It is well known that substance use disorders and suicide are significant problems among our nation’s military veterans. Many studies indicate that the rates of alcohol use, suicide, and PTSD are higher in Veterans than that of the non-Veteran population. Considering these alarming statistics, it is important that clinicians and federal policymakers identify targeted care options to help Veterans whom may be struggling with these issues. Here is what we know about the scope of the problem:
Fortunately, there are a number of services and interventions designed specifically to help reduce SUDs among Veterans. This includes behavioral health treatment facilities, pharmacological treatment programs, preventative screening measures, Alcoholics Anonymous, Narcotics Anonymous, and VA Medical Centers across the country.
Treatment Options for Veterans
One approach that the VA has implemented for Veterans utilizing their services is system wide alcohol screening. Known as the SBIRT Method, this process helps clinicians to identify and intervene on risky and unsafe alcohol habits before they progress into full blown disorders.
Created by the Substance Abuse and Mental Health Services Administration, the SBIRT method (Screening, Brief Intervention, and Referral to Treatment) has been linked to lower healthcare costs, lower rates of drug and alcohol misuse, and reduced risk of trauma.
The program includes outlines for addressing alcohol abuse, illicit drug abuse, tobacco use, depression, trauma, and anxiety. If we had a simple program like SBIRT that was universally accepted and implemented by institutions, we would have a way to identify and treat behavioral health issues before they turned deadly.
If there is an indication for and a willingness to seek treatment on the part of the Veteran, then a biopsychosocial assessment is completed by VA doctors, followed by the development and implementation of a comprehensive treatment plan. These treatment plans usually involve:
- SUD-focused pharmacotherapy
- Psychosocial interventions
- Cognitive behavioral therapy interventions
- Contingency management therapies
- Motivational interviewing
These types of interventions focus on identifying and changing harmful thoughts and behaviors that are associated with substance use, cravings, and relapse. While not specific to Veterans, this population could benefit from abstinence incentives, stress management practices, and behavioral interventions.
As the 18 - 34 demographic is the population most at risk for developing SUDs and the population least likely to utilize VA healthcare, researchers have begun to research alternative and novel methods of engaging these individuals in treatment. Web based interventions were found to be one effective means of engaging this population, at least according to one study utilizing Facebook and a sample of 784 Veterans.
PTSD and Substance Use Disorders in Veterans
PTSD is a relatively common occurrence in individuals who have experienced a traumatic event, whether that be exposure to combat, sexual assault, natural disaster, or childhood trauma. Veterans are at increased risk for experiencing PTSD due to their exposure to near death situations, the death of those close to them, and significant threats to their own and other’s lives.
Veterans may try to manage PTSD symptoms through self medication with drugs and alcohol. However, continued abuse of substances can gradually incur more harm in the long term, leading to the development of a SUD. Veterans struggling with dual diagnosis of PTSD and SUDs will need to find treatment that adequately addresses both issues.
Stats on PTSD/SUD Frequency for Veterans
Stats taken from National Center for PTSD
- Roughly 20% of Veterans seeking treatment for PTSD also have a SUD.
- Almost 1 out of every 3 Veterans seeking treatment for SUD also has PTSD.
- The number of Veterans who smoke nicotine is almost double for those with PTSD.
- In the Iraqi and Afghanistan wars, roughly 10% of returning veterans had a problem with alcohol or other drugs.
- Women with PTSD were 2.48 times more likely to meet criteria for alcohol abuse or dependence and 4.46 times more likely to meet criteria for drug use and dependence than women without PTSD.
- Men with PTSD were 2.06 times more likely to meet criteria for alcohol abuse or dependence and 2.97 times more likely to meet criteria for drug use and dependence than women without PTSD.
- The National Vietnam Veterans Readjustment Study found that 74% of Vietnam Veterans had comorbid SUD and PTSD diagnoses.
- From 2003 to 2013 the number of Veterans with comorbid SUD and PTSD in VA care increased more than three-fold.
The statistics indicate a dire need for us to advance our understanding and accessibility for treatment of dually occurring PTSD and SUDs. Currently, over half of individuals seeking treatment for SUD across the nation also meet the criteria for PTSD. Unfortunately, individuals diagnosed with both disorders have poorer treatment outcomes on average than those with one or neither. Individuals with both disorders also have additional psychiatric and functional problems related to medical, legal, financial, and social situations.
