PTSD & Substance Use Disorders Among Veterans: Treatment & Recovery

Veterans who struggle with post-traumatic stress disorder (PTSD) may also struggle with a addiction or other co-occurring mental health disorders.¹  PTSD and addiction can have a bidirectional relationship, meaning people with PTSD may use substances to cope with their symptoms and using substances can worsen PTSD symptoms.¹

If you’re a veteran who’s struggling, or you know someone who is, specialized treatment can help. Seeking dual diagnosis treatment which focuses on treating drug and alcohol addiction and PTSD at the same time can lead to positive outcomes.¹

What is PTSD?

PTSD is the acronym for post-traumatic stress disorder, which is a mental health disorder that some people may develop after exposure to actual or threatened death, serious injury or sexual violence.^{2, 9} Due to the nature of military life and work, veterans can have a risk of developing the disorder at some point, but anyone who has experienced trauma can develop PTSD.²

Symptoms of PTSD are intrusive, distressing, and can severely interfere with a veteran’s life, negatively affect their ability to effectively cope with stress, or impair their job or ability to work, interpersonal relationships, and other life situations.^{2, 9} In many cases, symptoms of PTSD develop soon after the traumatic event, but they can also start months or years afterward.²

The symptoms of PTSD include:²

• Reliving the traumatic event via recurrent, involuntary, and intrusive distressing memories, also known as flashbacks.
• Avoiding events or situations that remind you of the traumatic event, such as staying away from crowded areas or people who were also involved in the event.
• Having more negative thoughts and feelings after the event, such as mistrust, numbness, guilt, or shame.
• Feeling on edge or keyed up, which is also known as hyperarousal and can cause difficulty sleeping, concentrating, substance misuse, aggressive behaviors, and heightened startle responses.

Risk Factors for PTSD

As mentioned above, anyone can develop PTSD after a traumatic event, but Veterans may be particularly susceptible to the disorder due to the nature of their work and the challenges that they may face once they return home.³

Some of the risk factors for PTSD in Veterans include:

• Being exposed to a very long or intense trauma.²
• Experiencing sexual assault or combat.²
• Having a prior history of exposure to trauma.²
• Having little or no social support after the trauma.²
• Experiencing high levels of stress after the trauma.²
• Being hospitalized or injured during combat.³
• Having an SUD.³

PTSD and Drug or Alcohol Addiction Among Veterans

PTSD and SUDs are bidirectional, which means that each disorder can influence the other.¹ In a recent study of Veterans with PTSD and alcohol addiction, researchers explain that there different theoretical models regarding the relationship between SUD and PTSD, including:⁴

• The self-medication theory, meaning a person uses substances to self-treat their symptoms.
• The susceptibility theory, meaning using substances prevents proper trauma processing and worsens PTSD symptoms
• The mutual maintenance model, meaning there is a reciprocal relationship between PTSD and substance use, where people use substances to alleviate PTSD symptoms, but substances actually make PTSD worse because they interfere with the emotional processing of the trauma.

For example, military Veterans with PTSD who have trouble sleeping may use alcohol or drugs to experience drowsiness and fall asleep, but using alcohol this way can actually worsen sleep and increase the risk of SUD.¹ Similarly, Veterans with PTSD may feel numb or disengaged from their lives and use substances as a way of improving their mood, which it may do temporarily but as substance use continues it can also make these symptoms worse and result in SUD.¹ Substances may make it easier at first to avoid dealing with the trauma, but they can also worsen and lengthen the trauma and lead to SUD.¹

If you’re struggling, you’re not alone. According to the U.S. Department of Veterans Affairs (VA):¹

• More than 2 out of 10 Veterans with PTSD also have an SUD.
• 1 out of 3 veterans with an SUD also has PTSD.
• Around 1 in 10 returning Veterans from the wars in Iraq and Afghanistan seen at the VA have a problem with alcohol or other drugs.
• War Veterans with PTSD and alcohol problems tend to binge drink, meaning consuming around 4-5 drinks or more in about 1-2 hours.

Treatment for PTSD and Addiction

Receiving evidence-based treatment for the dual diagnosis of PTSD and SUD is one of the most effective way to treat both conditions and can lead to positive outcomes, including improvements in both PTSD and SUD symptomatology.^{1, 4} The VA offers many services and treatments for co-occurring PTSD and addiction, as do private rehab centers like American Addiction Centers (AAC).⁵

Veterans’ dual diagnosis treatment for addiction and PTSD can take place in different settings, including inpatient rehabs and outpatient clinics that offer specialized programs for Veterans.⁵ Treatment can involve different types of therapies in group or individual settings. ⁵ Veterans can also receive medications for PTSD as well as medications for opioid and alcohol use disorders.^{1, 3}

Trauma-focused therapies for Veterans can include:

• Cognitive processing therapy (CPT), which helps people change the way they understand and think about the trauma.^{1, 2}
• Prolonged exposure (PE), which involves talking about the trauma until it is no longer upsetting.^{1, 2}
• Eye movement desensitization and reprocessing (EMDR), which involves focusing on hand movements or sounds while talking about the trauma with a therapist.^{1, 2}

Treatments for SUD in Veterans can include:

• Cognitive-behavioral therapy (CBT), which helps people identify and replace unhelpful thoughts and behaviors related to substance use.^{1, 6}
• Contingency management (CM), which provides positive reinforcements, such as tangible rewards, when a person achieves desired behavioral outcomes, like negative drug tests.^{1, 6}
• Relapse prevention, which teaches people necessary skills so they can avoid substance use and achieve long-term recovery.⁵

Veterans may also participate in evidence-based therapies for co-occurring SUD and PTSD, including:

• COPE, a specific type of therapy for SUD and PTSD.¹ This is a highly structured form of CBT that involves 12 weekly, 90-minute sessions to help people achieve specific treatment goals.⁷
• Seeking Safety (SS), which is a present-focused coping skills-based treatment for co-occurring SUD and PTSD.⁴

VA Drug & Alcohol Addiction Treatment Programs

Veterans who are enrolled in the VA’s healthcare program may access rehab or addiction treatment services through the VA’s healthcare system.⁵ People who are not yet enrolled in the VA health care program can contact the VA at 1-800-827-1000, or visit the VA’s enrollment website.⁵

The VA also offers addiction and PTSD treatment through its community care provider network when the VA is unable to provide care.⁸ This means that Veterans who have received prior approval from the VA can obtain treatment from private rehabs that are approved as external providers by the VA.⁸ To learn more, you can visit the VA’s community care website.

Find Veterans PTSD & Addiction Treatment Centers Near You

If you’re a Veteran who’s struggling with PTSD and substance use, or you know someone who is, you should understand that dual diagnosis treatment can help people take back control of their lives and start the path to recovery. The first step might be to speak to your VA healthcare provider or your family physician to discuss your treatment needs and options and ask for referrals to treatment centers.

You can also use our Rehabs.com directory to find suitable rehabs that offer specialized treatment programs for Veterans across the country. Or call us at to speak to a knowledgeable admissions navigator about your rehab options and verify your insurance benefits.