Studies show that PTSD and substance abuse disorder are strongly related, especially in veterans. If you’re a veteran and you think you may have a substance abuse problem, this is the post for you. If you know a veteran and are concerned with their drug or alcohol use, this post can help you too.
Today, we’re going to tackle a complex question: why do so many veterans turn to drugs and alcohol?
We’re also going to explore the role played by prescription drugs, and we’ll take a deep dive into substance abuse disorder itself. You’ll learn the difference between tolerance, dependence and addiction, and you’ll learn to recognize signs of substance abuse disorder.
Let’s get started.
Why Do Some Veterans Use Drugs and Alcohol?
Many men and woman who have served in the military struggle with drug or alcohol addiction. Experimentation with drugs or alcohol may begin as a coping mechanism. Military life—especially life once deployed into an active combat zone—can be extremely stressful. Drugs may provide a short-term escape from the stresses of everyday life.
In addition, soldiers who have returned home from active duty may struggle with issues that cause them persistent psychological stress. Some individuals turn to drugs or alcohol, or both, as a way to escape these stressors. Further, veterans may have co-occurring disorders, such as PTSD or depression, which complicate matters. For instance, a veteran struggling with depression is more likely to self-medicate with alcohol or drugs. The term ‘self-medicate’ in this context means to alleviate symptoms using whatever tools available, without the supervision or approval of a doctor or mental health specialist. This can lead to substance abuse.
Many veterans struggling with addiction also have post-traumatic stress disorder. This disorder was once referred to as ‘shellshock’ This term was popular during World War One. Later, another term was used: battle fatigue. Once mental health professionals came to understand more about how traumatic events can impact brain function, they began to use the term post-traumatic stress disorder. PTSD can result from:
- Witnessing a particularly stressful, traumatic or horrific event, such as battle
- Sexual abuse
- Any sufficiently traumatic event
Most veteran-related cases of PTSD are caused by combat. However, around 22 percent of female veterans report having been sexually assaulted during their service. Indeed, while female military members make up only around 14 percent of the U.S. military, they are much more likely to experience sexual abuse during their service than are their male counterparts. This means that though they are fewer in number, they make up a disproportional number of sexual abuse cases.
Sexual assault is extremely traumatic by itself, but the issue is compounded by the fact that many such assaults are the result of an abuse of power and violation of trust. That is to say, they are often perpetrated by a superior officer on a junior officer. This can leave the victim with conflicting emotions.
On the one hand, there is the desire to see justice done. On the other, there is a desire to avoid rocking the boat, which may stem from wanting to fit in and be accepted. Victims in this situation may even suffer a form of Stockholm syndrome. This conflict creates cognitive dissonance, and the result can be unresolved trauma once military service is over and they return to civilian life.
Some symptoms of PTSD include:
- Trouble starting or maintaining relationships
- Misplaced aggression
- A feeling of hopelessness
- Intense flashbacks
- Problems with memory
- Low self-esteem
- Trouble sleeping
- Trouble concentrating
- Self-destructive behavior
Many of these symptoms come and go, and their intensity can vary by circumstance. However, they tend to present after a specific trigger. For instance, for an affected veteran, hearing a car backfire may trigger flashbacks of gunfire, which can in turn trigger other symptoms of PTSD, such as aggression, hopelessness and trouble sleeping.
Around 25 percent of veterans struggling with PTSD also struggle with substance abuse.
Veterans are more likely than the overall population to have chronic pain—from injuries sustained in the line of duty. Many prescription pain killers are habit-forming. What’s more, doctors often prescribe anxiety medications to veterans struggling with PTSD. Many of these are also habit-forming, though some, like Paxil and Zoloft, are not.
Habit-forming medications frequently prescribed to veterans include:
- Vicodin, OxyContin & Lortab.
- Ambien, Lunesta
- Valium, Xanax, Ativan
Veterans taking these drugs may develop tolerance and dependence, and that can lead to addiction. This means that they may also suffer withdrawal symptoms when they try to stop. Dealing with withdrawal symptoms while struggling with depression or PTSD is difficult and can contribute to the development of substance abuse.
What is Substance Abuse Disorder?
As mentioned, some veterans try to cope with PTSD, depression or general anxiety by drinking, smoking or taking drugs. However, substance abuse can lead to substance abuse disorder. Substance abuse disorder can, in turn, lead to a downward spiral that can leave a vulnerable veteran in a bad place, such as jail, or a desperate situation, such as homelessness.
