Sunday, July 10, 2016

Addiction and Suicide Amongst Veterans: Finding Hope In The Darkness

PTSD Veteran
Editor's Note:  This is a guest post from Elizabeth Turner, originally seen at DrugRehab.org.

Many brave men and women who serve our country live through traumatic experiences during deployment. Today, there’s more awareness about the many veterans who struggle with post-traumatic stress disorder (PTSD) as a result of their experiences, yet much work remains. PTSD is one of the primary reasons veterans may turn to drugs or alcohol – as a coping mechanism to deal with the traumatic memories, feelings of depression, and anxiety resulting from PTSD – particularly if the disorder is inadequately treated or, in the worst-case scenario, undiagnosed or untreated at all.

At first, the occasional drink (or the occasional use of recreational drugs) to relax and escape from traumatic memories or to cope with the challenges of re-entry into civilian society seems harmless, but when the underlying stress or other cause isn’t addressed, this behavior can quickly escalate to addiction. Combined with depression, PTSD, or any other underlying mental health condition, addiction increases the risk of suicidal thoughts and behaviors.

The complexity of these diseases and comorbidity (co-occurring disorders, or two or more disorders present at the same time) presents a serious risk for veterans. We’ve created this comprehensive guide to shed light on the issues facing many veterans including the risk of addiction, suicide, and other contributing factors such as PTSD, and to provide resources and information to give veterans and those who love them a renewed sense of hope for regaining their sense of normalcy and achieving well-being.

What You’ll Find in This Guide:

 Information on Substance Abuse Among Veterans

  • The Link Between PTSD and Substance Abuse Among Veterans
  • Addiction and Suicide Among Veterans
  • Coping with PTSD
  • Overcoming Addiction and Suicide

Information on Substance Abuse Among Veterans

 
The following resources offer information on the rates of substance abuse and addiction among veterans as well as contributing factors that increase the risk of addiction and underlying reasons for substance use and misuse among veterans.


A 2011 article in Psychiatric Times reports on the high rate of substance abuse among veterans, noting that veterans may return from combat with “a co-occurring triad of posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), and pain, which complicates the problems with substance abuse.” This article presents findings from several surveys and reports including data illustrating alarming findings regarding the rates of substance use and abuse among veterans including:

  • 27% of veterans recently deployed to Iraq screened positive for alcohol misuse (survey sample size: 6,527).
  • 25% of recently deployed soldiers screened positive for alcohol misuse in another study, as well as 12% for alcohol-related behavioral problems (survey sample size: 1,120).
  • In a sample of recently deployed military personnel with combat exposure, one study found a binge drinking rate of 53%.
  • The rate of frequent, heavy drinking in the military ranges between 15% and 20% in one large-scale survey conducted prior to extensive deployments to areas such as Iraq and Afghanistan.
  • A subsequent large-scale survey of 88,205 soldiers who had recently been deployed to Iraq found that 12% to 15% screened positive for alcohol problems.
  • These findings are alarming and may not even illustrate the true depth of the substance abuse problems among veterans. But the widespread prevalence of substance use and misuse clearly points to the need for better interventions and preventative measures such as treatments to enable veterans to overcome PTSD and more comprehensive screenings and interventions for addiction.

The National Institute on Drug Abuse (NIDA) states in a March 2013 report that the rate of illicit drug use is lower among military personnel compared to the general population. However, “heavy alcohol and tobacco use, and especially prescription drug abuse, are much more prevalent and are on the rise.”

Military service members who have experienced multiple deployments and exposure to combat situations have the greatest risk of developing substance abuse problems. “The stresses of deployment during wartime and the unique culture of the military account for some of these differences,” the NIDA explains. “Zero-tolerance policies and stigma pose difficulties in identifying and treating substance use problems in military personnel, as does lack of confidentiality that deters many who need treatment from seeking it.”

