Many veterans wrestle with stress from deployments to combat zones. The stressful military life coupled with injuries and illnesses puts them at an increased risk for substance use disorders. A growing number of veterans turn to drugs to cope with the pressure of societal reintegration after the military.
With a 52.7 percent increase in outpatient veterans treated for substance abuse disorders from 1995 to 2013, it is undeniable that addiction is a major concern among the veteran community.
Between 2006 and 2009, the army reported that more than 45 percent of the 397 noncombat related deaths investigated were the result of an alcohol or drug overdose.
More than one in four military deaths are attributed to substances of abuse, so it is no surprise that addiction is a prevalent issue in the United States military. Stress from the hectic military lifestyle including warzone and combat exposure contributes to an epidemic of drug use.
Illicit drug use is at an all-time low, but alcohol consumption and prescription opioid abuse are major areas of concern. Between 2006 and 2009, the army reported that more than 45 percent of the 397 noncombat related deaths investigated were the result of an alcohol or drug overdose.
Alcohol consumption is customary in the military. Service members drink on various occasions: leisurely, socially, to celebrate an event and to promote unity and camaraderie within their battalion.
Deployments and combat exposure are highly responsible for the growing alcohol consumption rate among military members. Veterans often use alcohol as a coping mechanism after stressful and traumatic events. Some of them use alcohol to self-medicate mental health issues. Reduced prices and ease of access on military bases may contribute to the increase in alcohol use.
The National Institute on Drug Abuse reported an increase in binge drinking among military personnel from 1998 to 2008. One out of five people in the military reported binge drinking every week during the month preceding the survey, and the rate was even higher for those exposed to combat.
During the Vietnam War, heroin and opium were popular among service members. The difficult war environment coupled with the challenges of their military lives led them to use these drugs. Forty-three percent of Vietnam War veterans used heroin and opium at least once. Half of those users developed a dependency on the drugs.
However, illicit drug use in the military has been on a decline since the enforcement of random drug testing policies in 1982. A 2008 Department of Defense survey reported that 2.3 percent of military personnel used an illicit drug in the last month compared to 12 percent of civilians.
Popular illicit drugs among military members are:
The wide availability and ease of access to prescription opioids poses a significant problem for the military. The misuse of prescription opioid pain relievers has been on the rise among service members.
Pain management for veterans is especially challenging. According to the VA, chronic pain plagues nearly 60 percent of veterans returning from the Middle East and 50 percent of older veterans, as compared with 30 percent of America’s adult population.
In 2013, the VA implemented the Opioid Safety Initiative for the management of opioid therapy. Measures of key clinical indicators from July 2012 to December 2014 showed:
Readjusting to normal life is a difficult process for veterans. Out of the 23.4 million veterans in the United States, 7.1 percent met the criteria for a substance use disorder between 2004 and 2006.
Service members return from combat zones with a myriad of problems including post-traumatic stress disorder (PTSD), depression or traumatic brain injuries. While some of these injuries and mental illnesses require the use of opioid pain relievers, a portion of service members misuse them, leading to addiction.
VA records disclosed that the two most common prescription drugs veterans abuse after the military are opioid pain medications and benzodiazepines.
In an audit of 20 VA rehabilitation facilities, 10 percent of patients received more than a week’s supply of narcotics at one time to self-administer. Widespread availability and lax supervision from doctors are major contributors to increased drug abuse among veterans.
Sixty-four percent of Iraq and Afghanistan veterans were prescribed at least one opioid in a one-year period. Of these veterans, four out of 10 had long-term opioid prescriptions. This is concerning because prescription holders are three times more likely to misuse prescription opioids than those without a prescription.
Sixty-four percent of Iraq and Afghanistan veterans were prescribed at least one opioid in a one-year period.
In 2011, the Journal of Pain and Symptom Management (JPSM) reported that 16.3 percent of veterans shared prescriptions to manage their pain, and 29 percent of veterans resorted to alcohol or street drugs to treat pain. Thirty-five percent of veterans used a combination of both. These dangerous practices increase the chances of an overdose.
Veterans who abuse drugs blame their addiction on the horrors of war. To them, alcohol and drugs are an escape.
35 percent of soldiers tried heroin while in Vietnam and 19 percent developed an addiction.
Researchers from the Washington University School of Medicine carried out a study on Vietnam War veterans and heroin use upon their return. The study, originally published in 1977, found that 35 percent of soldiers tried heroin while in Vietnam and 19 percent ended up developing a heroin addiction.
It is clear that combat exposure highly correlates to binge drinking among service members. In 2008, NIDA reported that 27 percent of active duty personnel who had been in combat engaged in weekly binge drinking.
As they transition to life after the military, some former military members struggle with alcoholism. A 2007 study published in the Journal of the American Medical Association revealed that 12 to 15 percent of Iraq and Afghanistan veterans had an alcohol use problem in the three to six months following their release.
Numerous studies link addiction to traumatic stress from being at war.
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Iraq or Afghanistan veterans has a substance use disorder.
People with PTSD often resort to alcohol and other drugs as a coping mechanism. Often, the coping mechanism turns into an addiction. The VA reports that people who used drugs and alcohol before a PTSD diagnosis remained faithful users after. However, PTSD is a causational factor for a potential addiction.
The relationship between PTSD and addiction is clear. According to the VA, more than one in five veterans with PTSD have a substance use disorder and one out of three veterans who seek addiction treatment has PTSD.
