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Why Veterans Are More Prone to Alcoholism?

The veteran in a wheelchair is depressed. He has problems with alcohol. He holds a glass of whiskey.Alcohol is one of the most widely abused intoxicating substances in the United States. According to the Centers for Disease Control and Prevention (CDC), 88,000 people die every year from alcohol-related causes, which range from alcohol poisoning and drunk driving accidents to cancer and liver failure. Excessive drinking is responsible for the deaths of one in 10 working-age adults. This includes heavy drinking, or more than seven servings of alcohol per week; binge drinking, or more than four servings of alcohol in two hours; and alcohol use disorder, which has components of heavy and binge drinking, but involves compulsive behaviors around alcohol, drinking more than intended, and escalating alcohol consumption over time.

Former members of the United States Armed Forces are at risk of developing alcohol use disorder (AUD) or otherwise self-medicating mental health struggles or chronic pain by drinking too much. Veterans are more likely, compared to their civilian counterparts, to suffer from post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), chronic pain, depression, and suicidal ideation. Alcohol is very widely abused by current and former service members, and PTSD, TBI, and pain may all trigger vets who otherwise did not struggle with problem drinking to begin abusing alcohol when they return home.

Veterans Abuse Alcohol at Very High Rates

Although the US military implemented restrictive policies in the 1980s to stop service members from excessive drinking, these policies were enforced inconsistently and did not squash the culture of heavy drinking or binge drinking in the US Armed Forces. Over 47 percent of active-duty service members reported binge drinking in 2008, which was up from 35 percent in 1998. That same year, 20 percent of military personnel reported binge drinking every week in the month before being surveyed. Among those with high combat exposure, the rate was 27 percent.

Veterans may retain this culture when they return home or begin to struggle with alcohol abuse for other reasons. The National Survey on Drug Use and Health (NSDUH) found that, compared to non-veteran counterparts, veterans were much more likely to consume alcohol. In fact, 56.6 percent of veterans, compared to 50.8 percent of civilians, used alcohol at some point in the month before the survey; 7.5 percent of veterans drank heavily compared to 6.5 percent of non-veterans; 26.8 percent of veterans with combat exposure drank heavily; and 54.8 percent of veterans with combat exposure binge drank.

Being exposed to combat dramatically increases the risk of developing PTSD, and it is the leading reason so many more veterans suffer from this mental health condition compared to non-veterans. One theory for why PTSD sufferers binge drink involves self-medication. When they experience periods of negative or dark thoughts, flashbacks, or insomnia, these veterans are more likely to drink too much in one sitting.

A survey of veterans returning from the Iraq and Afghanistan conflicts found that, among 88,205 soldiers, 12-15 percent screened positive for alcohol-related problems. A later survey of 6,527 veterans of these conflicts found that 27 percent screened positive for alcohol misuse. This led to behavioral problems on duty, including showing up late, being hungover, and drinking and driving.

In a 2016 study on 3,157 veterans ages 21 and older, lifetime prevalence of AUD was 42.2 percent and probable AUD was 14.8 percent. Veterans who struggle with AUD were found to have higher rates of mood and anxiety disorders, especially PTSD and depression. They were also more likely to have co-occurring drug abuse problems and increased rates of suicide attempts or thoughts. Alcohol makes all these conditions worse, so it is important to understand that psychiatric conditions, other drug abuse, and chronic pain or injury increase the risks of developing problems with alcohol.

TBI and PTSD Contribute to Alcohol Abuse

The most common problems associated with recently returning veterans are traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). About 20-30 percent of returning Iraq and Afghanistan veterans have a TBI. Suffering TBI increases the risk of alcohol abuse. Compared to veterans without TBI, discharge rates among those suffering mild TBI were 2.6 times greater and 5.4 times greater among those suffering moderate TBI.

One out of three veterans seeking treatment for substance abuse, including alcohol use disorder, will have PTSD. In general, about three-quarters of people who have survived abuse or violent trauma report that they struggle with alcohol abuse. People who struggle with PTSD and chronic pain will more frequently also struggle with alcohol abuse. Although many veterans who experience PTSD, chronic pain, and/or TBI are attempting to self-medicate severe symptoms, drinking too much will increase symptoms of PTSD, the risk of depression, and chronic pain symptoms. This confluence increases the risk of attempting or completing suicide.

The Definition of Alcohol Use Disorder Can Help Veterans and Their Loved Ones

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5), there are 11 criteria that clinicians use to determine if a person suffers from AUD:

1. Spent more time drinking than intended

2. Attempted to cut down drinking more than once and was unsuccessful

3. Spends a lot of time drinking or experiencing sickness from drinking too much

4. Experiences intense craving for alcohol

5. Finds that drinking too much, or being sick from drinking, interferes with working or taking care of family members

6. Continues to drink despite harm done to relationships, work, etc.

7. Has given up or cut back on enjoyable activities specifically to drink more

8. Has put oneself in dangerous situations due to drinking, such as drunk driving

9. Continues to drink despite feeling depressed, anxious, or developing another health problem

10. Feels like one must drink more alcohol to achieve the original effects

11. Develops withdrawal symptoms when alcohol is no longer in the body

People who experience at least two of these symptoms for more than a year likely struggle with addiction to alcohol. These criteria are the same for civilians and veterans, so if a loved one who is a veteran displays any of these symptoms, they may struggle with AUD or problem drinking.

Treatment for Veterans Struggling with Alcohol Abuse

When veterans enter treatment for substance abuse, alcohol is the most frequently reported abused drug. Although this is true of civilian populations as well, alcohol is more widely abused among veterans seeking treatment than their civilian counterparts. A report published with information from the Treatment Episode Data Set (TEDS) found, in 2015, that 65.4 percent of veterans seeking substance abuse treatment reported abusing alcohol; in comparison, 37.4 percent of non-veterans seeking treatment struggled with alcohol abuse.

The VA provides treatment options through the Veterans Alcohol and Drug Dependence Rehabilitation Program. Counseling and medication form the foundation of any effective addiction treatment, and the VA provides:

Medically supervised detox is the first step to overcoming alcohol use disorder, but entering a form of rehabilitation listed above, or combining approaches to rehabilitation, is extremely important. Veterans should be screened for co-occurring issues, especially PTSD, depression, suicidal ideation, anxiety, TBI, and chronic pain because these can affect treatment outcomes and long-term recovery. These issues must be treated alongside alcohol abuse for the veteran to receive effective treatment, feel safe, and remain on track to getting healthy.

Some veterans may not have access to a nearby VA hospital, and others may choose to get treatment outside the VA. It is important to find a program that understands veterans’ unique needs and perspectives, so they provide the best quality treatment. Today, many private treatment programs also specialize in addiction and mental health treatment for veterans.