Substance Use Disorder (SUD)
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Trauma-related responses such as uneven moods and heightened anxiety may lead to increased substance misuse (for example, alcohol and marijuana) or addiction (for example, opioids and benzodiazepines), the latter involving a physiological dependence on the drug and withdrawal symptoms.

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Many men and women who have served in the United States military struggle with a substance use disorder or an addiction. Veterans who have seen combat may have co-occurring disorders, such as depression or post-traumatic stress (PTS), in addition to addiction. Many veterans suffering from an addiction have co-occurring post-traumatic stress disorder. Once referred to as "shellshock" and later "battle fatigue," PTS can be caused by witnessing warfare or other significantly tragic or startling events. Traumatic events such as combat exposure and multiple deployments can trigger drug or alcohol use, which all too often can lead to substance misuse or addiction.

 

Although most cases of PTS are caused by combat, or when basic training aggravates childhood trauma, veterans may also develop the disorder after sexual abuse. About 23 percent of female veterans have reported being sexually assaulted during their time in the military, and research now indicates that 2% (1 in 50) of male veterans have reported being sexually assaulted while serving.

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Some symptoms of PTS include:

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• Flashbacks

• Memory impairment

• Impaired concentration

• Low sense of self-worth

• Hopelessness

• Sleep disorders

• Social relationship problems

• Aggression

• Self-destructive behavior (self-harm or substance abuse)

 

These symptoms may be triggered by anything that is a reminder of the traumatic incident. Many veterans turn to substance abuse numb their recollection of the incident. More than 20 percent of veterans with PTS also suffer from an addiction or dependence on drugs or alcohol. People with PTS have a more difficult time overcoming addiction than those without it. The symptoms of withdrawal combined with PTS amplify negative feelings and emotions that may lead to a relapse.

 

Addiction treatment programs that focus on PTS and addiction simultaneously are most successful for veterans.  Veterans with PTSD are often prescribed anxiety medications, most of which are highly addictive. To curb the risk of addiction, some doctors prescribe non-addictive antidepressant medications such as Paxil or Zoloft. Even veterans without PTSD can become addicted to painkillers prescribed for combat-related injuries.

 

Common addictive medications prescribed to veterans include:

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• Painkillers (Lortab, Vicodin, OxyContin)

• Benzodiazepines (Ativan, Valium, Xanax)

• Sedatives (Ambien, Lunesta)

 

Veterans taking these drugs may develop a dependence on them, meaning tolerance to their effects and symptoms of withdrawal when quitting. As time goes on, veterans may spiral into full-blown addiction, which is characterized by compulsive drug-seeking behavior.

 

To mitigate drug abuse among service members and veterans, some advocates are pushing for tighter regulations on how long addictive medications can be prescribed.

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VISN 1 (New England) Mental Illness Research, Education and Clinical Center (MIRECC)

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The VISN 1 New England MIRECC aims to improve the clinical care of Veterans with substance use disorders (SUDs) by employing a biopsychosocial approach to SUD and comorbid/co-occurring conditions, including mental health and medical conditions and psychosocial issues. The VISN 1 MIRECC develops, evaluates, and disseminates evidence-based interventions, tests scientific theories, and proposes novel clinical programs along the full continuum of SUD care. Using this approach, we work to translate scientific findings from our research labs into practice within VA clinical programs across the nation to promote the recovery of Veterans with SUD and improve their quality of life. The major goals of the VISN 1 MIRECC are:

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(1) Advancing Understanding of SUDs. Through genetic, human laboratory, large-scale screening and survey studies, and the analysis of VHA data sets, we investigate the complex interplay of SUDs and co-occurring conditions to improve diagnosis, treatment, and prevention strategies.

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(2) Developing Innovative Treatments for SUD. Develop and rigorously evaluate innovative pharmacological and psychosocial interventions for SUDs across the NIH Stage Model (e.g., intervention generation, efficacy testing, and effectiveness evaluations).

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(3) Bridging the Gap between Research and Practice. Conduct implementation and dissemination research to optimize delivery of effective SUD treatments and educational programming, including leveraging innovative technologies.

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(4) Cultivating Future SUD Clinician-Scientists. Recruit and train medical residents, clinical fellows, psychology interns, practicum students, and early-career scientists and encourage them to build SUD-focused careers in research and/or clinical care.

 

For additional information, visit the Substance Use Problems page at VA.gov.

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