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June 2, 2016

Substance Abuse and Veterans: The Link Between Addiction and Trauma

PTSD and the link between substance abuse

The link between addiction and trauma is probably nowhere clearer than among returning veterans of war, for whom the horrors of active-duty combat can often surface years later in the form of post-traumatic stress disorder (PTSD), substance abuse, or both. What follows is an exploration of key data and stats around addiction, trauma and substance abuse among members of the military. The emerging picture is telling for what it reveals about the urgent need for mental health treatment within a population that is especially vulnerable to the dangers of substance abuse.

PTSD Causes, Signs and Symptoms

PTSD is a psychiatric diagnosis for the cluster of various symptoms that can develop in some people after an extremely traumatic event, such as war, a crime, an accident or a natural disaster. Disruptive memories, flashbacks, nightmares, panic attacks, extreme anxiety, and insomnia can characterize this disorder. These symptoms can cause such ongoing suffering years after a trauma and can make one’s present life seem so unmanageable, that many who suffer from PTSD will turn to alcohol and drugs.

PTSD and Addiction Among Veterans of War

The diagnosis of PTSD is itself relatively new—even if the risks of exposure to trauma are as old as the human race. PTSD only first gained inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), the gold standard among mental health providers for diagnosing and treating psychiatric conditions, in 1980. That is when a group of Vietnam veterans, joined by the New York psychoanalysts Chaim Shatan and Robert Lifton successfully lobbied the American Psychiatric Association for the creation of a diagnosis termed “post-traumatic stress disorder.”

Since that time, the contours of PTSD and its various causes, symptoms, and treatments have undergone further refinement—especially as more and more vets have returned from combat zones like Iraq and Afghanistan showing signs of the disorder and its devastating impact in the form of substance abuse and other health repercussions. Mental and substance use disorders reportedly accounted for more hospitalizations among U.S. troops in 2009 than any other health problem.

Drug and alcohol addiction often emerge with a co-occurring, dual diagnosis of PTSD. More than two out of 10 vets with a diagnosis of PTSD also have a substance use disorder, for example. Of the vets who seek treatment for a substance use disorder, one out of three on average has a dual diagnosis of PTSD.

This link between PTSD and substance abuse appears that much stronger among homeless vets, who, according to a recent report by the Substance Abuse and Mental Health Services Administration, represented 21 percent of military service members who sought drug or alcohol treatment. (Roughly 70 percent of homeless vets experience a substance use disorder, according to the same report.)

Drug and Alcohol Abuse Among Veterans of War

The higher rates of drug and alcohol abuse that appear among veterans also shed light on the destructive mental health impact of war and war-related trauma. By one estimate, at least one out of 10 soldiers returning from the Iraq and Afghanistan wars had a problem with drugs or alcohol, for example.

Prescription painkillers are one such drug problem in the military, aligning with a larger U.S. opiate epidemic—and their misuse may be on the rise. In 2009, military doctors wrote approximately 3.8 million prescriptions for these highly addictive medications. The previous year, the percentage of service members who reported misusing prescription drugs was 11 percent. That was up from 2 percent in 2002 and 4 percent in 2005, according to the Department of Defense.

Binge Drinking and Alcoholism in the Military

Yet another finding has revealed the startling extent to which alcohol abuse in the form of binge drinking can show up in this same population: In 2008, almost half (47 percent) of all active duty service members reported binge drinking, up from 35 percent in 1998.

How frequently does such binge drinking occur? Some 20 percent of those in the military have reported that they binge drink at a rate of once a week (the equivalent of four drinks for women and five drinks for men in the course of two hours). Among those with exposure to active combat, binge drinkers allegedly represent an even higher proportion.

Such statistics may help to explain a cited 56 percent increase in the number of soldiers seeking treatment for alcoholism between the years 2003 and 2009, according to Addiction Center.

Mental Health Treatment Needs Among Vets

In the meantime, the data suggests that a large gap exists between the number of vets who need mental health treatment and those who go on to get the kind of care that actually meets their needs. Roughly half of the returning service members who need treatment actually seek treatment. Of those who get treatment, only slightly more than half of them receive adequate care.

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