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Whether they are active duty or retired, returning military personnel experience significantly higher rates of alcohol abuse than the general U.S. population. Men and women in the military also have unique treatment needs—and these have direct bearing on the question of how to find and afford help for an alcohol problem.
Nobody knows these things better than clinical psychologist Dr. Nicole Rothman, Psy.D.. She is on the frontlines of helping veterans with substance use disorders (SUDs), a majority of whom have struggles with alcohol. Last year, 2,858 veterans received treatment for alcohol-related disorders in the Substance Abuse Outpatient Program that Dr. Rothman manages at the West Palm Beach VA Medical Center.
Dr. Rothman is frequently consulted for her expertise on the topic of alcohol abuse and its treatment among returning vets, especially in relation to the local contours of the issue here in Palm Beach County, Florida (where Beach House Center for Recovery is based). She recently shared these insights in an exclusive interview with Beach House. (We also invite you to explore last year’s live panel discussion with Dr. Rothman regarding veterans, substance abuse and positive recovery outcomes.)
What follow are highlights from this latest interview, which will educate you on:
- the nature and scope of problem drinking among veterans
- the link between post-traumatic stress disorder (PTSD) and alcohol abuse—and why alcohol abuse disproportionately impacts veterans and their families
- evidence-based treatments that are helping many vets find hope and recovery
- how to find help for yourself or a loved one
- and what to know regarding your financial options
Problem Drinking in Returning Veterans
Problem drinking, defined as heavy or binge drinking on a regular basis, occurs at significantly higher rates among U.S. veterans. Consider, for example, the following findings by the National Institute on Drug Abuse (NIDA).
- Almost half of active duty service members reported binge drinking.
- 20 percent reported binge drinking on a weekly basis.
- Nearly one in three veterans with high combat exposure reported weekly binge drinking.
Such findings seem to accord with Dr. Rothman’s experience. Alcohol is the most common substance use disorder (SUD) among Dr. Rothman’s patients, and alcohol-related disorders affect “probably 65 to 70 percent” of the veterans she serves.
Strikingly, many of them are Vietnam vets. As to why, Dr. Rothman offered this explanation: “Back then the VA system wasn’t what it is today, and they were treated very poorly by the country … Alcohol was the most readily available substance at the time.” (And in this last sense, not much has changed. Alcohol is still “legal, socially acceptable, everywhere, cheap, embedded in our culture, and at just about every sporting event.”)
The Link Between PTSD and Alcohol Abuse
Yet on their own, external drinking cues like the ubiquity, legality and affordability of alcohol don’t really explain why alcohol abuse is much more common among military personnel than among U.S. civilians. Even a culture of drinking (which describes the military) is not really sufficient explanation. For that, we need to explore the research into PTSD and its link to alcohol abuse as it pertains to veterans:
- More than 2 of 10 veterans with PTSD also have a SUD.
- War veterans with PTSD tend to binge drink as a way to cope with the traumatic memories of combat.
- Almost 1 out of every 3 veterans (27 percent) who seek treatment for a SUD at the VA also has a diagnosis of PTSD.
Furthermore, multiple deployments, combat exposure and related injuries are associated with a higher likelihood of weekly problem drinking (heavy or binge drinking). And it is not a coincidence that these same factors also predict a greater risk of PTSD.
