Helping Veterans With PTSD and Substance Use

Anyone can suffer from posttraumatic stress disorder (PTSD). However, veterans develop the disorder at higher rates than the general population.

According to the National Center for PTSD, 7 to 8% of American adults will experience PTSD at some point in their lives compared to an estimated 30% of Vietnam Veterans, 12% of Gulf War Veterans and between 11% and 20% of those who served in the Global War on Terrorism in the Middle East.

Veterans returning home from combat zones are developing PTSD and experiencing symptoms that interfere with their daily lives, such as flashbacks, feelings of detachment and a distorted sense of self-blame or blaming others, becoming aggressive, reckless or displaying self-destructive behavior, according to the American Psychiatric Association.

As a result, relationships suffer, maintaining a job or staying in school becomes difficult or nearly impossible, and stress can cause someone to turn to drugs or alcohol to escape or distract from difficult emotions.

“War veterans with PTSD and alcohol problems tend to be binge drinkers. Binges may be in response to bad memories of combat trauma,” according to the center’s website.

Of those diagnosed with PTSD, 20% develop a substance use disorder (SUD), the National Center for PTSD reports.

Effects of Comorbid Disorders: PTSD and SUD

Using drugs and alcohol can worsen PTSD symptoms.

When the disorders co-occur, individuals may experience an increase of chronic physical health problems, increase of risk of violence, poor social functioning, higher rates of suicide attempts, worse treatment adherence and less improvement during treatment, according to a 2012 report published in Clinical Psychology Science and Practice.

People living with co-occurring disorders “report more intense cravings for drugs and alcohol and tend to relapse more quickly than individuals without PTSD upon completion of SUD treatment,” according to a 2012 report published in Current Psychiatry Reports.

Due to the prevalence of PTSD and substance use disorders co-occurring, mental health professionals continue to focus on advancing treatment options. 

Mental Health Care for Veterans: Treatment Options

The co-occurrence of PTSD and substance use disorders can be more difficult than treating each disease separately. However, it’s vital that they are treated simultaneously.

Florida Tech psychology professor Natalie Fala currently works with the Department of Veterans Affairs as a PTSD/substance use disorder psychologist. She says, “This job is important because it’s common for PTSD and substance use disorders to present together. We used to think that people needed to take care of their substance use first, and then we could treat their PTSD, but we’re finding out that we can treat both of these things at the same time, and it’s really important that we do this.”

According to the National Center for PTSD, treatment options that address both conditions can include a combination of psychotherapy and/or medications.

“Trauma-focused psychotherapies are the most highly recommended type of treatment for PTSD,” the center reports. These types of treatments focus on the memory of the traumatic event or its meaning. 

Fala says:

“There’s a lot of recent breakthroughs related to the treatment of PTSD as it relates to providing psychological services. A lot of the focus on the field is focused on helping people find ways to address their trauma instead of avoiding their trauma.

What we find out is avoiding trauma actually helps maintain the PTSD symptoms. So, we want to find ways to help people talk about their trauma, integrate it, and work through it so it’s not impacting every aspect of their lives.

We do that through a different, a few different psychotherapy approaches…All of these different therapies focus on helping people work through their traumas, address them, so they can move forward with their lives instead of feeling like they’re held back by the difficult experiences that they’ve had.”

Common techniques include visualizing, talking or thinking about the traumatic event. According to the center, those with the strongest evidence include Prolonged Exposure, Cognitive Processing Therapy and Eye-Movement Desensitization and Reprocessing.

Other types of trauma-focused psychotherapy include Brief Eclectic Psychotherapy (BEP), Narrative Exposure Therapy (NET), Written Narrative Exposure and Cognitive Behavioral Therapy (CBT) for PTSD. 

Fala says that there are some alternatives to trauma-focused therapies.

“Now I must say that not everybody gets to a place where they’re gonna work through these therapies, and that’s okay. Sometimes treatment just focuses on safety and stabilization, helping people be in the present moment, enjoy the present moment and not have to be caught up by what happened in the past or anticipating what’s gonna happen in the future.

So, a lot of therapies that I like to use, and many people tend to enjoy as well maybe compared to doing some of that more trauma-focused work, is things like mindfulness, so helping us focus on the present moment, getting the most out of the present moment while also being able to enjoy it.

And of course there’s other things, too. Like just finding ways to find balance in your life, enjoy your life, and take care of yourself are all really important aspects of treating PTSD.”

More of those other options are listed by the National Center for PTSD and include Stress Inoculation Training (SIT), which focuses on teaching skills and techniques to manage stress and reduce anxiety, Present-Centered Therapy (PCT), which focuses on current life problems that are related to PTSD, and Interpersonal Psychotherapy (IPT), which focuses on how trauma is affecting interpersonal relationships.

Research for these types of treatments is not as strong as trauma-focused psychotherapy, but it can help in dealing with the symptoms.

Research for substance use is also not as strong, according to Fala:

“Substance abuse is something that I think we need to continue to research. There’s a lot of other concerns out there that tend to get a lot more research attention than substance use does, but I would say that the thing that we’re really emphasizing for people and the veterans that I treat is getting them connected to their communities. Substance use tends to be a really isolating condition, especially when people have been really active in their addiction for a long time. So, we want to get them back out in their communities, engaged, and allowing themselves to feel fulfilled in meaningful activities.

So, while abstinence is our goal, we recognize that abstinence isn’t always possible for everyone. So, we might work on harm reduction techniques just to make their use as harmless as possible. Of course use is never going to be completely harmless, but it’s better than being fully engaged in that active cycle of addiction.

So just like with trauma work, we want to help people find ways to enjoy their lives and without the use of substances. So…getting connected to their communities, but also finding activities that bring them purpose and meaning, because it’s believed that those activities will crowd out that substance use so that’s it’s no longer a primary focus or drive in their lives.”

Medications may also be helpful when treating co-disorders. Those used to treat PTSD symptoms are also used for treating depression and anxiety.

Treatment options should be discussed with healthcare providers and monitored closely to determine the type of care that yields the best results for the individual.

While treatments vary depending on individual needs and outcomes, it does provide the “opportunity to improve systems, personal and professional relationships, and quality of life,” the center reports.

Where To Start?

The U.S. Department of Veterans Affairs provides information and programs for treatment options. Veterans who may be suffering from PTSD and SUD can start by locating a PTSD program through the U.S. Department of Veterans Affairs PTSD Program locator or Substance Use Disorder Program locator online. There is an SUD-PTSD Specialist trained in treating both disorders at each VA medical center.

For SUD treatment outside of the VA, veterans can use the Substance Abuse and Mental Health Services Administration’s online treatment locator to find treatments near you.

Anyone needing immediate assistance is urged to call the Veterans Crisis Line (1-800-273-8255).

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