It’s important to differentiate between tolerance, dependence and addiction.
Unfortunately, the media and television often use these terms interchangeably, leading to confusion. Tolerance, dependence and addiction are not different names for the same thing. You can think of two of the terms, tolerance and dependence, as stops along the way to addiction and substance abuse disorder. Indeed, knowing the proper use of these terms can give you a stronger understanding of the dangers of addictive substances.
The first thing to know is that tolerance and dependence are physical processes that occur in the brain and body. Addiction, on the other hand, is a term professionals use to refer to the need to engage in potentially self-destructive or anti-social behaviors in order to use a drug.
Addiction isn’t just about using a drug habitually. It’s a disorder that causes compulsive drug use, and the person often can’t stop on their own, even if they want to. This, naturally, can lead to the aforementioned self-destructive and anti-social behaviors. Drugs that cause tolerance and dependence have the potential to cause addiction.
Veterans are as susceptible to addiction as everyone else is, if not more so.
What is Tolerance?
Many drugs, like cannabis and cocaine, produce a high or euphoric state by hijacking the brain’s reward pathway. Typically, they do this by forcing the brain to release the feel-good chemical dopamine. Over time, the brain resists this by becoming less sensitive to dopamine.
Another way to think of this is to say that, over time, a person’s reaction to a drug will become dampened, or diminished.
If you’ve ever heard someone lament that their prescription pain killer ‘doesn’t work anymore,’ they may have developed a tolerance to it.
This can be particularly problematic for veterans with PTSD, as they are likely struggling with anxiety and other symptoms of the condition. If their pain medication stops working, they may take a higher dose than usual in order to make the drug work again.
There are two primary types of tolerance:
- Acute, or short-term tolerance results from repeated, short-term exposure to a drug. For instance, cocaine produces an intense high, but this intense high causes people develop tolerance to cocaine quickly. As a result, they begin taking more cocaine to get the high they’re accustomed to.
- This type of tolerance is the result of long-term drug use. This is common in people who rely on opioid pain killers. At first, the drug is like a miracle. But slowly, over time, the dose no longer has the same effect. Affected individuals may increase their dose without the approval of their doctor. This can lead to ‘doctor hopping,’ or frantic consults with new doctors so they can secure other prescriptions.
What Is Dependence?
Although the terms dependence and addiction are often used interchangeably, they are not the same thing. Dependence is a fairly predictable consequence of tolerance, though tolerance alone does not always lead to addiction, or substance abuse disorder.
What’s more, some people who develop dependence on a substance can lead relatively normal lives, while many people who develop substance abuse disorder see their lives fall apart without treatment.
Finally, the term dependence has a specific meaning in medical literature. Dependence denotes a physical condition in which the body adapts to the frequent presence of a drug. Cessation of the drug causes withdrawal symptoms.
Put another way, something that shouldn’t be there, is there, and it is having an effect on the body, so the body must adapt to its presence. Many drugs are central nervous system stimulants. The body adapts to them by becoming dependent on them. The body comes to rely on the drug to tell the nervous system when to be more active. If the person stops taking these stimulants, they’ll experience withdrawal symptoms because the brain now thinks of the stimulant as essential.
Let’s look at another example.
This time, we’ll look at prednisone, which is a synthetic hormone that mimics cortisol. When a person takes prednisone consistently over a long period of time, the body adapts by downregulating its own production of cortisol. So, if the person stops taking the medication, the body complains because it no longer has its own supply of the hormone cortisol. The result is withdrawal.
This is why people are well-advised to stay away from addictive drugs. Not because drugs are ‘bad.’ But because they change how the brain and body works at a fundamental level. Once those changes occur in the brain, nothing the person does will reverse them entirely. The good news is that the individual can learn coping strategies.
Drug dependence itself is a treatable condition. The process requires the affected individual to taper down their drug use, ultimately stopping altogether. This process is known as detoxification. Detoxification is best done with medical supervision in an accredited rehabilitation facility. Moreover, research shows that detox alone is not enough. Individuals who don’t participate in drug treatment programs after detox are more likely to relapse than those who do. This includes veterans.
What is Addiction?