According to the National Research Action Plan, created by the Department of Veterans Affairs, Department of Defense, Department of Human Services, and the Department of Education in August 2013 in response to the executive order, Improving Access to Mental Health Services for Veterans, Service Members, and Military Families, “Military service exposes service members to a variety of stressors, including exposures to death, risk to life, sustained threat of injury or actual injury, and the day-to-day family stress inherent in all phases of the military life cycle and its transitions. Stress is a major contributor to both the onset and exacerbation of substance abuse and mental health problems and is related to a variety of negative physical health outcomes.”

The Link Between PTSD and Substance Abuse Among Veterans

Research has demonstrated a link between PTSD and substance abuse disorders among veterans. While it’s not clear whether PTSD is the direct cause for substance use or abuse or the two are consequences of a single underlying cause (the latter is the current hypothesis generally accepted among researchers), there is a clear link between the two pointing to the need for more robust approaches to mental health services for veterans.


According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “18.5% of service members returning from deployment to Iraq or Afghanistan have post-traumatic stress disorder (PTSD) or depression.” Yet only approximately half of veterans who require mental health treatment seek it, and among them, just over half of those who receive treatment receive adequate care.

A 2014 article in Psychology Today points out that PTSD and addiction are typically viewed not as being directly related to one another, rather as two consequences arising from the same root cause. In the case of veterans as well as any other individuals having endured traumatic experiences, trauma is believed to be the underlying cause of both PTSD and addiction. Richard Taite, author of the article, explains, “For returning veterans, it is the power of these overwhelming experiences that create PTSD and it may be the same power that drives addiction, with or without the two occurring together. From combat or car crash or abuse, trauma creates addiction.”

According to the National Center on PTSD, the incidence of PTSD and substance abuse comorbidity is high among veterans. More than two out of ten veterans with PTSD also have SUD (substance use disorder), and one out of every three veterans seeking help for SUD also has PTSD. Additionally, war veterans with both alcohol problems and PTSD tend to be binge drinkers, which is believed to be in response to traumatic memories in attempt to drown out visions and memories of these experiences.

Addiction and Suicide Among Veterans

Addiction Veteran 
In addition to the link between PTSD and substance abuse, research has also demonstrated an increased risk of suicide among veterans as a whole but in particular those with substance abuse disorders or addiction. The following resources offer information on recent data regarding addiction and suicide risks among veterans.


In 2012, the number of US veterans who died by suicide exceeded the number of deaths in combat. According to the Department of Defense Suicide Event Report for 2014, “269 Active Component deaths and 169 Reserve Component deaths were attributable to suicide.” Additionally, 1,126 suicide attempts were reported, and, “The most common method of attempting suicide was the use of drugs (illicit or prescription) and/or alcohol.” Previous reports can be found at the National Center for Health & Technology website.

DrugFree.org reports on findings from several studies that point to the high rates of substance abuse, alcohol use, and suicide among veterans and active service members alike. One study found that the suicide rate among active-duty service members reached an all-time high in the previous year, and also notes, “Research indicates that as many as 43 percent of active duty soldiers reported binge drinking within the past month, according to the report.”

“A number of studies have shown that there are links between veteran substance abuse, depression, and suicide. In one study that involved roughly 600 veterans who were deployed to either Afghanistan or Iraq, 39% of the vets were screened and showed positive for probable alcohol abuse. Three percent of the vets screened were positive for probable drug use,” explains Lifeline for Vets. “A larger study that involved more than 675,000 active duty personnel determined that the rate of both substance use disorders and depression has increased among active members of the military. Another study determined that the rate of suicide across all military services in the USA increased between 2005 and 2007.”

Brandon Caro, author of a 2015 novel called Old Silk Road, offers personal insight into the issue in his compelling account of his own struggle and suicide attempt following his experience as a Navy corpsman (a combat medic) for The New York Times.

Coping with PTSD

Veteran SupportCoping with PTSD is a key element of successful transition back into civilian life as well as long-term well-being for veterans who experience stress, anxiety, and other symptoms of PTSD as a result of experiences in combat or other trauma exposure. The following resources offer valuable information on the resources, approaches, and services available to help veterans cope with and overcome PTSD.


