Studies have shown that deployment and combat exposure in Iraq and Afghanistan can result in new-onset heavy drinking, increased consumption of alcoholic beverages, and dangerous behaviors such as binge drinking. Easy availability and the stress of coping with the challenges of war play a role in the increased use of alcohol by service members.
The misuse of prescription and illicit drugs has been increasing worldwide, but unfortunately, it has risen more rapidly in the United States military compared to the civilian population. Service men and women often receive prescription pain medications to treat chronic pain from injuries sustained during combat. Prescription anti-anxiety drugs may be given to veterans soon after discharge to help with the psychological stress of readjustment to civilian life. One study found that prescription opioid misuse and the use of illicit drugs such as crack and heroin was exceedingly uncommon prior to entering the military. However, some service members developed patterns of misuse during deployment with continued abuse after return to civilian life. How bad is the substance abuse problem in active military personnel? What are the challenges of addiction treatment for veterans? Read on to learn more.
Substance Abuse in Active Duty Military
Data shows that tobacco, alcohol, and prescription drug abuse are more prevalent and steadily increasing in members of the armed forces compared to the rest of society. Interestingly, illicit drug use is lower in the U.S. military compared to the civilian population. Why do active duty members of the military abuse alcohol and prescription drugs?
One of the biggest reasons for substance abuse in military personnel is the stress of deployment in a war-torn region. Loneliness, fatigue, being away from home, and spending months on end in a challenging environment makes members of the services particularly vulnerable to substance abuse. The unique culture of the military and the strict discipline are other factors that influence addictive behavior. The stigma associated with addiction and the lack of confidentiality act as deterrents in seeking treatment for drug and alcohol problems.
Illicit drug use remains low in the military, likely because the Department of Defense has a zero-tolerance policy in this regard. Random drug tests, dishonorable discharge, and criminal prosecution act as deterrents. Less than 3 percent of military personnel report use of illicit drugs compared to 12 percent in the general population. In the 19 to 25 age group (where illicit drug use is most likely), the rate is less than 4 percent in military personnel compared to about 17 percent in civilians.
According to the National Institute on Drug Abuse, prescription drug abuse has risen steadily from 2 percent in 2002 to 11 percent in 2008, with opioid pain medications being the most commonly abused drugs by military men and women. Where do service members get prescription pain pills? Growing misuse in the military is driven by widespread availability and an increase in the number of prescriptions for opioid pain medications. The trend is worrisome. Between 2001 and 2009, the number of prescriptions for pain pills written by military doctors increased four times to nearly 4 million. Injuries sustained during combat and the strain of handling heavy equipment during multiple deployments have likely played an important role.
Binge drinking, new-onset heavy drinking, and misuse of prescription drugs are highest among military personnel with multiple deployments and active combat exposure. American troops deployed in Iraq and Afghanistan are able to obtain alcohol even in Muslim nations where access to liquor is controlled. In fact, liquor is sold at U.S. bases at a discounted price compared to civilian stores. Barrack parties are an accepted part of military culture and are believed to promote camaraderie and help deal with the stresses of the battlefield. Binge drinking among men and women in military service has shown a disturbing increase from 35 percent in the late 1990s to 47 percent a decade later. Many active duty personnel self-medicate with alcohol to numb the pain or deal with post-traumatic stress disorder. Those with exposure to high combat report the highest rate of alcohol abuse.
Addiction in Veterans: Sobering Statistics
Retired members of the armed forces are not immune to addiction. This group of people must deal with complex health and economic challenges. The psychological stress of combat experiences and the demanding environment of military life can trigger substance use disorders. Long deployments and frequent moves lead to strained relationships with loved ones. Thousands of veterans face critical problems such as unemployment and homelessness. It is not surprising then that veterans use drugs and alcohol as a crutch to deal with the hardships of service and readjustment to civilian life.
