  • Group Therapy: Group therapy is a fundamental aspect of treatment programs for veterans. Some treatment centers offer groups tailored specifically for trauma survivors, including veteran-exclusive groups.
  • Inpatient Rehabilitation: In certain cases, veterans may benefit from initiating their recovery journey with inpatient rehabilitation. These programs allow veterans to reside within a treatment facility, offering a controlled environment and separating them from triggers during treatment.

Supporting Veterans with Co-Occurring PTSD and SUD

If you know a veteran struggling with both PTSD and addiction, your support can be transformative. Here’s how you can make a difference:

  • Educate Yourself: Learn about their symptoms and triggers. This understanding enables you to provide additional support during exacerbations of symptoms and helps you recognize distressing situations to help them avoid triggers.
  • Practice Patience: Recognize that living with PTSD can lead to changes in behavior and mood. Show patience and empathy, understanding that these changes are a result of their mental health condition rather than how they truly feel about you.
  • Encourage Seeking Treatment: Veterans with co-occurring PTSD and SUD achieve the best outcomes when they engage in treatment. Encourage them to seek professional help and support them in scheduling and attending appointments.

Additional Resources for Veterans

For veterans seeking additional resources regarding PTSD, consider the following:

  • VA Benefits Hotline: Contact the toll-free number 855-586-2889, available from Monday to Friday, 8:00 a.m. to 9:00 p.m. ET.
  • The VA Mental Health Page: Access information about VA programs and treatment options on the VA’s mental health page.
  • National Center for PTSD: Gain access to research publications and information about PTSD treatment through the National Center for PTSD’s website.
  • Afterdeployment.org: Explore expert information about mental health treatment after deployment on the Afterdeployment.org website. This resource offers guidance on recognizing the need for assistance.

Veteran Recovery Is Our Mission

Our facilities have helped thousands of veterans overcome a drug or alcohol addiction. At The Recovery Village Ridgefield, 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  

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.