Substance Abuse and Addiction in US Veterans

With the war in Iraq over and the war in Afghanistan coming to an end, more and more of the United States Armed Forces are coming back home. Unfortunately, many troops face a tough return because they have developed physical and mental illnesses, the most common of which are Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI). These kinds of disorders, as well as some of the medications prescribed to treat symptoms, can contribute heavily to substance abuse and addiction. The steadily increasing rate of substance abuse and addiction in veterans has produced a number of clinics and special programs to successfully provide counseling and treatment. Government programs such as SAMHSA and ACSAP, as well as privately run Phoenix House, Freedom Care, Veterans Healing Initiative and VETcare offer a variety of treatments for veterans suffering from substance abuse and addiction.

Statistics  

The military has had issues with substance abuse, suicide and alcoholism for some time, but recently there have been reports of a significant increase in these problems. Studies have shown that reasons for the increase have to do with the lengthy or multiple deployments, as well as a higher rate of combat exposure, in the Iraq and Afghanistan wars. The U.S. Department of Veterans Affairs states that more than two out of every ten veterans with PTSD suffer from substance abuse problems (“PTSD and Substance Abuse in Veterans,” 2011). Additionally, one out of every three veterans being treated for substance abuse problems has PTSD. Furthermore, suicide rates increased eighty percent from 2004 to 2008 in the Army alone (Castillo, 2012). Just recently the numbers increased to over one suicide a day in July, which results in a twenty-two percent increase from last year (Burns, 2012).

According to a study done by the National Institute of Drug Abuse (NIDA), “prescription drug use doubled among U.S. military personnel from 2002 to 2005 and almost tripled between 2005 and 2008,” (“Substance Abuse among the Military,” 2011). Additionally, a 2009 policy brief released by the Drug Policy Alliance stated, “approximately 30 percent of Iraq and Afghanistan War veterans report symptoms of PTSD, TBI, depression or other mental illness or cognitive disability,” (“Healing a Broken System,” 2009). The Drug Policy Alliance report also mentioned that the increase in substance abuse contributes significantly to the number of veterans serving prison time; “46 percent of veterans in federal prison were incarcerated for drug law violations.” These statistics mirror the undeniable fact that U.S. veterans need to receive better and more preventative care when they come home.
What are PTSD and TBI?

PTSD is a large contributing factor to alcohol and substance abuse in U.S. veterans. The disorder can develop in many ways, such as combat exposure, sexual or physical abuse or assault, terrorist attacks, natural disasters and severe accidents. Symptoms include flashbacks, nightmares, feeling emotionally numb, depression, insomnia and feelings of being on edge. While these symptoms would be somewhat normal for someone who had experienced a traumatic event, PTSD is usually the diagnosis when symptoms persist for over three months and begin to interfere with daily life. The National Center for PTSD puts the rate of PTSD in Iraq and Afghanistan veterans at 11-20%, and in Vietnam veterans at 30% (“How Common is PTSD,” 2012). Without timely treatment by professionals trained in helping veterans, substance abuse can become a crutch for veterans suffering from PTSD.
TBI is a physical injury that can have long-term or short-term effects on the brain. A TBI occurs when an object hits the head with a significant amount of force. This could occur through something as regular as a car accident as well as more combat oriented accidents like shrapnel entering the brain or an IED explosion. The effects of a TBI can include emotional and behavioral changes, changes in the senses, trouble speaking and an inability to concentrate. A combination of TBI and another disorder such as PTSD is known as “polytrauma” and can require an astonishing amount of counseling, treatment and care (“Understanding Traumatic Brain Injury,” 2011). Veterans suffering from TBI can have chronic pain as well, which is oftentimes a catalyst for substance abuse because of the various painkillers prescribed.

Alcohol Abuse  

Alcohol abuse in the military can stem from a variety of factors. Veterans suffering from PTSD are likely to binge drink to offset symptoms or any triggers that could bring on a flashback or nightmare. Because some of the symptoms of PTSD and TBI can be loss of sleep and chronic pain, veterans can use alcohol as a tool to self-medicate. Troops coming back from deployment can also face relationship issues and difficulty adjusting to life at home, problems that they feel alcohol may distract them from.
According to a study done by the American Journal of Preventative Medicine in 2005, over forty-three percent of active-duty military personnel reported “past-month binge drinking, resulting in 29.7 episodes per person per year,” (Stahre et al., 2009). Heavy drinkers alone counted for almost twenty percent of all active-duty military personnel. The study concluded that binge drinking was common and that a significant amount of it was reported in underage soldiers.