Compared with other Iraq and Afghanistan war veterans, those with PTSD exhibited higher-risk of opioid use and adverse clinical outcomes, including injuries and overdose.SEAL, K.H. ET AL., JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2012
Combined with a substance use disorder, PTSD can spiral into a series of problems including:
Several veterans who suffer from PTSD resort to drugs and alcohol to self-medicate, but self-medication causes symptoms to worsen in the long run. In cases where the person suffers from insomnia, substance use alters the quality of sleep, and the user feels groggy and restless.
Some PTSD symptoms include a surge of emotions, paranoia and a feeling of alienation from others. The intake of drugs and alcohol magnifies these symptoms, making these feelings worse.
Drugs and alcohol are not helpful for people with PTSD. The substances cause them to avoid the traumatic memories associated with their time in the military, which delays treatment.
of Afghanistan and Iraq veterans experienced difficulties reintegrating with their friends and family.
Numerous studies have shown that extensive use of prescription opioids and antidepressants puts veterans at a high risk for fatal overdose.
According to a 2012 study by the Journal of the American Medical Association (JAMA), veterans diagnosed with PTSD-associated mental illness were more likely to receive opioid prescriptions. The authors further remarked that the veterans were prone to alcohol and drug use disorders, received higher and more frequent doses of opioids and had prolonged opioid use.
The research linked prescription opioids to adverse clinical outcomes such as injuries, central nervous system depression and overdose in veterans returning from Iraq and Afghanistan.
Veterans with PTSD were more likely to be prescribed a benzodiazepine with more than one opioid at the same time. The mix of prescription pills heightens the risk of overdose in veterans.
Another study published in the American Journal of Psychiatry observed a correlation between accidental overdose and co-occurring disorders in veterans receiving care from the Veterans Health Administration. The researchers also found that the rate of accidental overdose doubled for VHA patients compared to the regular U.S. population.
Mental and substance use disorders were the primary cause of hospitalization among U.S. troops in 2009. Aside from the plethora of health consequences from alcohol and drug abuse, substance use disorders bring a number of other issues to veterans’ lives.
Veterans who return with mental and substance abuse issues are more likely to face difficulties in their personal and professional lives. Veterans who use substances cause distress to their immediate families with their change in behavior.
Securing employment after service is difficult for veterans. A report funded by VA Health Services Research and Development pointed out that 30 percent of young veterans faced unemployment issues after their release from the military in 2011.
The study revealed that nine percent of Iraq and Afghanistan veterans have been arrested since returning home. Alcohol, drug misuse and high levels of anger caused by PTSD contributed to the arrests. Criminal records related to drug misuse make it even more difficult to acquire a job.
Veterans account for 11 percent of the homeless population. With PTSD and substance use disorders making it difficult to find employment, veterans often do not have the financial resources to afford a home.
According to a survey carried out by the 100,000 Campaign, three out of four homeless veterans reported having a substance use disorder. A 2014 report by the Substance Abuse and Mental Health Services Administration stated that homelessness among veterans who abuse substances makes treatment difficult.
Veterans are victims of the ripple effects of war. They return with injuries and illnesses that can lead to addiction if left unattended. When drug abuse conflicts with the law, the result is incarceration. Sixteen percent of veterans are in prison for drug-related infractions.
According to a 2012 report by the Drug Policy Alliance, more than 140,000 veterans were in prisons or county jails in 2004. There is concern that these figures will magnify in coming years because of discharge rates and an increasing number of veterans.
Studies show that substance misuse and addiction are major contributing factors to veteran incarceration. Nine percent of Iraq and Afghanistan veterans reported being arrested, according to a national survey.
Veterans with substance use disorders need the appropriate level of treatment after they get out of prison. Many of them are susceptible to death by drug overdose after their release. Unfortunately, they face a number of obstacles that limit their access to services and resources.
Treatment is crucial to veterans if they wish to resume a normal life where they can thrive without substance abuse. Luckily, a combination of medication-assisted treatment and therapy has proven to be effective in helping veterans recover.
The VA offers different levels of treatment to cater to veterans afflicted with a substance use disorder. They also offer different options where veterans can seek treatment in case VA Care Centers are not available.
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As one of the largest providers of mental health care, the VA provides treatment for more than 1.1 million patients possessing a mental illness or substance use disorder. The VA offers comprehensive services regardless of the duration of treatment.
The VA also provides veterans with a list of resources to help them achieve a substance-free life. For the treatment of substance use disorders, VA centers are equipped with psychologists specialized in cognitive behavioral therapy, motivational interviewing, and motivational enhancement therapy.
Cognitive behavioral therapy teaches veterans to recognize negative behavior associated with substance use and work on changing their attitude to improve their lives. CBT encourages positive thinking in veterans and helps them shape their future. The veteran will meet a therapist once a week for 12 weeks.
Motivational interviewing helps veterans find motivation to change substance using behaviors and focus on practices that are more constructive. MI is a conversation between the therapist and the veteran highlighting the reasons he or she wishes to make a change and the potential benefits that come with the change.
The VA diagnosed 375,000 patients with a substance use disorder in 2007.
To ensure that veterans have the substance abuse treatment they need, the VA provides flexible treatment options during the evening and on weekends. The organization has residential treatment options for veterans who live far from a VA facility or do not have fixed housing. The VA also has special programs designed to help women, current conflict veterans and homeless veterans.
Treatment at VA facilities is not always readily available because of the increasing number of veterans and dependents requiring care. However, veterans have several options in case they need timely treatment:
Veterans with dishonorable discharges are not eligible for VA care; however, they can receive treatment at regular facilities treating substance use disorders.