Substance Abuse with Veterans and Active Duty Military
According to an article in the journal Substance Abuse and Rehabilitation, an estimated 11 percent of people seeking first-time care in the Veterans Administration health system report having a substance abuse disorder. (1) The Veterans Administration has determined that men are more likely than women to experience a substance abuse disorder. The other group with higher rates of substance abuse was veterans aged 25 or under.
Veteran Substance Abuse by the Numbers
There are approximately 23.5 million veterans in the US today and 2.3 million active military service members. It is estimated that 1.5 million veterans had a substance use disorder in 2014.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), an estimated 1 in 15 veterans suffered from a substance abuse disorder in the past year. (2) This number can be broken down by the years of service.
This includes:
Alcohol Abuse
Alcohol is the most prevalent substance abused in the military. (3) People serving in the military may turn to alcohol as a means to relieve stress and to socialize with other military personnel. As a general rule, the more often a person has been exposed to combat, the more likely they are to engage in heavy or binge drinking.
Opioid Abuse
Another substance commonly abused in the military are prescription painkillers. Opioid prescriptions increased in the Veterans Administration system from 17% to 24% between 2001 and 2009. An estimated 46.9% of the prescriptions were for oxycodone, 39.5% were for hydrocodone, and 6.8% were for codeine. If a person had a diagnosed mental illness (such as depression or anxiety), they were more likely to have an opioid prescription than those who didn’t.
Abuse of Illegal Drugs
Reported rates of illicit drug use increase when active duty personnel leave military service. Marijuana accounts for the vast majority of illicit drug use among veterans with 3.5% reporting use, and 1.7% reporting use of illicit drugs other than marijuana in a 1-month period. (4) From 2002 to 2009, cannabis use disorders increased more than 50% among veterans treated by in the Veterans Health Administration (VHA) system. (5) Other illicit drugs are of concern for some veterans. One government report notes that more than ten percent of veteran admissions to substance use treatment centers were for heroin (10.7%), followed by cocaine at just over 6%. (6)
(4) Source: Teeters, J.B., Lancaster, C.L., Brown, D.G., & Back, S.E. (2017). Substance use disorders in military veterans: prevalence and treatment challenges. Substance Abuse and Rehabilitation. 8, 69-77. doi:10.2147/SAR.S116720.
(5) Source: Jamal, A., King, B.A., Neff, L.J., et al. (2016). Current cigarette smoking among adults—United States, 2005-2015. MMWR Morbidity and Mortality Weekly Report, 65, 1205-1211. doi: http://dx.doi.org/10.15585/mmwr.mm6544a2
(6) Source: Veteran’s Primary Substance of Abuse is Alcohol in Treatment Admissions, The CBHSQ Report, SAMHSA, November 10, 2015. https://www.samhsa.gov/data/sites/default/files/report_2111/Spotlight-2111.html
Signs of a Substance Abuse Disorder
Doctors usually diagnose a substance abuse disorder by certain using criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). There are 11 criteria listed in the DSM-V, and a person has to meet two or more of these criteria for a doctor to diagnose them with a substance abuse disorder. These include:
- Using the substance more and more over time or over a longer time than the person intended.
- Trying to quit using the substance but being unable to.
- Spending a significant amout of time using, recovery from, or obtaining a particular substance.
- Having frequent, strong cravings for a substance.
- Substance abuse interfering with home, school, or work-life.
- Continuing to use a particular substance even if friends, jobs, or other relationships have been lost as a result of substance abuse.
- Ending particpiation in activities previously enjoyed due to substance abuse.
- Engaging in substance abuse in situations where a person may be put in danger. Examples include drinking and driving.
- Continuing to abuse substances regardless of physical or psychological problems.
- Having to use more and more of a substance to achieve the same effect.
- Experiencing withdrawals from a substance when use stops.
Denial
In addition to these symptoms, veterans struggling with a substance abuse disorder will often be in denial about their condition. It’s common for people struggling with substance use disorders to blame others for their particular situation. For example, if they lose a job, it’s because they have a terrible boss or their superiors “don’t know how to run a business.” Sometimes, a loved one may even blame close family members, saying that their family members drove them to drink.
Symptoms
Ultimately, a substance use disorder will cause a person to experience one or all of the following symptoms:
- Cravings: Strong cravings for alcohol or drugs.
- Loss of Control: Losing control over how much or how often they use.
- Tolerance: Using more alcohol as a means to achieve the same high as before.
- Withdrawal: Experiencing symptoms like shaking, nausea, anxiety, or other symptoms. The severity and type of symptoms depend upon the substance and length of time of abuse.
Questions to Ask Yourself
If you have some of the symptoms of substance abuse listed above, it’s time to seek help. If you still aren’t sure, ask yourself some of the following questions. If you answer yes to any, these could be a sign of a substance use disorder:
- Has anyone ever told you that you should cut down on your drinking or drug abuse?
- Have you ever tried to quit drinking or using drugs, but found you couldn’t?
- Do you ever lie to other people about how much you are using or how often you use it?
- Do you go through your prescription medications much faster than a doctor expects you should?
- Have you ever felt ashamed or embarrassed about how your drinking or drug abuse?