The Substance Abuse and Mental Health Services Administration estimates that about 7 percent of U.S. veterans have a substance use disorder. Almost 20 percent of military men and women who have served in Afghanistan or Iraq suffer from PTSD, depression, or traumatic brain injury, all of which are conditions which predispose to addiction. Mental health conditions and substance abuse are the leading cause of hospitalizations among U.S. troops.
Exposure to war leaves veterans grappling with extreme stress upon returning home. The mental scars of traumatic situations and lingering pain from physical injuries can drive veterans towards illicit substances. Mental illness, PTSD, and substance abuse are all concerning problems in this group of people. However, the National Council on Alcoholism and Drug Dependence reports that use of illicit drugs by veterans, including marijuana, methamphetamine, heroin, and cocaine, is lower than the general population.
Veterans may be prescribed highly-addictive prescription anti-anxiety and pain-relieving medications to treat legitimate conditions such as PTSD and chronic pain. However, unregulated use of these drugs can spiral into full-blown dependence and drug-seeking behaviors. Lack of access to affordable and effective addiction treatment may fuel the problem of substance abuse in U.S. veterans. According to a study conducted by the Department of Defense, prescription drug misuse is two and a half times higher in military personnel compared to civilian rates.
Studies show that more than 40 percent of US military veterans suffer from alcohol use disorder at some point in their life. Veterans have a tendency to hide drug and alcohol problems, manifesting in eventually in dangerous behaviors such as binge drinking and domestic violence. Self-medicating with alcohol to deal with PTSD is also common.
The Numbers That Reveal the Reality
The Department of Defense (DoD) enforces a strict zero-tolerance policy for drug use among active military personnel. But according to the NIDA, veterans still have higher rates of tobacco addiction, alcoholism, and prescription drug misuse than civilians. Substance abuse among veterans is steadily increasing.
The following statistics illustrate the magnitude of the problem of substance abuse among veterans in the United States:
- 7.1% of veterans developed substance use disorder (SUD) during the period from 2004 to 2006, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
- 2 out of 10 veterans who suffer from post-traumatic stress disorder go on to develop SUD, according to the National Center for PTSD.
- 1 in 6 veterans of the Iraq and Afghanistan campaigns experiences symptoms of PTSD, according to the National Institute on Drug Abuse (NIDA).
- 20% of female veterans who have served in Iraq and Afghanistan have been diagnosed with PTSD, according to the U.S. Department of Veteran Affairs.
- 1 out of 4 veterans of the Iraq and Afghanistan campaigns reports experiencing the symptoms of a mental health disorder, according to the U.S. Department of Health and Human Services.
- 25% of young veterans aged between 18 and 25 years exhibited the symptoms of SUD or other mental health disorders between 2004 and 2006, according to the National Institute on Drug Abuse. This is double the instance reported by veterans aged 26-54 years and 5 times more than for veterans aged 55 years or older.
Reasons for Substance Abuse in Veterans
According to the U.S. Department of Veterans Affairs, 1 in 10 soldiers returning from war service in Afghanistan and Iraq face drug and alcohol problems. Active military personnel and veterans can become addicted to illicit drugs, prescription pills, and alcohol for a number of reasons:
- High incidence of post-traumatic stress disorder
- High incidence of mental health conditions
- Combat exposure
- Traumatic brain injuries
- History of substance misuse during active service
- Chronic pain due to overuse and injuries
- Inability to cope with stress
- Difficulty in transitioning to civilian life
- Stressors of being a woman in the military
- Inability to recognize or acknowledge the problem
- Reluctance to seek help due to stigma
Veterans and PTSD: increasing the risk of addiction
Post-traumatic stress disorder (PTSD) is a psychological condition commonly seen in U.S. military veterans due to experiencing life-threatening events during deployment. PTSD can happen to anyone but is more likely to occur after long-lasting and intense trauma, such as during combat. Age, gender, additional stressors, and social support all affect the development and severity of PTSD.