The National Center on PTSD outlines a few treatment options that hold promise for veterans suffering from PTSD, including those who also have a comorbid substance use disorder, including:
  • Cognitive behavioral therapy (CBT) – a therapeutic approach to changing the way a person thinks about their previous traumatic experiences and the aftermath of those experiences.
  • Cognitive processing therapy (CPT) – an approach designed to help people with PTSD develop new ways to cope with their distressing thoughts and memories using skills to reshape the way they think about themselves, the world, and others.
  • Prolonged exposure therapy (PE) – an approach that helps to decrease the distress associated with certain trauma-related thoughts, feelings, and situations through gradual, prolonged, and repeated exposure.
The Department of Defense and the Department of Veterans Affairs released a mobile app in 2012, PE Coach, designed for PTSD patients, designed to provide PE therapy. The app offers “a mobile way of assessing symptoms, recording therapy sessions, receiving reminders for homework and appointments and learning more about PTSD.”

The US Department of Veterans Affairs enables veterans to locate programs to help overcome the symptoms of PTSD and the associated challenges the disorder creates. This searchable database provides information on PTSD programs in all 50 states.

The US Department of Defense Office of Warrior Care Policy offers a number of care coordination programs designed to ease the transition back into civilian society for military members returning from deployment. These and other programs offer support for returning military personnel with the goal of making the challenges of the transition easier and enabling veterans to cope with many of the challenges and emotions that may come with transitioning back to civilian life.

By taking advantage of programs such as Operation Warfighter, which helps wounded and disabled veterans secure internship opportunities, veterans may be able to successfully cope with their experiences and re-integrate into civilian society. Additionally, by receiving support for some of the primary struggles veterans face following deployment, such as securing work, the overall stress of the transition may be more manageable for some veterans. By reducing stress in other areas, veterans may be better able to cope with symptoms of PTSD – or seek and receive treatment more readily if they do experience symptoms associated with PTSD.

Real Warriors outlines five key steps veterans can take to support PTSD treatment, including links to a number of resources for finding treatment options, tools for success in reducing stress, returning to work, and more, and information on recent VA bills and initiatives designed to streamline access to mental health care for veterans. The Real Warriors Veterans Forum is also a useful resource, providing a way to communicate with other veterans and their family members who have experienced similar challenges.

Overcoming Addiction and Suicide

Support Veteran 
Addiction is a common consequence of substance use in veterans, often arising from an attempt to drown out the symptoms of PTSD, depression, or another comorbid mental health condition. The following resources offer information on treatments, services, and other resources that are available to veterans to help prevent and overcome addiction and manage mental illness effectively to eliminate suicidal ideations and reduce the number of suicides and suicide attempts among veterans.


If you are concerned about your use of alcohol or drugs and fear that you may be developing an addiction, After Deployment offers an assessment that you can take online, confidentially, to evaluate your symptoms and behaviors. While this can be a positive first step in determining if you have a problem, the best course of action is to seek the help of a mental health professional or treatment provider. Fortunately, the Department of Veterans Affairs has focused on providing more comprehensive services for veterans in recent years as they relate to substance use and abuse, PTSD, depression, and other health concerns. There are a variety of other resources outlined below enabling veterans to secure adequate treatment for many health concerns including addiction and suicide.

The DoD Deployment Health Clinical Center is aimed at supporting mental health for service members during and post-deployment. “The current military psychological health research paradigm was largely shaped by the 2012 executive order ‘Improving Access to Mental Health Services for Veterans, Service Members, and Military Families.’ The executive order charged DoD, along with the Departments of Veterans Affairs (VA), Health and Human Services (HHS), and Education, to improve coordinated research of PTSD and traumatic brain injury (TBI) through development of the National Research Action Plan (NRAP),” the Deployment Health Clinical Center website explains.
The website further explains that since the NRAP was released, “Areas of research focus have included improving access and quality of mental health and substance abuse services for service members and their families, prevention of suicide, early diagnosis and treatment of mental health disorders, better coordination of care among providers and services, and integration of family members into military mental health care.”

