Substance Use Disorders (SUDs) are common among military veterans due to a variety of factors ranging from mental health struggles to military culture. The most prevalent SUD among them, however, is alcoholism or alcohol use disorder (AUD).
This article aims to provide more information on the pervasiveness of alcohol use disorder in veterans and what you can do to help if you or a loved one is struggling with alcohol or substance use today.
Although strict policies for the US military that were implemented in 1986, alcohol consumption, heavy drinking, and alcohol use disorders are the most prevalent form of SUDs among military personnel.
One study by the National Survey on Drug Use and Health even found that veterans were more likely to use alcohol (56.6%) compared to their non-veteran counterparts (50.8%) and more likely to report heavy use of alcohol.
Despite efforts by the Department of Veterans Affairs (VA) to reduce rates of SUDs and alcoholism in veterans, this number continues to rise which is particularly concerning since alcohol is the fourth leading cause of preventable death in the US population.
While 14.1 million adults ages 18 and older were found to be struggling with Alcohol Use Disorder (AUD) in 2019, 25% of soldiers who served in Iraq and Afghanistan were diagnosed with PTSD, depression, anxiety, or chemical dependency after returning home and 30% of Vietnam veterans were diagnosed with the same at some point of their lives.
Among veterans, specifically, studies have found that alcohol use in this group has an increased risk of interpersonal violence, poorer health, and mortality.
Fortunately, there is an increasing amount of interest and information on how best to treat veterans with alcohol use disorders. Alcohol counselors are now able to work with veterans one-on-one to identify signs of PTSD and provide them with the subsequent tools necessary for preventing future triggers that may lead them to alcohol overconsumption.
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), alcohol use disorder (AUD) is a medical condition where one has an impaired ability to control or stop alcohol use despite the negative consequences it has on their social life, professional life, or personal health. The colloquial term “alcoholism” is often used to describe the conditions that encompass AUD. Other terms often used interchangeably when talking about AUD are alcohol abuse, alcohol dependence, and alcohol addiction.
AUD is classified as a brain disorder and can be considered mild, moderate, or severe in nature. As a brain disorder, AUD has also been found to be responsible for lasting changes in the brain caused by alcohol misuse. These changes can even make individuals even more vulnerable to relapse; leading to greater tolerance for alcohol and an increased risk of alcohol dependency.
Because alcohol consumption is often used to suppress traumatic events or numb associated triggers, veterans and those who have experienced traumatic experiences such as combat are particularly vulnerable to AUD.
The safest and most effective way to overcome alcohol use disorders is to seek professional help from an alcohol treatment center or specialist who can provide the tools needed to overcome this disorder.
Heavy alcohol consumption has long been considered a social and cultural norm for military personnel when it comes to stress relief, socialization, and recreation. It is also no surprise that this particular group turns to such substances to alleviate seemingly insurmountable feelings of stress and trauma due to high levels of combat exposure.
One study revealed that those who experienced high levels of combat exposure were at a higher risk of problematic alcohol use and heavy and binge drinking compared to other military personnel.
On the highest end of those who experienced high levels of combat exposure, 26.8% were more likely to engage in heavy drinking, 54.8% were more likely to engage in binge drinking relative to 17% and 45% of other military personnel, respectively.
The likelihood of one developing an AUD partially depends on the amount, frequency, and pace at which alcohol is consumed.
In addition to genetics and family history, one characteristic that increases the risk of developing an AUD is a history of trauma. Depression, post-traumatic stress disorder, and combat stress disorder are all co-occurring with AUD and are associated with an increased risk of AUD. The veteran community in particular is susceptible to these conditions as a consequence of what they may experience while in combat.
The unique factors associated with military service, military culture, deployment, and trauma exposure cause this group to be more vulnerable to alcohol use disorder. These experiences also contribute greatly to this population experiencing psychological struggles such as post-traumatic stress disorder (PTSD). PTSD is a severe anxiety condition that generally occurs as a result of extreme events. For military personnel, service members, and veterans, these extreme events could be witnessed during combat such as gunfire, major injuries, and explosions. Although the symptoms of PTSD may reveal themselves shortly after a traumatic event occurs, this disorder can take years to properly diagnose.
The co-occurrence of PTSD and AUD in military and veteran populations is important to consider because of the negative implications which exist due to the health and well-being of veterans and active-service duty members.