Symptoms of PTSD include:
- Reliving the experience (nightmares, flashbacks, distress, sweating, fast heartbeat)
- Avoiding situations, conversations, and places that trigger memories of the event
- Uncontrollable negative thoughts and feelings
- Hyperarousal (jitteriness, trouble sleeping, lack of concentration, anger, irritability)
- Reckless driving, drinking, smoking, doing drugs
- Hopelessness, despair, shame, and anxiety
- Employment difficulties
- Relationship problems
What causes PTSD in veterans?
Also known as combat stress or shell shock, PTSD is the result of severe trauma or life-threatening events experienced during war. Symptoms can surface within hours or many months to years later. Is PTSD permanent? Untreated, the symptoms can possibly last a lifetime. The severity of the symptoms may wax and wane, typically increasing around the anniversary of the event. With treatments, such as exercise, mindful breathing, emotional reconnection, and support groups, PTSD symptoms may fade and the individual can lead a normal life.
How does PTSD contribute to substance abuse?
PTSD and substance use disorders frequently go hand-in-hand. People with PTSD are up to two to four times more likely to battle an addiction. Among veterans with PTSD, 27 percent also have a substance use disorder. In fact, PTSD, substance abuse, and addiction have a complex relationship that makes treatment challenging. The distressing symptoms of PTSD can lead a veteran to use drugs or alcohol as a temporary escape. The high levels of stress in veterans can make them turn to drugs and alcohol for relief. Access to prescriptions opioid painkillers for injuries sustained during combat predispose veterans to misuse.
Substance Abuse in Military Females
The relationship between substance use and combat stress varies by gender. Although women in the military report considerably lower heavy drinking compared to their male colleagues, the use of illicit drugs and tobacco is comparable for both genders. However, women have to deal with the additional stress of being a woman in the U.S. armed forces. The challenges of being a female in a traditionally male-dominated environment are predictive of the risk of illicit drug use. Are women in the military are more likely to abuse substances? Being a female in the military increases the chances of developing substance use problems because:
- Women report twofold higher rates of depression than men
- Women experience greater stress due to gender differences in coping mechanisms
- Nearly twice as many women report PTSD before entering military service than men
- Women may experience sexual harassment, sexual trauma, or fear of sexual assault
Female veterans report sexual assault or harassment at a rate of 10% to 30%, compared to 1% of male veterans.
Studies show that up to 10 percent of women veterans have alcohol use disorder and up to 16 percent of women VA patients have a confirmed diagnosis of substance use disorder. Women veterans with substance use disorders are more likely to have suffered childhood sexual abuse, military sexual trauma, domestic violence, depression, anxiety, PTSD, mental health conditions, and comorbid medical conditions. Moreover, death and suicide rates are higher in female VA patients with substance misuse.
Interestingly, the prevalence of heavy drinking, binge drinking, and substance use disorder is broadly similar in women veterans and non-veterans. Alcohol misuse and drug dependence re generally higher in men veterans than women veterans.
Life After Active Duty
United States service members deployed in war are at constant risk of injury and death. Returning home to friends and family is a happy circumstance. Yet, it is not easy to get back to normal life following a war. The transition to civilian life involves finding housing and employment. Veterans must also get used to the lack of military benefits and unit camaraderie.
The homecoming theory is a framework for understanding the stressors of reintegration into civilian society. Many veterans think of the military as their family and feel a sense of belonging with unit members due to shared experiences. Normal civilian life can feel alien to returning service members due to lack of structure, loss of purpose, and a sense of disconnection.
Some of the difficulties faced by service members returning home include:
- Debilitating psychological and physical ailments
- Active criticism of the war from which they have returned
- Changed family and personal circumstances
- Reconnecting and getting reacquainted with family and friends
- Readjusting to the civilian workforce and finding employment
- PTSD, depression, mental health conditions, traumatic brain injury
- Missing military life and unit support
- Feeling alienated or bored with mundane civilian life
Smoking Among Pilots
While the Federal Aviation Administration forbids alcohol use within a minimum of 8 hours of flight (known as “bottle to throttle”), this is only a guideline. A pilot is prohibited from flying with any blood alcohol level above 0.0%. Many airlines use the rule of 12 hours rather than 8. There is also a list of prescription drugs that pilots may take for genuine medical conditions. Smoking is permitted, and this can be an issue.