Transitioning back to civilian society is a primary challenge faced by many veterans, but there are resources that can help to make the changes easier. “InTransition is a free, voluntary program with coaches who provide psychological health care support to service members, veterans and their health care providers during times of transition. Service members can call to self-enroll 24/7,” explains the InTransition website. “The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) provides the Military Health System with current and emerging psychological health and traumatic brain injury clinical and educational information. We identify gaps and prioritize needs in psychological health and TBI research, and then translate that research into clinical practice to improve patient outcomes.” Call 800-424-7877 to self-enroll or ask your current provider or case manager to make a referral.

Military OneSource is an essential resource for military service members and veterans, offering information on the full spectrum of healthcare provided for veterans and active service members. The website includes a comprehensive section on suicide prevention, addictive behaviors, substance abuse, and more. Additionally, those who experience stress or PTSD will find the Managing Stress section to be a plethora of valuable insights and knowledge.

isorders common among military service members including PTSD, depression, traumatic brain injury (TBI), chronic pain, and suicide, among others.

In 2007, the Department of Veterans Affairs implemented a comprehensive effort to reduce suicide among veterans. Part of this effort entailed making improvements to data collection systems, which by 2010/2011 had matured enough to enable the VA to analyze the effectiveness of suicide prevention efforts and make improvements to prevention and treatment programs falling short of desired goals.

The U.S. Department of Veterans Affairs also maintains a searchable database to enable veterans to easily locate substance use disorder programs across the U.S.

Vets4Warriors is a peer-to-peer support network for military members and their families. Callers are matched with a Vets4Warriors peer with the knowledge and experience to help them cope with a variety of scenarios including:

  • Staying healthy
  • Problem solving
  • Managing and reducing stress
  • Exploring treatment options
  • Coping with a loss
  • Transitioning out of the military
  • Reintegrating following deployment
  • Financial planning
  • Overcoming challenges
  • Coping with loss
  • Building and strengthening relationships

The Department of Veterans Affairs and the Department of Defense provide a National Resource Directory, including information about a variety of services and opportunities available to veterans and their families. Additionally, you can find information on several crisis and help lines including:

Veterans Crisis Line: Call 1.800.273.8255 and Press 1
Military Crisis Line: Call 1.800.273.TALK (1.800.273.8255)
National Call Center for Homeless Veterans: Call 1.877.4AID.VET (1.877.424.3838)
VA Caregiver Support Line: Call 1.855.260.3274
Wounded Warrior Resource Center: Call 1.800.342.9647

The Center for Deployment Psychology is an organization that “trains military and civilian behavioral health professionals to provide high-quality, culturally-sensitive, evidence-based behavioral health services to military personnel, veterans and their families.” A variety of training opportunities are available, some in distance-learning format for easy accessibility.

Make the Connection is a valuable service provided for military service members and veterans, offering inspirational stories of recovery from those with similar experiences as well as information on signs and symptoms associated with a variety of disorders and challenges including nightmares, alcohol or drug problems, anger and irritability, feeling on edge, flashbacks, stress and anxiety, and more.

PTSD, depression, anxiety, and other mental health issues are common among veterans who have been exposed to extraordinary trauma during deployment. While these veterans often struggle with reintegration into civilian life and may turn to drugs or alcohol as a coping mechanism, these behaviors are extremely risky, leading to addiction and possibly thoughts of suicide. Additionally, suicidal ideations may be present even in veterans struggling with inadequately managed mental illness but who have not attempted to self-medicate with substances. In any case, the feelings of hopelessness are often overwhelming and without appropriate intervention can lead to devastating consequences.

With more focus on the mental health needs of returning military service members, there are more resources available to veterans today to help them cope with the challenges of reintegration and seek treatment for mental health concerns. Using the resources in this guide, veterans can once again have hope that overcoming their symptoms and emotions in order to regain a sense of normalcy and lead a happy, fulfilled life following deployment is within reach.

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