There are a number of resources available to veterans and individuals struggling with substance abuse disorder (SUD), including treatment for alcohol, smoking, tobacco, and opioid addiction. The Disabled Veterans Resource Center refers veterans to various organizations if they are in need of these services.
Substance abuse disorders result in the deaths of more than one in four U.S. military members each year. A chaotic military life of daily stressors and combat exposure surrounded with highly-addictive and easily obtained tobacco, alcohol and prescription medications creates the perfect recipe for lifelong addiction.
Veterans return home with heightened anxiety, post-traumatic stress disorder (PTSD), serious injuries and pressure to quickly reintegrate into civilian society. Addiction only delays the difficult reintegration process and brings massive repercussions down the line, including debilitating health issues and an increased risk for unemployment, homelessness, incarceration and accidental overdoses.
Military service members understand the very real dangers associated with addiction, yet many are unable to avoid it. Military society is rife with on-base tobacco use and binge drinking, more so than most civilians face. Drinking and smoking are the military’s answer to generating camaraderie and alleviating boredom. When a soldier experiences combat trauma or a painful injury, he or she quickly learns to self-medicate with alcohol or request prescription drugs long past the time they really need them.
At home, veterans continue this learned trend of self-medication, only to realize they can’t stop when they decide they want to. These addicted individuals return with habits that make them ill-equipped to function in society. Addictions lead to relationship problems, divorce, unemployment, financial difficulties and deadly diseases. Combine addiction with PTSD and other military-related physical and mental disabilities and a veteran has slim chances of living a fulfilling life without fast and appropriate treatment.
The U.S. Department of Veterans Affairs (VA) does recognize the massive problem with addiction among veterans and offers a wide range of treatment protocols designed to help veterans recover fully from substance use disorders. Proper treatment can be extremely effective for veterans, providing new opportunities and a bright future. And while many veterans believe that the VA doesn’t offer service-connected disability benefits for tobacco, alcohol or drug abuse, this is not the case. Veterans are indeed able to collect VA benefits for disabilities associated with substance abuse disorders. They merely need the right advocates to guide them in the right direction.
Diagnostic Criteria for Substance Use Disorders
Substance use disorders present with two or more of the following symptoms over a 12-month period:
- Use of a substance in larger amounts or over a longer timespan than intended
- Unsuccessful attempts and/or persistent desire to reduce or stop use
- Substantial amounts of time spent obtaining, using,
and/or recovering from the substance
- Strong craving for the substance
- Use causes significant interference with work, school or home responsibilities
- Using despite repeated social or interpersonal consequences
- Missing important occupational or recreational activities
because of the substance use
- Using in situations that could be physically hazardous
- Using despite repeated or persistent physical or mental consequences
- Developing tolerance to the substance
- Experiencing withdrawals when not using the substance
The PTSD – Addiction Cycle
Over 20% of veterans with PTSD have a substance abuse problem, and nearly 33% of veterans who seek treatment for substance abuse also have PTSD. Researchers believe that veterans with PTSD turn to alcohol, tobacco and prescription medications to alleviate problems with insomnia, depression and traumatic memories.
Addiction among veterans with PTSD generates a snowball effect. While the initial trauma of service causes the PTSD, concurrent substance use causes the PTSD to spiral out of control, adding the further trauma of life-threatening health problems, relationship difficulties, depression, failure to hold employment and an ever-dwindling social support system.
This inability to lead a fulfilling life while struggling with alcohol or drug addiction only enhances PTSD symptoms, including insomnia, agitation, paranoia and social isolation. In turn, the veteran’s addiction only grows worse as they rely more and more on drugs or alcohol to cope. Addiction also delays recovery from PTSD, allowing the veteran to continue suppressing traumatic memories.
Unfortunately, veterans diagnosed with PTSD are more likely to receive highly addictive opioid prescriptions from VA hospitals, further exacerbating the problem. Prescription opioid use among veterans can lead to depression, chronic health problems, injuries and overdose. Researchers have found that accidental overdose rates for VA patients are double that of the U.S. civilian population.
TBI and substance abuse
Up to 30% of veterans returning from Iraq or Afghanistan reportedly suffered a TBI during service, and studies suggest that between 10% and 20% of individuals with TBI develop substance abuse disorders. Victims of TBI have a 2.6 (mild TBI cases) to 5.4 times (more severe TBI) higher rate of alcohol and drug addiction that civilians with TBI. This discrepancy may be caused by military veterans being less likely to seek and/or receive proper medical care for their TBI than civilians.