Smoking is not allowed on commercial or military flights. This can be an issue on long-haul flights because nicotine withdrawal symptoms have been shown to affect pilot judgment within 12 hours of cessation. This may not have been an issue in the days when smoking was allowed on flights, but that is no longer the case.
Smoking and substance abuse among pilots, both military and civilian, has some interesting ramifications.
Smokers have a higher level of carbon monoxide in their systems (up to 15% in heavy smokers, as compared to less than 0.5% in non-smokers), making their respiratory system much less efficient at carrying oxygen.
With such a high level of carbon monoxide, pilots are more susceptible to hypoxia (lack of oxygen to the brain) that can cause poor judgment, poor coordination, and in extreme cases, loss of consciousness. The effects of hypoxia are magnified at higher altitudes.
As well, the eyes need a tremendous amount of oxygen to function properly at night, and it has been demonstrated that the night vision of heavy smokers can be reduced by 40% when compared to that of nonsmokers.
As with the general population, smoking cessation among pilots reduces the risk of stroke and heart attack, COPD, cancer, and a host of other chronic (and not so chronic) illness. It can also cause many illnesses that can disqualify a pilot from flying. Smoking cessation has also been demonstrated to improve sleep and improve mental function, certainly an asset for any pilot.
What are the Symptoms of Veteran Substance Abuse?
Alcohol and illicit drugs produce temporary feelings of euphoria. It is this euphoric “high” that users crave. But as the effects of the substance wear off, so do the pleasant feelings. Users may experience depression, apathy, and listlessness. Chronic substance abuse alters brain chemistry and functionality, so long-time users may exhibit lasting behavioral and mood changes:
- Decreased interest in personal hygiene and appearance
- Abnormal behavioral responses
- Abnormal behavioral responses
- Unexplained weight loss
- Lethargy and excessive sleepiness
- Sores on the face or mouth
- Watery or red eyes
- Giving up cherished activities
- Withdrawing from company
- Secretive behavior
- Spending money without being able to account for the expenses
Addicts are often preoccupied with procuring the substances that they are addicted to. They spend a large part of the day consuming these substance and then dealing with the withdrawal symptoms and then getting another high. This is a vicious cycle. The addict has no inclination, interest, or energy left to engage in hobbies or interact with friends and family members.
Secretive behavior such as lying about consumption habits, hiding away the substance of abuse, or spending money without being able to provide a satisfactory explanation for the expenses are tell-tale signs of substance abuse.
However, symptoms like weight loss, insomnia, lethargy, or sores on the face or mouth can also be caused by some underlying physical disorder. So it always makes sense to investigate.
Dangers of Addiction in Military Men and Women
Military personnel struggling with the stress of deployments are at increased risk of substance abuse. Addiction is a major concern in the veteran community because it can have devastating consequences, especially when combined with illnesses and injuries from combat. Some of the dangers of addiction in military personnel returning home include:
The U.S. Department of Veterans Affairs reported a little under 40,000 homeless veterans in 2016, down from 76,000 in 2009. The majority of homeless vets are single males and suffer from alcohol and/or substance abuse and mental illness. About 70 percent of homeless vets have a substance use disorder. More than 10 percent of the homeless population in America are veterans who end up on the street due to lack of affordable housing, adequate income, and social support.
21% of veterans in substance use treatment were homeless in 2011.
Battling conditions such as PTSD and substance abuse and with insufficient training for the civilian workforce, service men and women are at a disadvantage when competing for jobs, leading to unemployment. According to the Bureau of Labor Statistics, there were about 370,000 unemployed veterans in 2017 with nearly 60 percent of them in the 25 to 54 age group. The good news is that unemployment rates for veterans have been declining over the years.
