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This article will provide a brief review of some potential causal mechanisms underlying this relationship, including self-medication and genetic vulnerability models. It also addresses the possible implications for assessment and treatment of military personnel with co-occurring disorders. NIDA and other government agencies continue to research strategies for managing substance use disorders and related mental health issues in people with military experience. The research questions can be complex and vary with different population subtypes, and can reveal the need for additional research directions. Given the extensive exposure to traumatic events among military personnel, PTSD has emerged as the 3rd most prevalent diagnosis in veterans using VA services, after pain disorder and depression (Stecker, Fortney, Owen, McGovern, & Williams, 2010). Prevalence rates of PTSD among returning veterans have varied widely (estimates ranging from 5-50%), due to differences across study populations and diagnostic definitions used to determine PTSD status (Ramchand et al., 2010).
His treatment provider continued monitoring his PTSD symptoms across the course of treatment, and his scores on the PTSD Checklist indicated persistence in his PTSD symptoms. As the veteran felt more comfortable with the therapeutic process, he agreed to engage in PTSD-focused therapy in both individual and group settings. The veteran began attending Seeking Safety (Najavits, 2002), a coping-skills based group therapy for co-occurring PTSD and substance use disorders.
Military Post Traumatic Stress Disorder
MBC is the use of patient-reported information, collected as part of routine care, to inform clinical care and shared decision making, individualize treatment, and assess progress toward recovery goals. VA’s initiative will use the PTSD Checklist for DSM-5 (PCL-5) for assessing PTSD and the Brief Addition Monitor for assessing SUD. CPT can be done in either a group or individual format, usually for about 12 sessions lasting 60 to 90 minutes each. During this treatment, your therapist will teach you how to use tools to test out your thoughts about the trauma, and you will decide if these thoughts are based on facts or feelings. You will also come up with more balanced thoughts and work toward accepting what happened.
This article will examine the links between military traumatic stress and mental health problems, such as posttraumatic stress disorder (PTSD) and between military traumatic stress and problematic alcohol use. Furthermore, it will summarize the pathways that may explain ptsd and alcoholism these links and describe possible implications for assessment and interventions with veterans. To summarize the literature to date, comorbid PTSD and alcohol use disorder has emerged as a highly prevalent and increasingly recognized problem in U.S. veteran populations.
Substance use treatment for Veterans
Difficulty with anger and concentration are symptoms of PTSD, not signs that your partner doesn’t love you. If your partner seems irritable or has a hard time remembering what you said, try not to take it personally. Let your loved one know that you won’t judge him or her no matter what he or she has been through. Sometimes people who have PTSD think that their family members will be shocked to learn about some of the things they did while deployed and will no longer love them. This may cause them not to talk about their experiences, which will worsen their PTSD.
- To improve access to optimal care, in 2008 VA authorized funding for an SUD specialist to augment each facility’s specialty PTSD treatment services.
- Service members can face dishonorable discharge and even criminal prosecution for a positive drug test, which can discourage illicit drug use.
- However, despite a strong theoretical base, integrated, exposure-based treatments for comorbid PTSD and alcohol use disorder have not been widely disseminated, given that attrition rates were higher than 50% (Coffey et al., 2010).
- Further, many clinicians have considered exposure-based treatments unsafe for patients with comorbid PTSD and alcohol use disorder, such that triggering negative affect may lead to even riskier substance use behaviors.
- Recommended psychotherapies include prolonged exposure therapy, cognitive processing therapy, and eye movement desensitization and reprocessing.
- NIDA and other government agencies continue to research strategies for managing substance use disorders and related mental health issues in people with military experience.
The 2017 VA/DoD Clinical Practice Guideline for PTSD recommends that evidence-based treatments for PTSD and SUD, including psychotherapy and medication, be available to Veterans and that having one disorder not preclude Veterans from getting evidence-based treatment for the other disorder (25). The VA Uniform Mental Health Services Handbook https://ecosoberhouse.com/article/boredom-drinking-and-how-to-stop-it/ (28) requires that all VA Medical Centers provide access to either PE or CPT for Veterans wit PTSD. Thus, PE and/or CPT should be accessible to Veterans with PTSD and co-occurring SUD. To our knowledge, no study has examined strategies that aim to prevent the development of comorbid PTSD and AUD in military and veteran populations.
Descriptive Data
The veteran endured severe PTSD symptoms throughout the 40 years since returning from Vietnam, and his primary coping strategy was alcohol use. After witnessing the death of his friend in Vietnam, he avoided forming close attachments with friends or family, stating, “Vietnam taught me to never get too close to anyone.” His vivid nightmares, which often frightened intimate partners, made living alone seem the best option. He described a feeling of “invincibility” after surviving Vietnam, and he frequently engaged in risk-taking or adrenalin-seeking activities (such as dirt bike riding). This case study highlighted the long-lasting, chronic effects of combat-related trauma on multiple aspects of one’s life, including social, occupational, and psychological functioning.
- While preferable to sequential treatment, patients typically receive PTSD and alcohol use disorder treatment from different providers and clinics, which can result in an uneven and confusing approach.
- Interestingly, location of deployment and the likelihood of exposure to enemy hostility appeared to be more related to severity of PTSD symptoms (Allison-Aipa, Ritter, Sikes, & Ball, 2010), while multiple deployments were more related to increased alcohol related problems (Fontana & Rosenheck, 2010).
- Frequent heavy drinking also varied as a function of ethnicity, with Hispanic and non-Hispanic Whites exhibiting higher rates of problematic drinking than non-Hispanic Blacks.
- Try to remember that when you feel like you don’t want to do something, this is often a symptom of PTSD, and it keeps PTSD going.
- Research on the self-medication hypothesis and genetic studies suggests that alcohol misuse following military trauma is likely to be highly related to the co-occurrence of PTSD and other post-traumatic psychiatric problems.
The use of a cross-sectional design precludes the ability to make claims of causality. Thus, our findings suggest only associations among PTSD symptoms, self-compassion, fear of self-compassion, and alcohol misuse. Future work should incorporate prospective and longitudinal assessment to gain insight into the direction of these associations. An additional limitation is the data were collected using self-report assessments, and therefore, the responses may be subject to response biases (e.g., socially desirable responding). Furthermore, the use of self-report may be limited by the insight and/or willingness of the participants to respond accurately. Future research should incorporate additional methods of assessment to reduce the limitations of self-report assessments and add to the validity of the findings.
What Makes PTSD Worse?
Beginning with the Vietnam War, and more recently with the wars in Iraq and Afghanistan (Department of Defense [DOD], 2007, p. ES-1), PTSD has been the most commonly diagnosed mental health disorder for veterans returning from combat. These disruptions often lead to an impaired ability to function in social, educational, and work environments, making PTSD a very debilitating condition. More recently, research has found that PTSD and related disorders, such as depression, can develop in military personnel not only as a result of combat exposure but also as a result of childhood traumas, military sexual trauma (MST), mortuary affairs duty, and training accidents (Foa et. al. 2009).