Traumatic brain injuries can damage the release of neurotransmitters that affect the pleasure centers of the brain. Many TBI victims turn to alcohol and drug abuse to alleviate symptoms of anxiety and depression. In addition, most healthcare professionals prescribe addictive opioid painkillers to TBI patients, leading to more problems with addiction.
When PTSD and TBI are combined, the risk of substance abuse and addiction is significantly increased. And this combination is common. A study examining risk factors for PTSD found that TBI was by far the strongest predictor of post-deployment PTSD among service members and veterans – even more significant than the intensity of trauma experienced during combat. Up to 44% of veterans who reported loss of consciousness during service also exhibited PTSD symptoms.
MST and alcohol abuse
In addition to TBI increasing the risk for substance abuse among veterans, exposure to military sexual trauma (MST) is also a predetermining factor for addiction. Studies show that military members who suffer MST have elevated rates of alcohol abuse when compared to those not exposed to MST.
Available Treatments for Substance Abuse Disorder
The VA offers several successful treatment methods, both behavioral and pharmacological, that help rehabilitate veterans from addictive disorders. The VA offers both inpatient and outpatient programs, and several VA hospitals offer residential housing for those who live far from treatment facilities or are homeless. The VA also offers care through outside, community providers when a local VA hospital or clinic is not available. Marriage and family counseling, relapse prevention and continuing care are also available.
Tobacco cessation programs offer regular nicotine substitutes (patches, gum, medication), weaning schedules to help patients taper off the use of these substitutes and counseling programs to help adapt to the lifestyle changes that come along with quitting smoking.
Alcohol abuse and opioid addiction treatment programs offer medical detoxification and monitored withdrawal support. Three craving-reduction medications, acamprosate, disulfiram and naltrexone, are currently approved by the US Food and Drug Administration (FDA) for alcohol use disorders. Similarly, buprenorphine, methadone and naltrexone are FDA-approved for the treatment of opioid use disorders. Recent studies have investigated the use of prazosin, topiramate and N-acetylcysteine in the treatment of coexisting substance abuse disorder and PTSD.
The VA offers motivation and cognitive therapy programs that involve meeting with a therapist once weekly for 12 weeks. Motivational therapy helps veterans to “reset” their thinking around productive habits by emphasizing why the veteran desires freedom from addiction and the benefits that come along with sobriety. Cognitive behavioral therapy helps veterans recognize the real threats of substance abuse and works to shift the veteran’s thinking in a positive direction.
Service-Connection for Substance Abuse Disorders
While the VA does not grant direct service-connection for substance abuse disorders, veterans are indeed able to service connect their alcohol or drug abuse problem as secondary to other service-connected conditions.
When a veteran’s alcoholism or drug abuse disability is determined to be caused by or aggravated by a service-connected disability, the VA may grant secondary service connection and pay disability compensation for the alcoholism or drug abuse disability.
For example, if (1) you are service-connected for PTSD as a result of your time in service, and (2) you develop an addiction to alcohol which (3) eventually leads to cirrhosis of the liver, your cirrhosis can be service-connected since it was a result of your alcohol addiction - as long as you can show that the alcoholism was caused by the PTSD you developed as a result of serving in the military. A veteran who is PTSD service-connected and develops hepatitis C from a contaminated needle after developing a heroin addiction would also be eligible to file a claim for benefits by secondary connection of the hepatitis C.
Examples of disabilities commonly associated with alcohol and/or prescription drug abuse:
- Anemia
- Arrhythmia
- Brain damage
- Breast cancer
- Cardiomyopathy
- Cirrhosis
- Colon cancer
- Dementia
- Diabetes
- Esophageal cancer
- Fatty liver disease
- Heart disease
- Hepatitis
- Hepatitis C infection
- Hepatocellular carcinoma
- HIV infection
- Hypertension
- Insomnia
- Myopathy
- Oral cancer
- Peripheral neuropathy
- Seizure disorders
- Sleep apnea
- Stroke
- Sudden cardiac death
- Wernicke-Korsakoff disease
VA benefits also extend to survivors of military veterans who lose their lives to alcohol or drug abuse. In the above scenario, should the veteran die from cirrhosis, eligible family members may be eligible for Dependency and Indemnity Compensation (DIC), Dependent’s Educational Assistance (DEA), Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) medical care, loan guaranty benefits and accrued benefits.