Treatment Options for Veterans with Dual Diagnosis
Many studies have revealed a number of promising treatment options for Veterans with dual diagnosis. There is no single approach that shows the most promise more so than traditional methods of treatment, but Veterans should still seek specially tailored help through a number of programs, including primary care and behavioral health as well as any setting such as outpatient, intensive outpatient, or residential. The important component of recovery in this instance is that shared decision making occurs between treatment providers and Veterans to determine the best suited path to recovery.
Several studies have shown promise in using structured psychotherapy to create positive outcomes for Veterans seeking dual diagnosis treatment for PTSD and SUDs. Veterans struggling with PTSD and SUDs could benefit greatly from trauma-centered, cognitive behavioral therapies such as Prolonged Exposure Therapy and Cognitive Processing Therapy. Research has also borne out results showing patients suffering from PTSD and SUDs who receive cognitive behavioral therapy for both disorders are more likely to reduce symptoms than patients who only receive treatment for one.
Medication Assisted Treatment
Several studies have found positive results for comorbid treatment involving the use of SSRIs (Selective Serotonin Reuptake Inhibitor) in addition to psychotherapy. Using a combination of Prolonged Exposure Therapy and Naltrexone was more effective in reducing drinking after residential treatment than either method separately. An important study on the use of benzodiazepines for Veterans with alcohol problems found no evidence of positive outcomes and could potentially create harmful effects.
Difficulties in Treating Veterans
According to the VA, there are as many as 3.4 million Veterans living in rural areas in the United States who are enrolled in the VA healthcare system. Access to healthcare, especially mental health services, can be problematic for Veterans living in rural areas. Advancements in technology such as Telehealth can improve the quality of life for rural Veterans by making access to medical services available everywhere.
Most People Do Not Believe They Need Treatment
Why would Veterans struggling with substance abuse issues not feel the need to get help? For one, it could be a lack of awareness about how severe their issues are. It could also be a lack of faith in the efficacy of clinical treatment. They may also feel like getting sober isn’t worth the effort and they would prefer to be high the rest of their lives.
There is a lack of adequate screening measures in place to monitor behavioral health, allowing many cases of addiction to go unnoticed and untreated. By incorporating vital screening measures for substance abuse, suicidal ideation, and other mental health indicators into more organizations,
Screening for substance abuse, suicidal ideation, and other mental health indicators is a critical step that healthcare systems and businesses can implement to begin saving lives. The Substance Abuse and Mental Health Services Administration has a specific outline known as the SBIRT method (Screening, Brief Intervention, and Referral to Treatment) that has been linked to lower healthcare costs, lower rates of drug and alcohol misuse, and reduced risk of trauma. School, businesses, and healthcare organizations can use this tool to help identify individuals at risk for suicide or developing a substance abuse disorder. The process is as follows:
- Screening: Involves screening patients on a regular basis using age-appropriate questionnaire
- Brief Intervention: Involves an intervention with patients that show at-risk behaviors by introducing feedback on their unhealthy behaviors while educating them about available tools and resources involved with substance abuse and suicidal ideation.
- Referring for Treatment: If a patient is considered at high risk, they are referred for further professional assessment and services.
Next Steps for Veterans Seeking Treatment
There are many different treatment options available if you are seeking treatment for co-occurring PTSD and SUD. The first step is to talk with a VA health professional, call the VA crisis line, or get in contact with a VA PTSD or VA SUD program. Fortunately, the VA Uniform Mental Health Services Handbook requires that all VA Medical Centers provide access to either Prolonged Exposure and Cognitive Processing Therapy for Veterans with PTSD. It also states that Veterans cannot be denied access to mental health residential treatment programs based on length of abstinence and that opioid replacement therapies such as methadone and buprenorphine also be made available. Here are resources you can access to begin finding treatment.
Find a VA PTSD Program
Find a VA SUD Program
Find a VA Medical Center
There also drug and alcohol rehab centers around the country that offer advanced cognitive behavioral therapies to treat substance abuse disorders. Call your nearest treatment center to find out what kinds of therapies they offer, and what options are available for you.
At Landmark Recovery, we do everything possible to make sure our patients receive the best possible care. We believe in creating a supportive network of love and access to resources that can help you break free from the chains of addiction. Visit our website to learn more about drug and alcohol rehab.