Addiction is a chronic condition in which the person compulsively seeks and uses a drug despite harmful consequences. This means that they’ll seek and use a drug even if it creates problems in:
- Existing relationships
Drug addiction may also result in:
- Legal troubles
- Financial troubles
- Health troubles
Because of chemical dependence, the addicted brain views obtaining and using the drug as a priority. To the addicted individual, then, securing a supply of the drug and a safe place to use it can feel like a matter of life and death. This is what leads to some of the anti-social behaviors associated with heavy drug use.
Also, keep in mind that many addictive drugs strongly stimulate the pleasure center of the brain. As addiction progresses, the affected individual begins to associate pleasure more and more with the drug and less and less with other pleasurable activities. This means that getting high is one of their main sources of joy. Complicating matters is the fact that when they’re not high, they spend a good deal of time feeling guilty for things they did while high.
Not everyone who uses an addictive drug will become addicted, or develop substance abuse disorder. There are a number of factors that influence your risk. These are:
- Genetic makeup
- Drug accessibility
- Age at which drug abuse began
- Socioeconomic status
- Family or home environment
To adequately treat addiction, you should seek medical attention. In addition to detox, rehab facilities can provide behavioral counseling and access to long-term support groups.
If you’re a veteran struggling with addiction, don’t underestimate the utility of behavioral counseling. These sessions aren’t just about sharing your past traumas with a therapist. They teach you powerful therapy modalities that can help you cope with triggers and withdrawal symptoms as they arise. Cognitive behavioral therapy, for instance, can help you identify and deal with thought distortions that can affect your behavior.
Once you have gone through detox, you’ll need these coping mechanisms.
When to Seek Help
If you’re a veteran struggling with PTSD and substance abuse disorder, you should seek help right away. The earlier you start treatment, the faster you can get a grip on addiction. Detox and the aforementioned therapy modalities can help you control your addiction, so you aren’t controlled by it.
If you’re unsure whether you should seek help, ask yourself the following:
- Do you think about using drugs a lot?
- Have you ever tried to stop or cut down, but weren’t able to? Even if you could justify it to yourself?
- Have you ever thought you couldn’t fit in unless you were under the influence of drugs or alcohol?
- Do you ever use drugs because you’re very upset at other people? Do you rely on these drugs to get along with others?
- Have you ever taken one drug to combat or counter the effects of another drug?
- Have you ever used a prescription drug that your doctor did not prescribe for you?
- Does the thought of running out of your drug scare you?
- Have you ever broken the law to get more drugs?
- Has drug use ever landed you in jail?
- Has drug use ever threatened your finances?
- Has drug use resulted in the loss of a relationship that was important to you?
If any of these apply to you, you should consider seeking help.
What If My Friends Think I’m Fine?
As a veteran, it’s only natural to seek the company of others who understand what you might be going through. But sometimes, relying on this for social interaction can be risky. For instance, if you’ve raised the possibility that you might have a substance abuse problem to your fellow veterans, some of them may be quick to assure you that you don’t have a problem. They want you to feel better, not worse, so they give you reassurance.
But if this happens, you should ask yourself a few questions.
- Does this friend also use drugs or alcohol? If so, it’s possible they’re afraid you’ll stop, which means they’ll have one less person to do drugs with.
- Did you recently reveal to them that you abuse drugs? If so, they may be struggling to absorb the information and may be in denial. They may look up to you and may not be able to fathom that you could be susceptible to addiction.
- How would you feel if the situation were reversed? How comfortable would you be telling them that they might have a problem? Your first instinct—especially if you served together—may be to comfort them, not to tell them hard truths.
Summary: don’t rely on your friends to be objective or completely honest. While it isn’t malicious on their part—it may be entirely subconscious behavior—your friends may assure you that you don’t have a substance abuse problem.
If you’re currently struggling with addiction, and you’ve never been through detox before, your first priority should be seeking the help of an accredited rehabilitation facility. After that, there are several therapies that can help you. The good news is, treating one condition often aids the other.
Trauma-focused psychotherapy has proven effective for PTSD in many individuals. This includes modalities such as Cognitive Processing Therapy, Prolonged Exposure as well as Eye Movement Desensitization and Reprocessing.
For substance abuse disorder, look to relapse prevention, cognitive behavioral therapy, and COPE.
We hope that this post has been helpful in identifying whether you or your veteran friend may have a substance abuse problem. If it has, share it with someone that you think needs to read it!
If you’re trying to get addiction treatment for yourself or for someone you love when it comes to PTSD and substance abuse, reach out to The Hills for comprehensive and caring treatment that will help patients detox and learn the skills to cope with their triggers and their addiction.