Treating Veterans for PTSD and Drug Abuse

When a person experiences a life-threatening event, or is the victim of (or witness to) something extremely traumatic, the fight-or-flight response kicks in. This is the body’s natural defense mechanism that protects people in times of danger. The stress response causes heart rate to accelerate, blood pressure and body temperature to rise, and breathing to become shallow while focus is heightened, and energy and attention levels spike. This is a normal and healthy reaction.

Post-traumatic stress disorder, or PTSD, is a mental disorder that can cause people to re-experience a trauma, experience flashbacks, and feel fear when the danger or threat has already passed. Essentially, those with PTSD live with a high level of stress, and the fight-or-flight response is often triggered when no threat is actually present.

About seven or eight out of every 100 people will suffer from post-traumatic stress disorder (PTSD) in their lifetime, the National Center for PTSD reports. The National Institute on Mental Illness (NIMH) publishes that approximately 3.5 percent of the American adult population battles PTSD, and around one-third of the time the illness is considered to be severe, meaning that it interferes with daily functioning abilities.

PTSD is commonly associated with war veterans, as soldiers and members of the military are regularly exposed to traumatic and hazardous situations and events. War veterans have an increased risk for developing PTSD, and this population may suffer from the disorder at higher rates than the general public. Rates of PTSD in the military veteran population vary depending on service era, but they have been estimated to be 10-30 percent, the National Center for PTSD publishes.

Drugs are a common method of self-medicating PTSD symptoms, as they can provide temporary relief from difficult emotions and a respite from troubling thoughts. Drug abuse can only compound the potential side effects, severity, and duration of PTSD side effects, however, as they only serve as a temporary solution to the problem. In fact, drugs and alcohol can make PTSD worse, interfere with treatment protocols, and cause additional problems.

Individuals battling PTSD are at least 2-3 times more likely to also suffer from issues related to drug abuse and addiction. This is even likelier for veterans, especially those exposed to combat, the journal Clinical Psychology (New York) reports. Veterans who struggle with both drug abuse and PTSD can benefit from specialized treatment programs that cater specifically to this demographic.

Spotting PTSD

Symptoms of PTSD typically start within three or so months after living through a traumatic event. In the case of veterans, PTSD symptoms may begin a few weeks or months after coming back from war or being involved in combat. Being injured in combat, witnessing the death of a friend or fellow soldier, or being in one of the many near-death situations associated with war and combat all increase the odds that a veteran will suffer from PTSD after the fact.

War and exposure to combat are not the only potential causes of PTSD, however. Military sexual trauma (MST), which includes both sexual assault and sexual harassment, can be a causal factor for PTSD, and this can occur at any time and not just at wartime.

Symptoms of PTSD may not start right away; they may appear several years after the actual traumatic event. When symptoms last a month or longer, and interfere with work production and interpersonal relationships, PTSD can be diagnosed. Mood swings, uncharacteristic aggression, irritability, restlessness, tension, and edginess, which often accompany PTSD, can disrupt families and lead to issues with spouses or partners.

The first step to getting help for PTSD is to recognize the signs of the illness. NIMH reports the following as classification for a PTSD diagnosis:

  • Arousal and reactivity symptoms (at least two must be present):
    • Sleep problems
    • Explosions of anger
    • Feeling on edge
    • Startling easily
    • Self-destructive and/or risky behaviors
  • Cognition and mood symptoms (at least two must be present):
    • Unrealistic feelings of shame and guilt
    • Memory difficulties surrounding traumatic events
    • Lack of interest in activities or things that were important or enjoyable before
    • Hopelessness
    • Negative vision of oneself and the world in general
    • Emotional numbness
    • Difficulties concentrating
    • Trouble feeling pleasure
  • Avoidance symptoms (at least one must be present):
    • Aversion to thinking or talking about the event
    • Staying away from people, things, or places that might be a reminder of the trauma or event
  • Re-experiencing symptoms (at least one must be present):
    • Nightmares
    • Flashbacks that induce a kind of “reliving” of the experience and can include the physical side effects of the stress response
    • Intrusive memories of the trauma at unwanted times
    • Significant emotional or physical response to a triggering person, place, or thing

PTSD can make people feel detached from themselves and the world around them, causing alienation from family and friends. Social isolation and difficulties connecting with people are common, especially in the veteran population when returning home from being deployed for a length of time. Appetite problems, sleep deprivation, depression, and suicidal thoughts and actions are additional side effects of PTSD as is drug and alcohol misuse.

Co-Occurring PTSD and Substance Abuse

As many as 20 percent of military veterans who suffer from PTSD also battle issues with substance abuse and addiction, the U.S. Department of Veterans Affairs (VA) reports, and one-third of the veterans who seek treatment for addiction also suffer from PTSD. Substance abuse, addiction, and PTSD regularly co-occur, meaning they are present at the same time in the same person. The journal Psychiatric Times publishes that alcohol is the most commonly abused substance by veterans struggling with PTSD; however, cocaine, marijuana, and opioid drugs (in that order) are regularly abused as well. In general, due to the military’s zero tolerance for illicit drug use, drug abuse rates are fairly low in military populations; however, substance abuse is common in veterans battling PTSD.