Having PTSD or AUD increases the likelihood of experiencing the other, and in national studies, 55% to 68% of veterans with probable PTSD showed evidence of having AUD as well, compared to 40% to 55% of veterans without PTSD.
The risk for both PTSD and alcohol abuse or misuse among veteran populations may vary because of differences in demographics, trauma, or stress exposure. There is little research, however, that examines risk factors for co-occurring PTSD and AUD, so we do not know the extent to which these factors may increase the risk for one disorder or both.
It has also been noted that in recent years, rates of problematic substance use among female veterans have been on the rise. SUD diagnoses among female veterans using VA services have increased by 81% from 2005 to 2010 and many women feel uncomfortable coming to the VA to seek treatment.
Additionally, female veterans with SUDs have been found to have higher rates of childhood sexual abuse, military sexual trauma, and domestic violence than female veterans without SUDs. The perceived stigma and shame associated with being a female substance user may contribute to female veterans feeling less comfortable with seeking help as well.
It is essential for providers to remain aware of women’s minority status within the military and the VA and to handle these women’s cases with compassion and sensitivity.
Healthcare professionals use the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to assess whether a person has AUD and to determine the severity of the disorder, if present.
In the assessment of symptoms, healthcare professionals may ask some of the following questions:
In the past year…
In total there are 11 questions that may be asked at any given time to assess AUD symptoms. If you or a loved one is experiencing more than one of these symptoms above, learn more about a further assessment and how alcohol treatment might be for you.
The DSM-5 uses the symptoms above as the metric for diagnosing and treating AUDs in veterans. Similarly to AUDs, the DSM-5 defines SUDs as a pattern of substance use that results in evident distress and/or impairment.
In diagnosing veterans for SUDs and AUDs healthcare professionals will ask if two or more of the following symptoms have been experienced over a 12-month period:
There are a number more questions asked during the assessment. Those above are only a small sample. To learn more about the diagnostic process of alcohol use disorders and substance use disorders reach out to your healthcare provider today.
There are numerous effective resources and interventions available for veterans when it comes to seeking help with AUDs. Veterans of all backgrounds, ages, and eras have been able to find the support they need when it comes to treatment for alcohol problems and long-term recovery.
Many treatments include pharmacological and behavioral therapies to help veterans struggling with AUDs. Evidence-based psychotherapies and behavioral interventions often involve short-term, cognitive-behavioral therapy (CBT) interventions that focus on maladaptive thoughts and behaviors associated with increased craving, use, or relapse to alcohol. These therapies may help reduce AUDs by helping to incentivize individuals to achieve and maintain their abstinence or improve their ability to successfully manage stress without substances.
In addition to behavioral and psychotherapies, pharmacotherapy can play an important role in the treatment of AUDs. Certain medications can help reduce withdrawal symptoms experienced during the detoxification stage of treatment, a stage that serves as a trigger for some to relapse. These medications can also help in decreasing ravings as well.
The three medications approved by the US Food and Drug Administration (FDA) for alcohol use disorders are:
For veterans who would like to seek help treating their alcohol abuse, there are numerous treatment programs available to veterans through VA Medical Centers (VAMC) throughout the country. Many veterans, however, are not connected through their local VAMC and even when they are connected they may face challenges accessing care.
In addition to pharmacological and behavioral treatments, veterans with AUDs are encouraged to engage with free self-help groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), available in most cities. These groups can provide veterans with ongoing care to help manage AUDs after treatment at a facility.
If you or a loved one is struggling with substance abuse or alcohol use disorders, you’re not alone. Veterans all over the world and across the united states are struggling with the use of alcohol and more. We’re here to help and are in the community care network. Reach out to a member of our admissions team today to find out if treatment is right for you and begin your road to recovery.
NIH, National Institute on Alcohol Abuse and Alcoholism–Understanding Alcohol Use Disorder
Teeters JB, Lancaster CL, Brown DG, Back SE. Substance use disorders in military veterans: prevalence and treatment challenges. Subst Abuse Rehabil. 2017 Aug 30;8:69-77. doi: 10.2147/SAR.S116720. PMID: 28919834; PMCID: PMC5587184.
Dworkin ER, Bergman HE, Walton TO, Walker DD, Kaysen DL. Co-Occurring Post-Traumatic Stress Disorder and Alcohol Use Disorder in U.S. Military and Veteran Populations. Alcohol Res. 2018;39(2):161-169. PMID: 31198655; PMCID: PMC6561402.