Effective Treatments for Vets with PTSD/Other Co-Occurring Disorders
Mental health problems like PTSD thus make it imperative that veterans with an alcohol use disorder seek comprehensive treatment, meaning treatment that addresses both the biological and behavioral roots of an alcohol habit using a variety of so-called modalities. For example, veterans who pursue outpatient treatment for alcohol at the West Palm Beach VA Medical Center can expect to receive one or more of the following evidence-based treatments, according to Dr. Rothman:
- Seeking Safety – a group therapy program featuring 25 once-weekly modules, each designed to equip patients with a specific coping skill or strategy for managing PTSD symptoms
- Motivational Enhancement Therapy – an intervention to help vets who are in denial about an alcohol problem move towards greater acceptance and responsibility
- Cognitive Behavioral Therapy – strategies and techniques that help patients manage cravings and relapse triggers and build greater self-control
- Contingency Management – a program that awards abstinence with individual vouchers (positive incentives to stay sober)
- Medication-Assisted Treatment – the use of medications like naltrexone, acamprosate, or Vivitrol (a naltrexone injection which lasts 30 days) to relieve alcohol cravings
- “Whole Health Approach” – a program that employs holistic elements like art, nutrition and music therapy in the service of greater health and wellbeing
- Peer Support – Mentoring relationships with other vets that provide a sense of connection and encouragement in recovery
Help for Veterans with an Alcohol Problem
If you’re a veteran with an alcohol problem, then, consider a detox and treatment program that offers the above therapies. Other evidence-based interventions for trauma and PTSD—one notable example is “Eye Movement Desensitization and Reprocessing” (EMDR), which is one of a number of alcohol treatments that Beach House offers—are also good to inquire about when you’re considering a prospective alcohol treatment program.
For veterans who go to the VA for alcohol treatment, Dr. Rothman said the typical protocol is as follows: admission to the ER for medical assessment, followed by 3-5 days of medically supervised detox, group therapy and individual counseling in the VA’s inpatient psychiatric unit; the alcohol patient is then transferred to a residential treatment program managed by one of the VA’s contracted “community partners.” During residential treatment, the alcohol patient receives once-weekly case management visits from a member of the VA staff. Following residential treatment, the alcohol patient is referred to a VA outpatient program for ongoing therapies.
Financial Options for Veterans Needing Alcohol Treatment
Financial considerations should never be a barrier to alcohol treatment for veterans who need it. Qualified veterans who have enrolled for VA benefits can often receive alcohol detox and residential treatment at little to no cost when they seek these services through the VA. For example, if you have a dual diagnosis like PTSD, major depressive disorder (MDD), bipolar disorder or schizophrenia, and this disability is service-connected (incurred as the result of your time in the military), then your alcohol treatment may be fully covered. At most, it might entail a relatively modest copayment, Dr. Rothman said.
Veterans who have private insurance in addition to their VA benefits may have even more treatment options—and these may be similarly affordable or worth the additional cost, depending on the specifics of their plan and their individual treatment needs. (Explore how Beach House works with health insurance companies to maximize coverage for alcohol treatment.)
Where to Go for Help for a Dual Diagnosis of Alcohol and PTSD
If you or a veteran you know is struggling with alcohol and think it may be related to co-occurring PTSD or another dual diagnosis, you need to know that recovery is possible, and that there has never been a better time in the history of the VA to get help for a mental health problem. Dr. Rothman said she has personally seen many dual diagnosis veterans go on to successfully manage their condition and experience a significantly better quality of life. If you’re interested in exploring your treatment options, contact your nearest VA medical center and ask to speak with someone in their Mental Health clinic. They should have a SUD-PTSD specialist on hand who can advise you regarding your situation, including providers you may wish to connect with.
Other Tips and Resources for Veterans and Their Families
The following tips and resources may also be of help to you and your family:
- Speak with your existing VA healthcare provider.
- Find a VA PTSD Program.
- Find a VA SUD Program.
- Call the VA’s information hotline at 1-800-827-1000.
- S. Department of Veterans Affairs, Treatment Programs for Substance Use Problems: http://www.mentalhealth.va.gov/MENTALHEALTH/res-vatreatmentprograms.asp
- S. Department of Veterans Affairs: National Center for PTSD: http://www.ptsd.va.gov/public/problems/ptsd_substance_abuse_veterans.asp
- Substance Abuse and Mental Health Services Administration, Veterans and Military Families: https://www.samhsa.gov/veterans-military-families
- SAMHSA Treatment Locator: http://findtreatment.samhsa.gov/ or 1-800-662-HELP
In addition to the above tips and resources, our dedicated counselors are available 24/7 to provide you with personalized advice and connect you with a treatment provider you can trust.