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The National Institute on Drug Abuse (NIDA) defines addiction as a chronic brain disease involving compulsive drug-seeking and drug-consuming behaviors despite the harmful physical, emotional, and social consequences. Intoxicating substances change structures in the brain by altering how the brain manages its chemistry. Specifically, neurotransmitters like dopamine, serotonin, and norepinephrine are released in large amounts, or prevented from being absorbed, so the person will experience elevated mood, increased relaxation or physical energy, and other short-term pleasurable benefits. The good feelings are related to the brain’s reward system, and once that area has been triggered, the person is more likely to seek out increasing amounts of the drug in order to have the same pleasurable experience. Attempts to quit are difficult, especially without help, and relapse back into substance abuse occurs in 40-60 percent of people who go through detox and rehabilitation to overcome addiction.
NIDA states that the reasons people begin abusing drugs include:
Current and former military service members share these risks with civilians. For example, one study revealed that among deployed troops who smoked cigarettes, 47.7 percent blamed stress, 25.1 percent blamed boredom, and 22.7 percent blamed existing addiction for causing their smoking. Veterans and current service members smoke and abuse other drugs at higher rates than civilians, largely due to more intense career stresses, which also trigger co-occurring disorders like PTSD, depression, and anxiety.
At least 14 percent of all formerly deployed service members struggle with PTSD, which puts them at increased risk of abusing substances. Conversely, abusing drugs or alcohol increases hyper-arousal effects, or the intense experience of stress and negative emotions, associated with PTSD, which may lead to more substance abuse.
The Center for Behavioral Health Statistics and Quality (CBHSQ) released a report in 2015 that noted that one in 15 veterans had a substance abuse disorder in the prior year. That rate was higher among veterans who had served in the military since September 2001. The Institute of Medicine (IOM) released a report in 2013 titled Substance Use Disorders in the US Armed Forces, which found that heavy drinking, defined as seven or more alcoholic beverages per week, was present in about 20 percent of veterans. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that about 7 percent of the general public engages in heavy drinking in comparison. The military’s overall illicit drug abuse was about 12 percent; in comparison, NIDA reports that about 9.4 percent of the US population, ages 12 and older, regularly abuses illicit drugs.
The most abused substances among veterans are outlined below.
Abuse of alcohol is consistently higher among current and former service members than among the general population. As much as 47 percent of active service members reported binge drinking in 2008, and 20 percent report regular binge drinking, which increases the risk of alcohol dependence and addiction. Among service members with combat exposure, binge drinking rates were as high as 27 percent. Veterans who seek treatment for substance abuse primarily need help overcoming alcohol use disorder (AUD): 65.4 percent of veterans, compared to 37.4 percent of non-veterans, entering drug and alcohol treatment programs need help primarily addressing AUD.
A Department of Defense (DoD) report from 2008 found that 11 percent of service members reported misusing or abusing a prescription medication, which most often was an opioid painkiller or a sedative. As rates of opioid abuse and addiction go up across the US, this is reflected in struggles among US service members and veterans. As with non-veteran populations, veterans seeking addiction treatment abuse opioids at high rates: 10.7 percent of veterans needed help ending heroin abuse, and 5.3 percent needed help overcoming addiction to other synthetic opioids, including oxycodone and hydrocodone prescription drugs.
In 2008, about 30 percent of all service members smoked cigarettes, and as with alcohol, rates of smoking were higher among veterans who had experienced combat.
Veterans seeking addiction treatment also abused illicit substances: 6.2 percent sought help overcoming cocaine addiction, 5.5 percent needed help ending marijuana abuse, 5.1 percent needed help overcoming methamphetamine abuse, and 1.9 percent needed help with another illicit drug.
Abusing drugs or alcohol is known to increase symptoms associated with mental health conditions, like depression, anxiety, bipolar disorder, and PTSD. It is also associated with increased risk of suicidal ideation, suicide attempts, and death by suicide. Substance abuse was associated with 30 percent of the US Army’s deaths from suicide between 2005 and 2009. Still, many veterans find that they abuse drugs or alcohol to mitigate symptoms of depression and PTSD. In fact, the VA notes that veterans tend to be binge drinkers, consuming a lot of alcohol during periods of intense negative emotion, sleeplessness, or flashbacks.
Post-traumatic stress disorder is a major contributor to co-occurring disorders like major depression and substance abuse. According to the VA, two out of 10 veterans struggle with PTSD and a co-occurring substance abuse problem, and one in three veterans seeking treatment for substance abuse also has PTSD.
Substance abuse and addiction are more common among younger veterans and among those who are not or have never been married. This suggests that experiencing combat early and coming home to less social support can contribute to struggles with drugs or alcohol. In some cases, service members join the military to escape traumatic home environments, and the original trauma may contribute to their substance abuse risks more than entering the military or experiencing combat.
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Veterans seeking treatment for substance abuse must be screened for PTSD, traumatic brain injury, depression, and suicidal ideation. The risk of these co-occurring with substance abuse is extremely high among veterans in particular.
As with other approaches to co-occurring disorders, evidence-based psychotherapy is the foundation of treatment. Cognitive Behavioral Therapy (CBT) and specific, trauma-focused counseling approaches can help veterans with PTSD or depression understand these issues as triggers for their substance abuse problems and learn better ways to cope with stress that do not involve drugs or alcohol.
Medically supervised detox is also extremely important. The VA offers medications like buprenorphine, naltrexone, and naloxone as prescriptions for people working to end alcohol or opioid addiction. The VA also has smoking cessation treatments available, including medication and counseling.
Not all veterans want to use the VA for addiction treatment, or they may not have easy access to their nearest VA hospital. The VA and veterans insurance may provide some options outside the VA system, so it is important to ask for help.
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