Members of the United States Armed Forces returning from combat or active duty face many challenges at home – adjusting to civilian life, using veterans’ benefits, finding employment outside the military, and returning to families they have not seen for months or years. Their families, too, experience intense psychological and emotional stress while their loved one is gone. Even when a veteran experiences few other struggles, the stress of returning home and trying to make a new, different life can be immense.
Unfortunately, many service members, both on active duty and retired, develop mental health and substance abuse problems because of the amount of stress they endure. Post-traumatic stress disorder (PTSD) is one of the most common mental health problems among current and former military members, and depression, anxiety, insomnia, suicidal ideation, and substance abuse are closely associated with high rates of PTSD. Traumatic brain injury (TBI) from combat, too, can lead to mental and behavioral changes that contribute to higher rates of addiction and suicide.
The spouses, children, parents, and siblings of service members struggle alongside their loved ones. Mental, emotional, and behavioral stress deeply affects the person who suffered trauma, but it also affects those around them, who want the person to be well. Understanding how substance abuse and associated struggles affect veterans is important to encourage them to seek help; however, it is equally important to understand how these problems spread stress around military families and can affect the health of family members.
Why Veterans Are at High Risk for Substance Abuse
The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that there are 23.4 million US Armed Forces veterans living in the US, with 2.2 million active-duty service members and 3.1 million associated family members. SAMHSA notes that, among Iraq and Afghanistan veterans returning home, 18.5 percent reportedly have PTSD or depression and 19.5 percent have a TBI.
Between 2004 and 2006, 7.1 percent of veterans met the Veterans Affairs (VA) Administration’s criteria for a substance use disorder. Between 2005 and 2009, over 1,100 veterans died from suicide, or an average of one death from suicide every 36 hours. The military suicide rate reached an all-time high in 2012. Mental health and substance use disorders led to the hospitalization of more troops in 2009 than any other cause, including disability or injury.
Many veterans struggle with co-occurring PTSD and substance abuse, which impact their behavior, emotions, legal status, physical safety, and financial stability. Psychiatric Times published an article in 2011 that reported veterans face a difficult triumvirate of co-occurring conditions:
- Physical pain
These three co-occurring struggles increase the risk of alcohol abuse, smoking cigarettes, prescription opioid and sedative abuse, and even illicit drug use like marijuana abuse. While there is little information on illicit substance abuse among active-duty military members – likely because, when discovered, these service members are dishonorably discharged – alcohol and cigarette statistics are well known. Problems with alcohol and smoking start during active duty, for many veterans.
A survey of US Army soldiers, for example, found that 27 percent screened positive for alcohol misuse when they returned home from a tour in Iraq. Another survey of 1,120 deployed soldiers found that 25 percent screened positive for alcohol abuse, and 12 percent screened positive for alcohol-related behavioral issues like drunk driving or experiencing frequent hangovers. Veterans who have both PTSD and alcohol abuse problems tend to be binge drinkers, which the VA suspects involves drinking during episodes of flashbacks or negative thoughts.
Cigarette smoking is a struggle for many current and former service members. A survey found that 51.9 percent of male soldiers and 41.7 percent of female soldiers smoked before being deployed, and 58.3 percent of men and 51.2 percent of women smoked during deployment.
Among veterans who received prescription opioid painkillers to treat pain, 2 percent report developing an addiction to these drugs. That survey found that pre-existing mental health struggles predicted whether or not the veteran would develop an addiction to their prescription narcotics. As more civilians receive opioid prescriptions and struggle with addiction, the same pattern presents in the military, too.
Two out of 10 veterans with PTSD also have problems with substance abuse, according to the VA. One out of three veterans seeking treatment for addiction has PTSD.
While around 50 percent of veterans who need help seek it, few actually receive the care they need. There are several complex reasons for this, but it often means that veterans’ families will be their primary support network while they seek treatment. This is an important role, but it can be stressful for families.
The Impact on the Family
Naturally, those close to a veteran will feel sympathy and worry for their loved one. Behavioral changes like drinking a lot or abusing drugs, alongside personality changes from a TBI or PTSD, can be very stressful and intense on families. Depression is common among family members of traumatized individuals because they realize their loved one was not as safe as believed, their view of the world may change, and they feel grief from loss.
