Veterans and Substance Abuse: Treatment for Co-Occurring Disorders

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Nearly one quarter of US veterans returning from duty overseas show symptoms of substance abuse – and of those, about a third also suffer from Post Traumatic Stress Disorder or another mental health condition. What’s more, the Department of Veterans Affairs estimates that about 80 percent of homeless veterans suffer from both substance abuse, and a moderate to severe mental health condition.

Stress and Trauma Can Lead to Co-Occurring Disorders

In general, people with an addiction are twice as likely to have a mental health issue such as depression, bipolar disorder, or PTSD, and the reverse is also true: people seeking treatment for a mental health concern are twice as likely to have a substance abuse problem as well. But the incidence of these co-occurring disorders – the combination of addiction and a mental health problem – is dramatically higher for veterans of all branches of military service.

The stresses of service and the trauma of combat in particular, heighten the risk of addiction combined with a mental health condition, particularly PTSD, among veterans, but many never get the specialized treatment they need.

To help more veterans heal from addiction and mental illness, the US Department of Veterans Affairs and specialists in both mental health and addictions are partnering to identify veterans at risk for co-occurring disorders and ensure that they have access to integrated treatment for co-occurring disorders that addresses both substance abuse and mental health concerns.

Co-Occurring Disorders: A Complicated Relationship

Which came first – the addiction or the mental illness? Untangling the often-complicated relationship between these two disorders creates special challenges for identifying those at risk and getting them the integrated treatment they need.

Addiction and mental health conditions can occur in any combination, and their symptoms can often mimic each other, which makes diagnosis and treatment especially difficult. For example, depression can be marked by lethargy, lack of interest in activities, and slow responses – and so can an addiction to opioids and other central nervous system depressants. The euphoria and grandiose thinking of a bipolar swing can also look like the high from cocaine or amphetamines.

Factors contributing to both substance abuse and mental health disorders can include biological and genetic tendencies, as well as environmental conditions and life experiences, such as trauma or ongoing abuse.

Some people misuse substances ranging from illicit drugs to prescription medications to ease existing emotional pain or discomfort, while others develop mental health issues such as depression in response to their experience of substance abuse. That’s why treating co-occurring disorders requires a coordinated effort between mental health and addictions services to create an integrated treatment plan that addresses both sides of the problem.

Veterans Are At Higher Risk for Co-Occurring Disorders

For veterans, issues relating to their military experiences can make the experience of addiction and mental health problems even more acute.

Veteran substance abuse rates and the rates of mental health issues are far higher than for those who haven’t served. Along with general contributing factors, veterans face special issues relating to their time in service that make the experience of addiction and mental health problems even more acute.

Post Traumatic Stress Disorder Can Lead To Substance Abuse

According to the Department of Veterans Affairs, nearly a third of veterans seeking help for addictions also suffer from Post Traumatic Stress Disorder, or PTSD, related to experiences in combat or serving in high-risk areas.

Individuals who have been injured in combat or who have witnessed combat related events can experience symptoms related to the event for months and years afterward.

Common PTSD symptoms include:

  • Reliving the traumatic event. People with PTSD can have flashbacks, nightmares or vivid, intrusive memories of the traumatic event.
  • Avoiding “trigger” situations. PTSD sufferers may try to avoid situations or people that trigger memories of the event, or they may avoid talking or even thinking about it in any way, acting as if it hadn’t happened at all.
  • Experiencing negative feelings. Veterans with PTSD might feel guilty that they survived while others didn’t, or angry at circumstances that caused the event. Or they may find it hard to feel at all.
  • Experiencing hyperarousal. PTSD sufferers may feel constantly jumpy, hyper alert, or have trouble sleeping. It’s also common to feel irritable, have angry outbursts, startle easily, or find it hard to be around people and noises for very long.

Because of the multitude of ways PTSD can impact a veteran’s life, it’s not surprising that many veterans turn to alcohol or drugs to cope. The combination of PTSD and substance abuse takes a toll not only on the individual who has experienced trauma, but also on those around them. Marriages can end, friendships can suffer, and it can be hard to find and keep a job – all factors contributing to the high rate of homelessness among veterans with PTSD and co-occurring substance abuse.

Veterans with PTSD and addictions are also more likely to engage in risky behaviors such as driving while drunk or high, or committing major and minor crimes.

Injuries Play a Role in Veterans Substance Abuse

Veterans who are wounded in combat are also at high risk for co-occurring disorders. Many suffer from traumatic brain injury (TBI), an often-under diagnosed ailment whose effects may not be apparent until weeks or months after the injury. Symptoms of TBI include changes in mood, memory, coordination and other functions, and many veterans turn to alcohol or drugs to help them cope.

Combat injury also raises the risk of mental health issues such as depression, along with the possibility of addiction to prescription pain medications such as OxyContin or Vicodin. Combined with other substances such as alcohol, these medications can cause overdose or death.

Reentry to “Regular” Life Can Cause Stress for Veterans

Whether a soldier has experienced combat or not, returning to daily life after deployment can have its own stresses, which can create short and long term mental health issues that often lead to substance abuse.