Injuries, including traumatic brain injury (TBI), are common for combat veterans, which can elevate the risk for both PTSD and drug abuse. Prescription opioid drug abuse is on the rise with the veteran population, the National Institute on Drug Abuse (NIDA) warns. A veteran may be prescribed these drugs for pain related to injuries sustained training or in battle, and they may begin misusing them when they are no longer medically necessary. Prescription narcotics are considered highly addictive and abused at staggering rates.
Marijuana, alcohol, and opioids are all central nervous system depressants that act to blunt the stress response, which may be a desirable side effect for someone struggling with PTSD. These substances may provide a temporary escape from difficult emotions and negative intrusive thoughts that accompany the disorder. They may seem to make it easier to sleep and reduce tension while providing pleasure and easing depression. Cocaine is a stimulant drug that may seem to be the answer for fatigue and concentration issues while causing a surge of euphoria, or an intense “high.” Drugs wear off, however, and the “crash” that comes when drugs process out of the body can be more intense and cause PTSD symptoms to be even worse than they were before the drugs were introduced.

Regular drug abuse also changes the way the brain processes rewards and pleasure, and alters brain chemistry, which can lead to compulsive drug use, an inability to control dosages and overall use, and significant withdrawal symptoms when the drugs process out of the body. Addiction is a brain disease that requires specialized care to stabilize the brain and allow it time to heal. Addiction and PTSD can become complexly intertwined, and veterans who suffer from both will benefit most from integrated treatment that can provide care for both disorders at the same time.

Medications and Therapies for PTSD and Drug Abuse

PTSD is often treated with a combination of medications and therapeutic techniques, Psych Central publishes. Medications like antidepressants and sleep aids are often helpful to dispel the sleeplessness and negative emotional symptoms of the disorder. When drug abuse is also a factor, however, treatment providers may need to adjust the type of medication used.

Some medications are more prone to misuse and dependence, and others may react negatively with certain drugs of abuse, so these things need to be taken into consideration. Also, veterans commonly suffer from TBI, which can alter medication regimens as well.

Symptoms of drug withdrawal that often accompany addiction may also be optimally managed through medical detox, which regularly includes the use of medications for physical stabilization. A drug screening and thorough evaluation prior to admission into a treatment program can help medical, substance abuse, and mental health professionals to ensure that treatment protocols are safe and will aid in recovery for co-occurring disorders.

In addition to medications, co-occurring PTSD and drug abuse are treated with a variety of therapeutic methods. Therapy sessions often include individual, group, and family sessions. Veterans may benefit from group sessions that are comprised of other veterans who can empathize with and understand each other while working toward common goals. Families and spouses who attend therapy and counseling together can learn how to improve communication skills as well as become more educated on the disease of addiction and on PTSD treatment and recovery.

Therapy models often used to treat PTSD and addiction include:

  • Cognitive Behavioral Therapy (CBT): CBT helps a person identify triggers for negative thoughts that lead to self-destructive actions, learn how to cope with stress, and improve self-esteem and life functioning.
  • Exposure therapy: This form of CBT helps individuals to face their fears in a safe and controlled environment in order to learn how to work through painful emotions, fear, and anxiety.
  • Traumatic Incident Reduction (TIR) therapy: Painful and traumatic events are often “blocked” as a defense mechanism. TIR can help individuals to safely “unblock” and deal with difficult emotions and thoughts.
  • Contingency Management (CM): CM offers small rewards for remaining drug-free, which can provide motivation to remain abstinent and work toward recovery.
  • Cognitive Processing Therapy (CPT): This therapy model is trauma-focused. It can help individuals to understand how the trauma they have experienced affects their emotions and lives in general, and how to adjust for improved functioning.

Treatment Considerations for Veterans with Co-Occurring Disorders

PTSD and drug abuse can be treated on an outpatient or residential basis. The level of care needed will differ from person to person. Typically, in the case of co-occurring disorders, residential treatment programs can provide the highest standard of comprehensive care to help individuals reach healthy emotional and physical balance, free from drugs. Inpatient programs can provide around-the-clock mental health support and medical care as well as offer a highly structured and stable environment that may be highly beneficial for a military veteran.

A set sleeping, eating, and waking schedule is predictable, and this can enhance healing and ease stress. Medications can be properly managed, and therapy and counseling sessions, as well as life skills, relapse prevention, and educational workshops, are built into the daily schedule. Veterans will learn healthier ways for managing stress and coping with potential triggers without the need for mind-altering illicit drugs.

Holistic methods, like chiropractic care, acupuncture, spa treatments, massage therapy, yoga, equine therapy, mindfulness meditation, art therapy, fitness programs, and more, can all enhance a treatment program as adjunctive measures used in tandem with traditional care methods. Support groups that are comprised of other veterans can be very helpful in providing encouragement and aiding in building a healthy peer network of people who understand and support each other. Specialized treatment programs that understand the individual pressures of a military veteran and work to treat co-occurring drug abuse and PTSD in an integrated and simultaneous fashion can greatly enhance a long and sustained recovery.

Further Reading