PTSD & Substance Use Disorder in Veterans

Written by Abby Doty

& Medically Reviewed by Jenni Jacobsen, LSW

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Last Updated - 08/29/2023

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Updated 08/29/2023

Coming home after serving the country can also bring traumatic memories and PTSD. Many veterans may cope with this by heavily or frequently using substances.

Veterans often grapple with the aftermath of their service experiences when transitioning back to civilian life. This can lead to an increased likelihood of developing post-traumatic stress disorder (PTSD) due to exposure to traumatic events. Additionally, veterans may struggle with substance abuse issues, which can often be linked to their PTSD.

When a veteran is diagnosed with both PTSD and a substance use disorder, this is referred to as dual diagnosis. This combination of conditions among veterans can be a direct result of the impact of warfare, but recovery is possible with comprehensive treatment.

Understanding PTSD

PTSD is a psychological disorder that can develop after exposure to a traumatic event, such as a severe accident or a violent death. It can occur due to direct exposure to trauma, like being threatened with a weapon, or indirectly, such as witnessing or learning about a traumatic event.

Individuals with PTSD often exhibit intrusion symptoms, including flashbacks of the traumatic event, unwanted memories, nightmares and severe psychological reactions when confronted with reminders of the event.

People with PTSD may also try to avoid memories or reminders of the traumatic event, leading to changes in mood and behavior. These changes can result in persistent negative moods and self-blame for the traumatic event. It’s also common for individuals with PTSD to withdraw from social interactions and struggle to experience positive emotions.

Prevalence of PTSD and Substance Abuse Among Veterans

Veterans diagnosed with PTSD are more likely to develop substance use disorders or addictions — called dual diagnosis. Research indicates that nearly half of individuals with PTSD also struggle with a substance use disorder. Moreover, the Veterans Administration reports that over 20% of veterans with PTSD also have a substance use disorder.

PTSD & Alcohol Addiction

Alcohol misuse and PTSD are common issues among veterans. They may use alcohol as a temporary escape from negative emotions or to suppress painful memories if they have PTSD. However, as tolerance to alcohol builds, larger quantities are needed to achieve the same effects.

If PTSD remains untreated and alcohol consumption increases, the individual is at risk of developing alcohol dependence. This can then worsen mental health issues. Research shows that up to two-thirds of veterans seeking treatment for alcohol dependence from the VA also have PTSD.

PTSD & Drug Addiction

Veterans with PTSD are also at risk of developing drug addictions. Studies involving veterans of the Iraq and Afghanistan wars indicate that male veterans may use drugs to self-medicate PTSD symptoms. For female veterans, drug misuse is linked to future PTSD symptoms, suggesting that the relationship between drug addiction and PTSD varies between genders. Veterans injured in combat may be particularly susceptible to opioid addiction, as they may become reliant on prescription painkillers used to manage chronic pain. In such cases, PTSD and substance misuse may not be directly related.

Identifying Triggers & Symptoms of PTSD in Veterans

Veterans with PTSD often encounter triggers that can provoke symptoms of the disorder. These triggers can be events or memories that cause PTSD symptoms to surface. For example, loud noises reminiscent of explosions or gunfire can trigger symptoms like anger outbursts, a heightened startle reflex or destructive behavior such as substance misuse.

Symptoms of PTSD can be categorized as follows:

  1. Intrusion Symptoms
  • Recurrent thoughts related to the traumatic event
  • Disturbing nightmares about the trauma
  • Flashbacks, which means the trauma feels as if it’s happening again
  • Severe stress when confronted with reminders of the traumatic event
  • Physiological reactions to reminders of the trauma, such as increased heart rate
  1. Avoidance Symptoms
  • Efforts to avoid reminders of the traumatic event
  • Attempts to suppress distressing thoughts or memories of the event
  1. Negative Shifts in Mood
  • Inability to recall details of the traumatic event
  • Pervasive negative thoughts, such as believing the world is dangerous
  • Misplaced self-blame or blaming others for the trauma
  • Persistent negative emotions, including shame, guilt, anger and fear
  • Loss of interest in usual activities
  • Feeling disconnected from others
  • Inability to experience positive emotions
  1. Changes in Arousal and Reactivity
  • Sudden anger outbursts
  • Engaging in risky behavior
  • Hypervigilance
  • Being easily startled
  • Difficulty concentrating
  • Sleep disturbances

