More than 10 percent of U.S. veterans have been diagnosed with a substance use disorder (SUD), slightly above the rate in the general population. Male veterans aged 18-25 years have the most significant rates.
Alcohol and marijuana are some of the most popular substances that veterans use. However, smoking and misuse of legal prescription medications are also relatively common.
SUD in veterans may co-occur with other mental health issues, such as post-traumatic stress disorder (PTSD). Many veterans experience other concerns that increase the risk of substance misuse, including chronic pain, suicide ideation, difficulty adjusting to civilian life, and homelessness.
Due to their particular experiences and struggles, veterans may require more specialized treatment strategies for SUD. Here are some things that therapists should keep in mind when working with veterans affected by SUD.
Understand the barriers to care
According to a report by the Institute of Medicine, numerous factors can prevent veterans and active duty servicemembers from getting SUD treatment. These include:
- Insurance coverage gaps
- Fear of negative impact on career or relationships
- Stigma
- Lack of confidentiality
- Belief that a person doesn’t need help
Therapists should be aware of these barriers to care and consider how to reduce them.
Besides providing treatment themselves, therapists can direct veterans with SUD to a variety of resources. For example, each Veterans Affairs medical center offers treatment options. The U.S. military’s Tricare health system for active duty personnel has information about drug and alcohol use on its website.
Consider a variety of treatment options
Like other mental health concerns, SUD in veterans may require a combined approach. This could include cognitive behavioral therapy, possibly with contingency management, and medication.
Relapse prevention is crucial for SUD treatment. This strategy includes its own set of techniques, including:
- Identifying triggers for drug use and relapse
- Developing coping skills to manage cravings
- Relapse prevention plans
- Monitoring for early warning signs of relapse
- Creating a supportive social network
- Making necessary lifestyle changes
Behavioral health providers may want to tailor their SUD treatment plan to address other, specific symptoms or conditions that accompany substance misuse. This could include pain management techniques for veterans struggling with an addiction to pain medication. Sleep problems, anger, and social disconnection may also contribute to SUD and should be addressed as part of treatment.
Treatment for SUD may have to include PTSD
According to the U.S. National Center for PTSD, more than 20 percent of veterans with PTSD also have SUD. Of those veterans seeking treatment for SUD, nearly one-third of them also have PTSD. Behavioral health providers who serve veterans with SUD should be prepared to address PTSD.
One option for addressing both conditions is the Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) program. This therapeutic approach combines prolonged exposure therapy for PTSD with relapse prevention for SUD.
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