Research indicates a correlation between trauma, such as combat exposure or military sexual trauma, and the risk of suicide. Studies suggest that PTSD, which is common among veterans, is associated with suicidal behaviors. In fact, it is estimated that there is 1 suicide every 36 hours among members of the armed forces. Combat-related guilt for acts committed during war is a predictor of suicide attempts. Moreover, in addition to suicidal ideation, combat veterans with depression and PTSD are more likely to make fatal suicide attempts on account of their weapons training. PTSD treatment can help manage suicidal thoughts, but the key is ensuring that both clinicians and mental health professionals screen carefully for these conditions in veterans.
Veterans make up 20% of national suicides, with 22 veterans dying each day by suicide.
Veteran substance abuse has many devastating consequences. Poverty, homelessness, mental health conditions, and substance abuse all predispose an individual to criminal behavior. According to the Bureau of Justice Statistics, approximately 200,000 veterans are incarcerated in state and federal prisons, many for violent offenses. In addition, veterans with PTSD or traumatic brain injury are at an increased risk of death upon release from prison.
46% of veterans in federal prison were there for violation of drug laws, and 61% of all incarcerated veterans met criteria for drug dependence/addiction.
Addiction Treatment for Veterans
Many returning service members suffer from major depression, PTSD, traumatic brain injury, and suicidal ideation. In the last two decades, more than 2 million Americans have served in Iraq and Afghanistan. In addition, the VA provides care to vets from World War II, Korea, Vietnam, and the Persian Gulf War. More than 1,200,000 past service members received mental health care from the VA in 2010. Yet, only 50 percent of vets who need treatment for mental health conditions receive appropriate care. There is a need to increase capacity and provide additional training for the existing workforce providing mental healthcare to veterans.
Why do vets not ask for help? Some of the reasons why service members returning home hesitate in seeking help include:
- Shame or embarrassment over seeking mental health treatment
- Stigma associated with substance use disorders and addiction
- Lack of awareness about mental health and substance abuse issues
- Logistical challenges to obtaining care (accessibility and affordability)
- Concerns over the quality of care offered by the VA and lack of confidentiality
- Lack of awareness about eligibility
- Demographic barriers such as age and gender
- Long wait times
Where to Find Help for Veteran Substance Abuse?
- The Department of Veterans Affairs (VA) Medical Center: Every VA medical center has health officers who can diagnose SUD and suggest an appropriate course of treatment. In addition, SUD-PTSD specialist who is trained to recognize and treat the symptoms of both these conditions are available to help find the best treatment options in order to help give up on drinking or abusing drugs. Here treatment is provided under the Veterans Alcohol and Drug Dependence Rehabilitation Program. However, a veteran must be enrolled in the VA health care system in order to benefit from this program.
- Private Addiction Treatment and Rehabilitation Centers: Many veterans choose to seek treatment at private inpatient or outpatient facilities that offer anonymity and guarantee confidentiality.
- Addiction Counselor: An addiction counselor can help identify the best course of treatment. Some veterans may need to undergo detoxification before they can enter a rehabilitation center. The presence of co-occurring mental and substance abuse disorders may necessitate more specialized treatment, and an addiction counselor can help identify the proper course of treatment as well as a rehabilitation facility that is properly equipped to deal with both issues.
- Mental Health Counselor: The presence of a mental disorder in veterans increases their risk of developing SUD. Proper treatment of PTSD and other mental health issues can help avoid SUD.
Substance abuse is a pressing concern in war veterans and active duty military personnel. These individuals are especially susceptible to addiction due to their intense experiences during deployment and combat. There are many challenges and barriers to reducing the substance abuse in veterans who are often grappling with PTSD and reintegration into normal society. A number of interventions, including behavioral therapies and pharmacological treatments, can help military men and women with drug and alcohol problems.