Treatment Options for Veterans with Co-Occurring PTSD & SUD

The most effective treatment for veterans with dual diagnosis involves integrated approaches that simultaneously address PTSD and addiction. Some common treatment modalities include:

  • Therapies: Talk therapy is often used to treat dual diagnosis in veterans. Cognitive processing therapy (CPT) and prolonged exposure (PE), both forms of cognitive behavioral therapy (CBT), have been found particularly effective for this population.
  • Medication: Some veterans may find relief from PTSD and addiction symptoms through medication. Antidepressants can help manage PTSD symptoms, while other drugs can help manage withdrawal symptoms and cravings related to substance misuse.
  • Group treatment: Group therapy is a crucial part of treatment programs for veterans. Some centers offer groups specifically for individuals with trauma, and some may even provide veteran-only groups.
  • Inpatient rehab: In some cases, veterans may benefit from starting their recovery journey in an inpatient rehab facility. These programs provide a safe environment away from everyday triggers, allowing veterans to focus on their treatment.

Supporting a Veteran with Dual Diagnosis

If a veteran in your life is struggling with dual diagnosis, they need your support. Here’s how you can help:

  • Understand their symptoms and triggers: Knowing their symptoms and triggers can help you provide support when they’re struggling and avoid situations that might be distressing for them.
  • Be patient: Veterans with dual diagnosis may exhibit changes in behavior and mood, such as anger outbursts, negative emotions and a lack of interest in usual activities. Remember, this behavior is a reflection of their mental health and not a reflection of their feelings toward you. Patience and understanding are crucial.
  • Encourage treatment: Veterans with dual diagnosis have the best chance at recovery if they engage in treatment. Encourage them to seek professional help and maintain their treatment schedule. You could even assist them in scheduling appointments or accompany them to show your support.

Additional Resources for Veterans

Here are some additional resources that can be beneficial for veterans with PTSD:

  • VA Benefits Hotline: The hotline is available Monday through Friday from 8:00 a.m. to 9:00 p.m. ET at 800-827-1000.
  • The VA Mental Health Page: This page provides mental health information about VA programs and treatment options.
  • National Center for PTSD: For research publications and information about PTSD treatment, this site offers helpful information.
  • This website provides expert advice related to mental health treatment after deployment, including guidance on when to seek help.

View Sources

Mann, Sukhmanjeet & Marwaha, Raman. “Posttraumatic Stress Disorder.“>Posttrau[…]ess Disorder.” National Library of Medicine, January 30, 2023. Accessed July 6, 2023.

McCauley, Jenna; Killeen, Therese; Gros, Daniel; Brady, Kathleen; & Back, Sudie. “Posttraumatic Stress Disorder and Co-Occurring Substance Use Disorders: Advances in Assessment and Treatment“>Posttrau[…]and Treatment.” Clinical Psychology (New York), 2012. Accessed July 6, 2023.

U.S. Department of Veterans Affairs. “PTSD and Substance Abuse in Veterans.“>“PTSD […] in Veterans.” Accessed July 6, 2023.

Straus, Elizabeth; Norman, Sonya; Haller, Moira; Southwick, Steven; Hamblen, Jessica; & Peitrzak, Robert. “Differences in protective factors among U.S. Veterans with posttraumatic stress disorder, alcohol use disorder, and their comorbidity: Results from the National Health and Resilience in Veterans Study.“>Differen[…]terans Study.” Drug and Alcohol Dependence, January 2019. Accessed July 6, 2023.

Livingston, Nicholas, et al. “Longitudinal assessment of PTSD and illicit drug use among male and female OEF-OIF veterans.“>Longitud[…]OIF veterans.” Addictive Behaviors, July 2021. Accessed July 6, 2023.

Dembek, Zygmunt & Chekol, Tesema. “The Opioid Epidemic: Challenge to Military Medicine and National Security“>The Opio[…]onal Security.” Military Medicine, 2020. Accessed July 6, 2023.

National Center for PTSD. “Effective Treatments for PTSD: Consider Cognitive Behavioral Therapy (CBT) as First Line Treatment“>Effectiv[…]ine Treatment.” January 2015. Accessed July 6, 2023.


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