It’s not uncommon for a returning veteran to find that family dynamics have changed. Spouses may have taken on new roles in a soldier’s absence. Children are older, with new interests and activities. And old friends and family members simply may not relate to that soldier’s most vivid experiences. If a returning soldier also suffers from PTSD or the aftermath of an injury, these issues can add severe stress that can lead to self-medicating with drugs or alcohol.

For some veterans, their time in service was a heightened experience that “regular” life just can’t replicate. Settling in to job and family routines, however desirable, may feel stressful, and it can be easy to turn to drugs or alcohol to handle the transition. For these reasons, many veterans’ support groups and treatment centers offer resources to help veterans and their families find solid ground after a soldier’s return home.

Women Veterans Have Special Issues

Along with the issues facing veterans in general, women veterans often have special concerns that contribute to both mental health and substance abuse.

Accounting for all other factors, female veterans have a suicide rate that’s 6 times higher than among non-military women. They may be more susceptible to PTSD after their service, too – not only from combat situations, but also from experiences within their own ranks.

The US Department of Veterans Affairs notes that 10 percent of women serving in the military have been raped during their service, and 13 percent report unwanted sexual contact or harassment. Many of these cases are never prosecuted or addressed, which can leave women veterans with mental health issues such as depression and anxiety.

Women in the services may also face special challenges with child and family care during their deployment – and these and other stresses can lead to an addiction to drugs or alcohol.

Spotting the Signs of Veterans Substance Abuse

The signs and symptoms that typically indicate that an individual is abusing drugs or alcohol can have many other causes, so it can sometimes be hard to spot an addiction. But in general, any of these six changes in mood and behavior can signal that someone is having a problem with substance abuse.

  1. Developing a physical tolerance for the drug. Over time, the body and brain adapt to a drug, so that users need more and more of it to get the effects they’re looking for – or, if they’ve been addicted for a long time, simply to get through the day and keep withdrawal symptoms at bay.
  2. Physical symptoms and behavior changes. People using opioids and other depressant drugs may be drowsy or sleepy, while someone using stimulants might be “wired,” hyperactive, or unable to sleep.
  3. Loss of interest in usual activities. When someone is addicted to a drug or alcohol, their focus shifts to managing that addiction – getting more of the drug, or hiding their use from others. That means they may abandon things and people that used to be part of their lives, or acquire new friends and activities that are related to using drugs.
  4. Withdrawal symptoms. When an addicted person can’t get the drug of choice, withdrawal symptoms can set in relatively quickly. Tremors, sudden flu like symptoms, and other unusual ailments could signal withdrawal – a potentially risky situation.
  5. Neglect of self-care. When an addicted person is focused only on getting and using a drug, it’s easy to skip meals, baths or personal grooming. Addictions can also contribute to skin and nail problems, or cause teeth to break and decay.
  6. Sudden problems with work or school. The first indicator of an addiction may be sudden trouble with keeping a work or school schedule. An addicted person may start coming to work late, missing classes, or having trouble completing assignments. Family members might be asked to help by calling in sick for them, or driving them so that they won’t be late.

How to Treat Co-Occurring Disorders Successfully

Treating the combination of mental health and substance abuse problems poses special challenges for specialists in both fields. Dedicated substance abuse programs may not be equipped to address mental health conditions, and vice versa – but as the number of people with co-occurring disorders continues to rise, rehabs and mental health services alike are exploring integrated treatment models work to address the complicated nature of these conditions.

Here are a few approaches that show promise for treating various combinations of substance abuse and mental health disorders:

1. Medication management

Medications for managing withdrawal and supporting addiction recovery can help people with co-occurring disorders, and so can medications for the symptoms of mental health issues such as anxiety, depression and bipolar disorder.

The role of medications in managing co-occurring disorders depends on individual circumstances, but medications may be an important part of a comprehensive treatment plan.

2. Individual and Group Therapy

Therapeutic approaches such as Cognitive Behavioral Therapy (CBT), which focuses on helping people develop new ways of dealing with situations, can help those with both substance abuse and mental health issues. In individual and group sessions, CBT and other therapeutic approaches help people work toward building stability and improving relationships in their lives.

3. Couple and Family Therapy

Recognizing that addictions and mental health issues impact families as well as individuals, integrated treatment models can include therapy to rebuild relationships and help spouses, children and other family members find healthier ways to connect and cope with the changes caused by a loved one’s combination of mental health issues and addiction.

4. Veteran’s support groups

Along with therapy and medication, veterans struggling with substance abuse and mental health issues can also benefit from veterans substance abuse groups and services designed just for them, where they can find support that reflects their experiences in service and combat.

According to the Substance Abuse and Mental Health Services Administration, around 8 million adults in the US suffer from a combination of addiction and mental illness – a condition that strikes veterans especially hard. With new insights into the relationship between these disorders and the experiences of veterans in service and in combat, today’s treatment for co-occurring disorders offers hope for recovery and a brighter future.