The Importance of Addressing Addiction Among Veterans

The Government’s Veteran 2020 fact sheet reported that there were 2.4 million veterans living in the UK as of 2017. They define a veteran as anyone who has served in the armed forces for at least one day, or Merchant Mariners who have worked on military operations.

Combat Stress, a UK-based charity that provides mental health support for military veterans, reports higher levels of substance abuse among veterans than civilians, particularly alcohol abuse. They have called for more specialised services for veterans and more effort to support social factors like work and relationships for people leaving the armed forces.

We’re going to examine the landscape of addiction amongst military veterans – the prevalence of addiction, how we can support the mental health of ex-armed forces personnel and what that support might look like.

Military veterans and post-traumatic stress disorder

PTSD is highly comorbid with addiction. An American study reported that people with a dual diagnosis of PTSD and addiction have a larger number of overnight hospital stays for addiction treatment, suggesting that a PTSD diagnosis means additional and more intensive support is required for addiction treatment. Like all dual diagnoses, treating both conditions together is crucial, and most likely to provide the best outcome for the person in treatment.

Armed forces veterans, having been exposed to high-stress situations, have more opportunities than civilians to develop PTSD. Government statistics suggest that PTSD amongst veterans is on the rise, from 4 percent in 2004-2009 to 6 percent in the 2014/2016 cohort. This is higher than the rate of PTSD amongst civilians, which is 4.4%.

For many, a rate of 6 percent seems strangely low, and experts have been researching why UK veterans may only be self-reporting PTSD at a rate of 6 percent. Military veterans may be less likely to report that they have PTSD and be more likely to seek treatment for other conditions that are negatively affecting their lives, like addiction, which carries less stigma within the military. The UK reports much lower rates of PTSD than their international allies despite facing very similar situations in combat, and this suggests that mental illness is highly stigmatised in the UK military, leading veterans to suffer in silence.

With PTSD rates rising and potentially being underreported, it’s important that addiction treatment for veterans takes into account the difficult situations they have faced and offers an open, destigmatising environment where veterans feel safe to talk about their experiences and their mental health.

Substance misuse rates amongst veterans

Combat Stress reports that rates of alcohol misuse are very high in the military, with 67% of men and 49% of women classed as having a drinking problem. Substance misuse isn’t as widespread but still more common than in the civilian population, with a rate of 5%.

The reasons for this aren’t clear, but there are several potential explanations. Even if a member of the military isn’t experiencing PTSD, military populations live and work in a very high-stress environment. Constant relocations and prolonged separations from friends and families can cause military personnel to turn to substances to cope with loneliness, missing their loved ones, and to relieve stress. Substances can serve the dual purpose of bonding with fellow military personnel and coping with fear and distress during deployment.

Alcohol and substance misuse rates are higher in veterans than in actively serving military personnel. Many veterans struggle to readjust to civilian life, and are reluctant to approach services at home for help, citing stigma against mental health and disbelief that they can be helped. On average, it takes a UK veteran 11 years to seek help after leaving the military. As a result, they tend to seek help at an older age and require longer treatment. Veterans who wait longer to seek help tend to have worse symptoms, particularly for PTSD.

Addiction, veterans, and exacerbating factors

One study on UK military veterans examined a sample of ex-military personnel who had sought treatment for mental health problems. Veterans who do seek help for mental health and addiction report poorer outcomes than the civilian population, and this study aimed to find out why.

Out of the sample they looked at, PTSD was the most common mental health issue reported, followed by anger, depression, anxiety and alcohol misuse. The relationship between these conditions was often complex, with 32% of the veterans studied with PTSD also meeting the criteria for three other health issues. Only 5% of those studied with PTSD had no co-occurring conditions.

The study found a high rate of additional, pre-service vulnerabilities, like adverse childhood events and traumatic incidents that occurred before military service. They also found that several other factors were linked to more severe symptoms – younger veterans and those who were unemployed or single tended to report worse PTSD and alcohol misuse.

The study made several suggestions about how to support veterans facing this constellation of addiction and mental health issues. The prevalence of pre-service adverse experiences and the overlap between multiple co-occurring conditions means that fully supporting and effectively treating veterans can be quite complex. Treatment programmes aimed at veterans need to take on board these suggestions to maximise their effectiveness.

How to most effectively treat veterans struggling with addiction

Interventions must focus on more than just PTSD

Many people immediately associate military service with PTSD – but the picture is much more complex than this. PTSD and addiction often occur together – but multiple conditions can all play a role. Addiction treatment for veterans needs to take into account the problems with loneliness, anger, depression and anxiety that can also be present.

Use a case management approach

Combat Stress piloted a case-management approach for helping veterans with addiction, and found it to be effective. Case management means bringing together medical staff, social workers and other professionals to tailor an approach for each veteran, rather than a piecemeal approach of separate services to deal with addiction, mental health, housing and lifestyle interventions. This approach has been proven to be beneficial when treating mental health and addiction together, and leads to the best outcomes – but because veterans can struggle with finances, employment and relationships it’s most effective to treat each veteran holistically, and to have a plan to address all these issues and how they intersect on a case by case basis.

Early intervention

The stigma against mental health amongst the civilian population is high – and this stigma seems to be even higher in the armed forces. This can mean that veterans delay getting treatment, and this leads to worse outcomes, and to veterans struggling in silence for far longer than they need to. Supporting veterans as they transition to civilian life, and signposting them to services that can support them when they’re struggling can allow them to get help sooner rather than later.

Rehab for veterans

The transition from military to civilian life can be tough. You might find that the coping mechanisms you used when you were serving are no longer helping, and are now getting in the way of progressing in your life.

Our tailored rehab services can help you to cope with the difficult experiences you have faced and the transition to civilian life:  without having to reach for substances to cope.

Reach out today to start a happier, healthier life.