PTSD and Substance Abuse in Veterans

Some people try to cope with their Posttraumatic Stress Disorder (PTSD) symptoms by drinking heavily, using drugs, or smoking too much. People with PTSD have more problems with drugs and alcohol both before and after getting PTSD. Also, even if someone does not have a problem with alcohol before a traumatic event, getting PTSD increases the risk that he or she will develop a drinking or drug problem.

Eventually, the overuse of these substances can develop into Substance Use Disorder (SUD), and treatment should be given for both PTSD and SUD to lead to successful recovery. The good news is that treatment of co-occurring (happening at the same time) PTSD and SUD works.

How common is co-occurring PTSD and SUD in Veterans?

Studies show that there is a strong relationship between PTSD and SUD, in both civilian and military populations, as well as for both men and women.

Specific to Veterans:

• More than 2 of 10 Veterans with PTSD also have SUD.
• War Veterans with PTSD and alcohol problems tend to be binge drinkers. Binges may be in response to bad memories of combat trauma.
• Almost 1 out of every 3 Veterans seeking treatment for SUD also has PTSD.
• The number of Veterans who smoke (nicotine) is almost double for those with PTSD (about 6 of 10) versus those without a PTSD diagnosis (3 of 10).
• In the wars in Iraq and Afghanistan, about 1 in 10 returning soldiers seen in VA have a problem with alcohol or other drugs.

How can co-occurring PTSD and SUD create problems?

If someone has both PTSD and SUD, it is likely that he or she also has other health problems (such as physical pain), relationship problems (with family and/or friends), or problems in functioning (like keeping a job or staying in school). Using drugs and/or alcohol can make PTSD symptoms worse.

For example:

• PTSD may create sleep problems (trouble falling asleep or waking up during the night). You might “medicate” yourself with alcohol or drugs because you think it helps your sleep, but drugs and alcohol change the quality of your sleep and make you feel less refreshed.
• PTSD makes you feel “numb,” like being cut off from others, angry and irritable, or depressed. PTSD also makes you feel like you are always “on guard.” All of these feelings can get worse when you use drugs and alcohol.
• Drug and alcohol use allows you to continue the cycle of “avoidance” found in PTSD. Avoiding bad memories and dreams or people and places can actually make PTSD last longer. You cannot make as much progress in treatment if you avoid your problems.
• You may drink or use drugs because it distracts you from your problems for a short time, but drugs and alcohol make it harder to concentrate, be productive, and enjoy all parts of your life.

VA has made it easier to get help. It is important to know that treatment can help and you are not alone.

What treatments are offered for co-occurring PTSD and SUD?

Evidence shows that in general people have improved PTSD and SUD symptoms when they are provided treatment that addresses both conditions. This can involve any of the following (alone or together):

• Individual or group cognitive behavioral treatments (CBT)
• Specific psychological treatments for PTSD, such as Cognitive Processing Therapy (CPT) (en Español) or Prolonged Exposure (PE) (en Español)
• Behavioral couples therapy with your spouse or significant other
• Medications that may help you manage the PTSD or SUD symptoms

Talk with your provider about treatment for specific symptoms like pain, anger, or sleep problems.

What should I do if I think I have co-occurring PTSD and SUD?

The first step is to talk to a health professional and ask for more information about treatment options. Each VA medical center has an SUD-PTSD Specialist trained in treating both conditions to reach the best health outcomes. If there are signals you are at risk for both disorders, you will be encouraged to talk with a provider about how to best support your recovery. There are treatment resources at every VA medical center. The VA wants you to have the best possible care for co-occurring PTSD and SUD.

• Find a VA PTSD Program
• Find a VA SUD Program

If you continue to be troubled or distracted by your experiences for more than three months or have questions about your drinking or drug use, learn more about treatment options. Life can be better! Talk to a VA or other health professional to discuss choices for getting started.