Other stresses include financial instability because the traumatized person may have a hard time finding or maintaining employment; anxiety, depression, and frustration because the veteran may not want to go out of the house or spend time with friends and family; stress and sadness because they have lost their former “normal” life; and, in some instances, the threat of emotional or physical violence from the veteran.
Veterans have high rates of substance abuse, but when their stress becomes their family’s stress, these family members are at risk of developing patterns of substance abuse, too. Children are more likely to begin abusing substances with peers during adolescence, and spouses may spend time away from home drinking or abusing other substances with friends rather than face their veteran spouse who is suffering. Sometimes, spouses or children will begin drinking or abusing drugs because it is the only way they can spend time with their veteran loved one.
In romantic partnerships or marriages, about 5-10 percent of people who develop PTSD after a traumatic event are unable to return to the previous level of closeness with their loved one, and this can cause lasting relationship problems. Divorce rates among veterans are high, and this may be one of the reasons. Survivors of trauma who develop PTSD may feel numb, distant from those they love, or have emotional outbursts and negative emotions that hurt their partner. While most people who develop PTSD are able to reconnect with loved ones, including romantic partners, it is important to get help before these relationships suffer.
Similarly, children whose parents have PTSD may suffer mental and emotional stress. They may respond in certain ways like:
- Displaying PTSD symptoms like those of their parent
- Taking on a caregiving or “adult role” to help their parent
- Academic problems at school
- Sadness, anxiety, or extreme worry about the parent
- Problems in relationships with friends, other family members, and romantic relationships later in life
Because these children suffer stress, grief, and guilt from their veteran parent having a condition they cannot control, these children are at risk of developing a problematic relationship with substances like alcohol, prescription drugs, or illicit substances because they are self-medicating.
Children whose parents abuse drugs or alcohol are less likely to receive other types of care they need, like medical or dental care. They are less likely to get prenatal care and early childhood care for the first two years of life. This stress may contribute to later substance abuse problems. Among families of veterans, substance abuse may compound other problems from mental health struggles.
How Veterans’ Families Can Help
When a loved one returns from a tour of duty, they may display new behaviors or emotional states, which could indicate PTSD, depression, substance abuse, a TBI, or chronic pain. The VA recommends that family members take a few steps to be supportive of their veteran loved one and encourage them to get help.
- Learn about PTSD, its symptoms, its impact, and how to take care of family members around the person with PTSD.
- Make genuine offers of help, like going to doctors’ appointments with the veteran.
- Offer to listen to the veteran if they need to talk or support them in other healthy ways if they do not want to talk.
- Plan relaxing family activities together, like enjoying a walk or going to a movie.
- Encourage the veteran to spend time with their children, close family members, or close friends who do not abuse substances.
The VA also points out that it is important for families of veterans to take care of themselves. Family therapy and individual counseling are key components of this because therapy can help everyone understand the root causes of PTSD, how it impacts everyone, and how to develop healthier coping mechanisms. Other ways the VA recommends to care for oneself include:
- Acknowledge emotions. Feeling helpless and guilty are normal responses to a veteran loved one who suffers, but the suffering is not the family’s fault or sole responsibility.
- Things will change slowly, and being frustrated or upset by this is also normal, but taking time is important.
- Find ways to care for physical health, including exercise and healthy meal-planning.
- Find time for activities and hobbies that are enjoyable, as well as seeing friends or family.
- Take time specifically to be alone and “recharge.”
- Remember good things, and find ways to make good memories during the healing process.
The VA recommends that loved ones of those who have suffered trauma encourage the veteran in their life to get treatment, such as:
- One-on-one, individual therapy
- Group counseling and mutual support groups
- Anger and stress management counseling, education, or training
- Assertiveness training
- Couples counseling
- Family education classes
- Family therapy, including for children and adolescents
For veterans suffering from substance abuse problems, medically supervised detox and evidence-based rehabilitation should work alongside the above approaches to therapy. Family members should receive screening for substance abuse, too, and education to understand their increased risk of substance abuse due to family stress.