Additionally, the report issued by the NIDA referenced a study in which Army soldiers were screened for alcohol abuse three to four months after returning from deployment. Twenty-seven percent were shown to have alcohol abuse problems and increased risk of harmful behaviors such as driving under the influence and drug usage (“Substance Abuse among the Military,” 2011). Unfortunately, the result of drinking and driving for a lot of veterans has been arrest. The aforementioned Drug Policy Alliance report stated that, of 140,000 veterans incarcerated in federal and state prisons in 2004, more than twenty-five percent had been drunk when arrested.

Drug Abuse  

As the cases of drug abuse continue to rise here at home, it is no wonder that cases are becoming more prevalent within the military as well. Opioid analgesics are often prescribed for veterans with TBI and chronic pain, while veterans suffering from PTSD are given a variety of anti-depressants. Obviously, this can pose a serious problem to preventing substance abuse in veterans with polytrauma.
Unfortunately, even though veterans with polytrauma have a higher risk of succumbing to substance abuse, they are twice as likely to be prescribed addictive pain medication as veterans only suffering from chronic pain. Veterans who had previously had substance abuse problems are actually four times as likely to be prescribed those medications as veterans without a history of mental health problems. This astonishing information was the result of the first national study conducted on the subject of substance abuse in the military, according to CBS News (“Study: Veterans with PTSD,” 2012). 

The study was published in the Journal of the American Medical Association and used a sample of 141,029 men and women who were “veterans of the Iraq and Afghanistan wars . . . diagnosed with non-cancer physical pain,” (Seal et al., 2012). 15,676 of those veterans were receiving opiate prescriptions.

The study concluded that the reason why veterans with a high risk of substance abuse are more likely to receive these medications is not a single one. One reason is that physicians hope the emotional stress often combined with chronic pain will be alleviated as well though the use of opioids. Another reason is that some primary care physicians who have a short time to see patients exhibiting high levels of distress will prescribe opioids without aligning the medication with other treatments such as therapy, or they will not be cautious enough to worry about the risks of habit-forming or substance abuse in the medications they are providing. The main problem throughout both these examples is that professionals lack the experience and training to successfully help veterans.

Additional Factors  

Another important factor that can contribute to substance abuse and addiction in veterans is Military Sexual Trauma (MST). MST refers to any sexual assault or harassment experienced by military personnel while serving, whether in the United States or on deployment. According to a fact sheet provided by the United States Department of Veterans Affairs, “1 in 5 women and 1 in 100 men respond ‘yes,’ that they experienced MST” (“Military Sexual Trauma,” 2012).

Experiences that can occur as a result of MST include some of the same symptoms shown in PTSD patients; depression, emotional numbness, nightmares, trouble sleeping, inability to focus and substance abuse. Additionally, veterans who have experienced MST may have an increased risk of relationship problems, feelings of severe mistrust, feelings of isolation and even eating disorders.       
What Can Be Done?

To combat the steadily growing rate of drug and alcohol abuse in the military, it is important to make sure that veterans are aware of the options available to them when they come back from deployment. Aside from the numerous centers for treatment specifically available to provide care for veterans, there are treatments and preventative measures that can be taken to decrease the amount of substance abuse cases in the United States Armed Forces.

According to Elements Behavioral Health, a company affiliated with rehabilitation centers such as Promises and The Ranch, a big problem for returning military personnel is the lack of available counselors and physicians who are trained to understand and sympathize with aspects of military life (“Counselor’s Lack of Military Knowledge,” 2012). Elements references a report issued by the Substance Abuse and Mental Health Services Administration (SAMHSA) in which veterans “feel a disconnect between themselves and their counselors due to their unfamiliarity with daily military life, routines, and language.” By seeking care in a facility designed to take care of them, veterans can ensure that they are getting the best and most appropriate treatment from a place that understands them. This solution is echoed in the study published by Seal et al. in the Journal of the American Medical Association.

In relation to drug abuse, prescription drugs should not be prescribed as the only solution. Another article Elements Behavioral Health released mentions successful methods of treatment for those suffering from PTSD and addiction include “medication, cognitive behavioral therapy, group therapy and exposure therapy,” (“A New Standard,” 2012). The Journal of the American Medical Association study upholds the idea of multiple treatments, stating in their conclusion that “These patients may benefit from biopsychosocial models of pain care including evidence-based nonpharmacologic therapies and nonopioid analgesics” and that “Integrated treatments that target both mental health disorders and pain simultaneously are effective for both problems and may decrease harms resulting from opioid therapy” (Seal et al., 2012).       
Where Can Veterans Get Help?

There are many facilities and programs available specifically to treat veterans with a variety of physical and mental health issues. While some are funded and run by the government, there are others that are private organizations. Some facilities are not strictly for veterans, but they feature many programs geared towards military personnel and their families.