- Have you had problems with the law, your friends and family, or your job because of your drinking or drug abuse?
- Have you ever blacked out due to your drinking or drug abuse?
If you answered yes to some of these questions, you could benefit from seeking help for a possible substance abuse problem.
Rock Bottom Misconception
A common misconception is that a person has to hit “rock bottom” before seeking treatment. This isn’t the case at all. If you’re starting to develop signs of a substance use disorder, it’s important to seek treatment as soon as possible. By seeking early treatment, it’s possible to reduce the risks for long-term physical and mental health problems related to substance abuse. You don’t have to lose everything before you decide it’s time to seek help.
Common Causes of Drug Use in Veterans
Several factors may contribute to a veteran developing a substance abuse disorder. Some of the biggest contributing factors include:
- History of deployment
- History of exposure to combat
- History of pain from injuries sustained while in the military
- Problems re-integrating into everyday society after leaving the military
- History of interpersonal trauma, such as child physical or sexual abuse
Military personnel can experience many difficulties in re-integrating or returning to everyday life after service. Examples of these stresses include problems sleeping, chronic pain, violence in relationships, and traumatic brain injury. These stresses don’t only lead to substance abuse, they can also cause other mental health disorders.
Chronic Pain
Chronic pain is hard for veterans and their families to deal with. Some service members with chronic pain turn to drugs or alcohol to find some relief. However, substance abuse frequently leads to more problems, including divorce and the loss of other close relationships. Before leaving a veteran with chronic pain, spouses often exhaust themselves trying to provide care. Chronic pain is another injury that can be hard to see, making it harder to diagnose and treat.
Sleep Problems
Studies have shown that the rates of sleep problems in veterans are alarmingly high. In one study, 74% of veterans reported symptoms that would lead to a diagnosis of insomnia. Veterans with PTSD suffer even higher rates of insomnia.
Traumatic Brain Injury
Research from the Lone Survivor Foundation estimates that more than 300,000 veterans have suffered a traumatic brain injury.6 Most brain injuries of veterans fall into two categories, mild traumatic brain injury and post-concussive disorder. These injuries are not visible, so it is hard to see that the veteran is suffering. The symptoms of these brain injuries can be inconsistent, making the injuries hard to diagnose.
Domestic Violence
A 2009 report from the VA found that 81% of veterans with depression or PTSD engaged in one or more violent acts against their partner in the previous 12 months. The research also showed that half of the veterans with PTSD performed at least one severe act of violence in that time. That rate is more than 14 times higher than that in civilians. In 2005, the VA received almost 143 cases per week.7
(7) Source: https://bit.ly/vetheadtrauma
Deployment Leads to Risky Behavior
Doctors associate a history of deployment with increased risks for problematic drinking, starting to smoke, engaging in risky behaviors, and using drugs.
Illegal Drug Use Increases After Active Duty
Doctors also know that rates of illegal drug use increase when a person leaves active duty. Of the veterans that admit to substance abuse treatment centers, an estimated 10% receive treatments for heroin addiction. An estimated 6% of treatment admissions are for cocaine use.
Zero-Tolerance Problems
Zero-tolerance drug and alcohol policies deter veterans and military personnel from seeking treatment. Many veterans are afraid they may lose their jobs or healthcare coverage when they need help. This is a major roadblock to veterans getting the help they need.
VA Screening Tool
The Veterans Administration created a screening tool with questions that doctors are supposed to ask when a person seeks treatment. This tool is known as Screening, Brief Intervention, and Referral to Treatment. (8) If the answers signal as alcohol use disorder, medical providers may give them a referral to a treatment specialist.
(8) Source: https://www.womensmediacenter.com/news-features/the-fatal-new-normal-for-wives-of-veterans
Trouble Getting Help
While there are known causes of increased risks for substance use disorders in veterans, there are also a lot of challenges that can sometimes prevent them from seeking the care they need. Examples of these challenges include lack of access to treatments (such as living far away from a Veterans Administration facility), fear of stigma or negative consequences for seeking treatment, lack of confidential services, and gaps in insurance coverage. While these concerns and fears are real, it’s important to realize that substance abuse can be deadly.
What Are the Long-Term Risks for Substance Abuse in Veterans?
Suicide
According to an article in the journal Substance Abuse and Rehabilitation, an estimated 30% of suicides in military veterans were in veterans who struggled with drug or alcohol abuse.9 Additionally, an estimated 20% of veteran deaths from high-risk behaviors were due to alcohol or drug use.
The same journal also reports on individual substances abused. The report showed that veterans who abuse alcohol are more likely to experience interpersonal violence, poor health, and greater risk for death due to alcohol abuse.
Homelessness
Veterans who struggle with a substance use disorder are also at greater risk for homelessness. (10) An estimated 11% of all adults experiencing homelessness are veterans. An estimated 70% of veterans who are homeless have a substance use disorder. Of the veterans in substance abuse treatment programs, an estimated 20% are homeless.
The Veterans Administration has programs available for veterans experiencing homelessness that can help address concerns such as substance abuse treatment, case management, housing assistance, and other vital services that can help find a home and the help needed to recovery from substance abuse.