We don’t know how many veterans will seek substance abuse treatment. We do know that significant numbers of veterans may be avoiding treatment for fear of the stigma associated with postdeployment stress effects (Tanielian and Jaycox, 2008). For many veterans who seek services, fear of having “mental health problems” or “substance abuse” attached to their service records may contribute to their decision to stay outside of all structures even remotely connected with the military. Experts at all levels agree that shame, stigma, and fear of military repercussions are significant blocks to help-seeking and recovery (Tanielian and Jaycox, 2008).
So let’s stop mincing words…are these soldiers weak or crazy? No. Absolutely not! The connection between post-trauma effects and substance use disorders is well known. For example:
- Between one third and one half of people seeking treatment for SUDs may also have posttraumatic stress disorder
- Having untreated PTSD has been associated with a more severe course and worse outcomes for substance use recovery.
Drug dependence is frequent in war veterans with posttraumatic stress disorder (Alcoholism: Clinical & Experimental Research, 2008)
- One preliminary study shows that “this generation of veterans has been much closer to trauma, has completed or may complete multiple tours of duty, and experience a greater prevalence of mental health issues (40%) and of those upwards of 60% also have a SUD” (Danforth, 2007, p. 11).
So why do veterans develop substance abuse issues? Here are a few reasons…
- When people respond to intense or unrelenting stress or threat, it often creates chemical imbalances that people instinctively try to deal with. When “normal” coping skills fail to bring relief, people may seek sex, drugs, alcohol, food or gambling to numb or escape the pain. Eventually the brain gets used to these substances and start to need more of them to get the same feeling of relaxation. To compound this, the drugs or alcohol cause changes in the brain which may also lead to feelings of depression and/or anxiety. Did you know that initially alcohol is a system depressant, but as it wears off, it causes symptoms of anxiety (fast heart rate, shortness of breath, dizziness, irritability)?
- Many of the other aftereffects of war—from the neurological effects of trauma to the psychological and spiritual effects of exposure to death and destruction—can be very destructive. Scientists are now doing imaging studies to show that people with traumatic brain injury often have similar brain changes as those who have been exposed to extreme trauma.
- It is important to remember a couple of things about trauma. First, not everyone responds the same way to the same situations. When we triage people after a crisis to identify who is more likely to develop PTSD, we look at if they have a history of mental health problems, how many stressors they have experienced in the last 6 months, how similar the person is to the victim, how close the event was, or how much of a threat the event posed to the safety of the person’s home, and how much positive social support they received immediately after the trauma. Secondly, when the alcohol and drugs that have “medicated” or numbed the memories leave the system, those stored memories and other symptoms of trauma can emerge at higher levels of intensity.
- Injured veterans with pain-management needs are often prescribed opioid pain relievers (Vicodin, Lortab, Hydrocodone etc). Even in the absence of combat stress effects or prior histories of substance use problems, their injuries can leave them more vulnerable to dependence on those medicines.
- Young male veterans with traumatic injuries may be more vulnerable to a number of risk-taking behaviors, including the misuse of alcohol, and less likely to seek or accept help for trauma and mental health issues (Good et al., 2008). Part of this may be due to the mistaken notion that seeking help means they are weak, or believing counseling involves talking for hours on end about that “F” word…you got it….Feelings.
Substance abuse treatment providers have begun to focus on individualized treatment and recovery-based systems of care. It is imperative for these providers to receive specialized training in the specific needs and issues veterans face both in the field and at home. Additionally, clinicians should use a comprehensive approach to helping the veteran in the areas of sleep hygiene, relationship issues, garnering social support, dealing with traumas and sheer exhaustion from being overstressed for an extended period and addressing problematic substance use behaviors. Remember that the veteran may or may not be willing to address issues which he or she feels could come back to destroy their military career. Provided the patient does not exhibit suicidal or homicidal ideation, the therapist may choose to present holistic interventions such as exercise, nutrition, time management, scheduling and sleep as adjuncts to assisting the person deal with “exhaustion” or “stress.” For sustained recovery, people need to feel like they are not “the only one.” They need to feel a connection with people who can relate to them (notice I did not say understand). they need to have a safe zone where they can physically, mentally and emotionally relax. And, they need to feel like what they do or have done has a worth and a purpose.
At Gainesville-NOVA Counseling, we provide a variety of services ranging from anonymous individual sessions to confidential group treatment. While group therapy is excellent for treating substance abuse, some people do not want to be “exposed.” What is most harmful not only to veterans, but also to their military and biological family is failing to have the courage to seek help. While many vets come back in body, many leave their heart, soul and spirit on the battlefield.