The Substance Abuse and Mental Health Services Administration, also known as SAMHSA, is a government-run organization that had its twentieth anniversary this year. According to their report detailing programs and future plans, the “Military Families Strategic Initiative” plans to “foster access to evidence-based prevention, treatment, and recovery support services for military service members, veterans, and their families at risk for or experiencing mental and substance use disorders” (“Leading Change,” 2011). Additionally, they assure that their workforce under the Military Families program consists of practitioners who are “well trained in the culture of the military and the military family and the special risks and needs that impact this population.” For more information about their programs and to get assistance, visit www.samhsa.gov.
Another government organization, called the Army Center for Substance Abuse Programs or ACSAP, is primarily run through the military. They provide guidance on non-clinical drug and alcohol issues, oversee testing programs related to substance abuse in the military and provide training, education and prevention services for soldiers. Their website consists of many informational tools regarding tests, laws, regulations and facts. They also provide information about their local centers where veterans and active-duty soldiers can get help for substance abuse issues. For more information, visit http://acsap.army.mil.

Private organizations such as Freedom Care and Veterans Healing Intiative (VHI) are dedicated to providing specialized care for veterans. Freedom Care has a variety of programs specifically for issues such as combat trauma, behavioral pain management, addiction, specialized women’s services and services for military children and wives. The key staff members at Freedom Care have military backgrounds and they even consult military prescribers in relation to medicinal decisions. Additionally, they also offer transportation to and from local bases and airports. VHI is a non-profit organization that works as a network for treatment programs, especially for veterans without insurance or VA benefits. Their affiliated programs include Samaritan Village, La Paloma, Loyola Recovery Foundation and Grace After Fire, a center specifically for women veterans. Their programs treat many issues prevalent in veterans, including combat trauma, sexual assault, depression and substance abuse. For more information about the programs offered through Freedom Care or VHI, visit www.freedomcare.com or www.vetshealing.org.
 
Phoenix House is a non-profit organization providing care for people suffering from substance abuse and addiction through 123 programs in ten states. They offer both outpatient and residential facilities through the Military Services Program in the Brentwood and Jack Aron Centers, with specific emphasis on treating PTSD and working towards suicide prevention. Like other treatment centers, Phoenix House staff members are trained to meet the needs of veterans and understand military-specific issues like PTSD and readjustment to being home. For more information on Phoenix House, visit www.phoenixhouse.org.

For veterans with substance abuse problems looking for residential settings, the Illinois based organization Hope for Tomorrow has created a program called U.S. VETcare. VETcare offers recovery homes for veterans of any gender, with in-house support groups, treatment and education services, peer mentoring and PTSD-specific counseling. According to an article in the Chicago Tribune, “residents are required to work and to complete daily household chores. They must attend five counseling meetings each week and are subject to alcohol and drug testing” (LaTour, 2011). There are rules and regulations at the recovery homes for veterans, but founder Jeff Gilbert stated last year that eighty-five to ninety percent of residents reported having the “longest and best” period of sobriety while going through the VETcare program. For more information about VETcare and Hope for Tomorrow, visit www.hopefortomorrow.net.
   
One Soldier Speaks Out

A U.S. Army Sergeant, who wishes to remain anonymous, is twenty-four years old and has seen two tours in Iraq and Afghanistan, respectively. “The first was eleven months, the second thirteen,” he says, in regards to his tours during the Iraq and Afghanistan wars. Though his base during both tours didn’t see a lot of combat, he says “there’s no point at which you can turn off the switch and relax.” Threats could come any time, from anywhere, even from friendly-fire by allies. He mentions that his base was attacked at least two or three times a month. 

When asked about substance abuse and addiction, the Sergeant had some stories to tell. He admits that “There was a lot of drinking behind the scenes. We even made our own [alcohol] at one point.” Aside from making their own alcohol, soldiers could acquire alcohol and drugs from the locals. The Sergeant mentions that there were several soldiers he knew of that were drinking “all the time,” and that he wasn’t sure if it was the stress of the job or of being away from home.

Some of the things that combat-oriented troops see on deployment can be horrific, but apparently coming back home can be just as terrifying. “Most people don’t know that returning home can be harder than being away, and people start using [drugs] when they get home,” the Sergeant mentions. A solider in his unit committed suicide one week before they were homebound, he recalls, as he confesses that “Personally, I can handle being over there better than being back.”

