The term co-occurring disorders—also referred to as dual diagnosis or comorbidity—refers to a diagnosis of two or more mental disorders, including substance use disorders, at the same time. As more active duty service members see combat situations, more are at risk for developing co-occurring disorders.
Read on to learn about:
- What co-occurring disorders are.
- Common mental and substance abuse disorders military veterans deal with.
- What is recommended for treatment.
Substance Abuse, Mental Health Struggles, & Veterans
Co-occurring disorders diagnoses can include:
- Mood disorders, such as:
- Depression or bipolar disorder.
- An anxiety disorder like panic disorder or PTSD.
- Substance use disorders, such as:
About 11 to 20% of service members returning from Iraq and Afghanistan struggle with both PTSD and depression, as these conditions frequently occur together.1
In addition, 19.5% report experiencing a traumatic brain injury (TBI) during deployment,2 which can lead to mood and behavioral changes that contribute to the risk of developing PTSD, depression, insomnia, and substance use disorders.
About half of the returning veterans of just the wars in Iraq and Afghanistan have been treated by the Veterans Administration (VA) for symptoms of mental illness—30% of those veterans report PTSD symptoms specifically.
Understanding how mental health struggles and substance abuse overlap among military veterans is integral to identifying symptoms and the right treatment program as soon as possible.
PTSD & Substance Abuse in Veterans
Veterans are at a higher risk for a few specific co-occurring disorders, often connected with PTSD.
What is PTSD?
One of the most prevalent mental health conditions diagnosed in veterans is post-traumatic stress disorder (PTSD).
PTSD can be triggered by:3
- A serious accident.
- War or combat, specifically:4
- Stress from being in a war zone.
- Being wounded in action.
- Becoming a prisoner of war.
- Natural disaster.
- Terrorist attack.
- Rape or other violent assault.
Military veterans may have experience with more than one of the above and, consequently, veterans with a substance use disorder (SUD) diagnosis often also have post-traumatic stress disorder (PTSD).
PTSD & Alcohol Abuse
Alcohol use disorder (AUD), heavy drinking, and binge drinking are a few of the most frequently reported types of substance abuse among veterans in general.5 In one study, 12 to 15% of soldiers who were deployed to Iraq abused alcohol.6
Military veterans who experience combat and a PTSD diagnosis were found to binge drink—which is considered 4 to 5 drinks, or more, in a 1- to 2-hour period.7 Over half of service members who had recently been deployed to combat zones binged alcohol.6
Another study found that alcohol use specifically among military veterans increased the risk of:5
- Interpersonal violence.
- Declining health.
PTSD & Marijuana Use
Statistics on the co-occurrence of marijuana and PTSD are hard to find, because service members who abuse illicit drugs like marijuana or heroin are dishonorably discharged and are no longer considered veterans of the armed services.6
However, as marijuana becomes a socially acceptable drug and is legalized in some states, the VA is tracking abuse rates more closely. Between 2002 and 2014, the number of veterans diagnosed with PTSD and marijuana abuse rose from 13 percent to 22.7 percent.
Other Co-Occurring Disorders
Depression & Alcohol Abuse
Alcohol abuse is already known to be high among veterans with PTSD,5 so this may contribute to increased rates of depression as alcohol changes brain chemistry.6 Depression and alcohol use disorder are closely associated in general, not just among veterans.
Heavy alcohol consumption among active-duty service members declined from the 1980s to 1990s but began rising again in the early 2000s. Binge drinking in this group rose from 35% in 1998 to 47% in 2008. These forms of drinking were closely associated with co-occurring mental illnesses, especially depression and PTSD.9
Other Anxiety Disorders, Insomnia, and Opioids
Abuse of opioid drugs, especially prescription painkillers, is rising among veterans as it rises in the general population.
- Doctors prescribed opioids to 17.8% of veterans with PTSD, and 11.7% with another mental health problem.5
- The percentage of veterans receiving pain management with prescription narcotics increased from 17% to 24% between 2001 and 2009.5
- In the same timeframe, the number of opioid prescriptions written by military physicians more than quadrupled.5
- In another study of 343 veterans, 35.3% reported aberrant pain management behavior, which included abusing prescription drugs, illicit drugs, and alcohol.10
Treatment for Veterans with Co-Occurring Disorders
The Veterans Affairs Administration is clear that the foundation of treatment for any mental or behavioral problem in veterans is talk therapy, known in the industry as psychotherapy.11
While some medical interventions—like antidepressant prescriptions or brief treatment with anti-anxiety medications—may be beneficial, medication-based treatments work best when combined with counseling.
The VA and other professional organizations recommend cognitive behavioral therapy (CBT) as the leading approach to treating co-occurring disorders, mental illnesses, and behavioral conditions among the general population as well as among veterans. For veterans with PTSD, trauma-focused treatment like cognitive processing therapy (CPT) and prolonged exposure therapy (PE) appear to work the best.11
Counseling that does not specifically deal with trauma is also beneficial in conjunction with therapy directed at PTSD. At the VA, this includes a program called Seeking Safety, which is an approach to psychotherapy that has been integrated with improved coping skills. It is often applied to treating co-occurring disorders among veterans.
Military veterans can reach out to facilities around the U.S. that cater to their specific needs—like Recovery First—for treatment. The VA also offers several different programs for veterans suffering from PTSD or substance abuse.
- U.S. Department of Veterans Affairs. (2018). How common is PTSD in veterans?
- Tanielian, T., Jaycox, L.H., Schell, T.L., Marshall, G.N., Burnam, M.A., Eibner, C., Karney, B., Meredith, L.S., Ringel, J.S., & Viana, M.E. (2008). Invisible wounds: mental health and cognitive care needs of America’s returning veterans.
- American Psychiatric Association. (2017). What is posttraumatic stress disorder?
- Friedman, M.J., Schnurr, P.P., & McDonagh-Coyle, A. (1994). Post-traumatic stress disorder in the military veteran. Psychiatric Clinics of North America, 17(2), 265-77.
- Teeters, J.B., Lancaster, C.L., Brown, D.G., & Back, S.E. (2017). Substance use disorders in military veterans: prevalence and treatment challenges. Substance Abuse and Rehabilitation, 8, 69-77.
- Saxon, A.J. (2011). Returning veterans with addictions. Psychiatric Times, 28(7).
- U.S. Department of Veterans Affairs. (2019). PTSD and substance abuse in veterans.
- U.S. Department of Health & Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. (2004). Alcohol’s damaging effects on the brain. Alcohol Alert, 63.
- Committee on Prevention, Diagnosis, Treatment, and Management of Substance Use Disorders in the U.S. Armed Forces; Board on the Health of Select Populations; Institute of Medicine. (2013). Substance use disorders in the U.S. Armed Forces.
- Goebel, J.R., Compton, P., Zubkoff,L., Lanto, A., Asch, S.M., Sherbourne, C.D., Shugarman, L., Lorenz, K.A. (2011). Prescription sharing, alcohol use, and street drug use to manage pain among veterans. Journal of Pain and Symptom Management, 41(5), 848-58.
- U.S. Department of Veterans Affairs. (2019). Treatment of co-occurring PTSD and substance use disorder in VA.