According to the Sergeant, the Army offers many resources for substance abuse and mental health; “We sit through hours of briefings and presentations on things like substance abuse programs, clinics and hotlines.” Unfortunately, the problem is that not everyone with substance abuse or addiction problems asks for help. “I’ve had two friends overdose,” the Sergeant says, “good soldiers who witnessed more than they could handle on their own.”
When asked about possible solutions to the rising rate of PTSD and substance abuse in the military, the unnamed Sergeant was optimistic. “Without watching someone 24/7, there’s no way to completely prevent people from using and abusing,” he says, “but I believe it would be a start to shorten the Army tours to six months.” He mentioned that the Army has the highest rate of PTSD and is also the only branch of the military that deploys soldiers for combat tours lasting more than six months. In relation to those who already have substance abuse and addiction problems, he says, they just have to be “willing to ask for help.” 

References  

“A New Standard in Treating PTSD and Addiction.” Elements Behavioral Health. 2012. http://www.elementsbehavioralhealth.com/trauma-ptsd/treating-ptsd-addiction/
“Army Probes Drug Use By Soldiers in Afghanistan.” NY Daily News. April 21, 2012. http://articles.nydailynews.com/2012-04-21/news/31380108_1_drug-overdoses-army-reports-soldiers
Burns, Robert. “Military Suicide Rate Surges to Nearly One Per Day This Year.” Huffington Post. June 7, 2012. http://www.huffingtonpost.com/2012/06/07/military-suicide-surges-_n_1578821.html
Castillo, Michelle. “Study: Suicide Rates among Army Soldiers Up 80 Percent.” CBS News. Last modified, March 9, 2012. http://www.cbsnews.com/8301-504763_162-57394452-10391704/study-suicide-rates-among-army-soldiers-up-80-percent/
“Counselors’ Lack of Military Knowledge Dissuades Veterans From Continuing Treatment.” Elements Behavioral Health. 2012. http://www.elementsbehavioralhealth.com/trauma-ptsd/veterans-ptsd-treatment/
“Healing a Broken System: Veterans Battling Addiction and Incarceration.” Drug Policy Alliance. Last modified November 4, 2009. http://www.phoenixhouse.org/wp-content/uploads/2010/12/DPA_IssueBrief_Veterans.pdf
 “How Common is PTSD?” National Center for PTSD. Last modified April 25, 2012. http://www.ptsd.va.gov/public/pages/how-common-is-ptsd.asp
Interview with U.S. Army Sergeant. Interviewed by Leah Honarbakhsh, September 18, 2012.
LaTour, Paul. “Homes Help Veterans Fight New Enemy: Addiction.” Chicago Tribune. June 8, 2011. http://articles.chicagotribune.com/2011-06-08/news/ct-x-w-aurora-veterans-20110608_1_aurora-university-addiction-recovery-home
“Leading Change: A Plan for SAMHSA’s Roles and Actions 2011-2014.” Substance Abuse and Mental Health Services Administration. 2011. http://store.samhsa.gov/shin/content//SMA11-4629/01-FullDocument.pdf
“Military Sexual Trauma.” United States Department of Veterans Affairs. August 2012. http://www.mentalhealth.va.gov/docs/mst_general_factsheet.pdf
“Mission and Objectives.” Army Center for Substance Abuse Programs. 2012. http://acsap.army.mil/sso/pages/public/mission.jsp
 “PTSD and Substance Abuse in Veterans.” United States Department of Veterans Affairs. Last modified April 3, 2012. http://www.ptsd.va.gov/public/pages/ptsd_substance_abuse_veterans.asp
Seal, Karen H., Y. Shi, G. Cohen, et al. “Association of Mental Health Disorders with Prescription Opioids and High-Risk Opioid Use in US Veterans of Iraq and Afghanistan.” Journal of the American Medical Association 307, no. 9 (March, 2012): 940-47.
Stahre, M., R. Brewer, V. Fonseca & T. Naimi. “Binge Drinking Among U.S. Active-Duty Military Personnel.” American Journal of Preventative Medicine 36, no. 3. (March, 2009).
“Study: Veterans with PTSD Are More Likely to Get Addictive Pain Med Prescriptions.” CBS News. March 6, 2012. http://www.cbsnews.com/8301-504763_162-57391894-10391704/study-veterans-with-ptsd-are-more-likely-to-get-addictive-pain-med-prescriptions/
“Substance Abuse among the Military, Veterans, and their Families—April 2011.” National Institute on Drug Abuse. Last modified April 2011. http://www.drugabuse.gov/publications/topics-in-brief/substance-abuse-among-military-veterans-their-families
“The Military Community.” Phoenix House Foundation Inc. n.d. http://www.phoenixhouse.org/services-for/military-services/
“Understanding Traumatic Brain Injury.” Polytrauma/TBI System of Care. Last modified February 8, 2011. http://www.polytrauma.va.gov/understanding-tbi/definition-and-background.asp