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Navigating PTSD and Substance Use in Veterans

Last Updated: November 3, 2023

Editorial Policy | Research Policy

Facing the aftermath of service, some veterans resort to using substances as a way to cope with their PTSD symptoms. Fortunately, treatments that address both addiction and PTSD together are available. 

Transitioning to civilian life can trigger various challenges stemming from military experiences. A higher susceptibility to post-traumatic stress disorder (PTSD) is one of these challenges, often leading to substance misuse. The coexistence of PTSD and substance abuse is often a direct consequence of military service, but effective treatment offers a path to recovery.

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Unpacking PTSD

Post-Traumatic Stress Disorder (PTSD) is a mental health condition triggered by exposure to a traumatic event. It may result from direct exposure to trauma, such as facing a threat from a weapon,, or from witnessing or hearing about traumatic events affecting others. Individuals with PTSD encounter intrusion symptoms, including flashbacks, unwanted memories tied to the trauma, nightmares, and intense psychological reactions triggered by reminders of the event.

PTSD involves efforts to avoid memories or triggers linked to the trauma, as well as changes in mood and behavior. Individuals with PTSD might consistently display negative emotions, place blame on themselves for the traumatic event, or withdraw from social interactions. Experiencing positive emotions like happiness becomes challenging, and sudden outbursts of anger, risky behavior, and sleep difficulties can manifest.

The Co-Occurrence of PTSD and Substance Abuse in Veterans

Veterans living with PTSD face a heightened risk of developing substance use disorders (SUD) or addictions. When PTSD and substance use disorder coexist, it’s termed as co-occurring disorders. Research indicates that nearly 50% of individuals with PTSD have co-occurring substance use disorders. Furthermore, data from the Veterans Administration shows that over 2 out of 10 veterans with PTSD also contend with substance use disorder.

The Connection Between Alcohol Addiction and PTSD

Among veterans dealing with PTSD, alcohol may become a temporary escape from negative emotions or distressing memories. Unfortunately, as tolerance builds and the effects of alcohol lessen, individuals may require larger amounts to achieve the same effects. Over time, untreated PTSD increases the risk of alcohol addiction and contributes to deteriorating mental health. Research suggests that up to two-thirds of veterans seeking treatment for alcohol addiction at the VA also have PTSD.

Exploring Drug Addiction and PTSD

Veterans burdened by PTSD are also at risk of developing drug addictions. Research involving veterans from conflicts like Iraq and Afghanistan indicates that male veterans are susceptible to using drugs as a means to self-medicate PTSD symptoms. In the case of female veterans, drug abuse is linked to future PTSD symptoms, revealing distinct gender differences in the relationship between drug addiction and PTSD. Veterans wounded in combat may be especially susceptible to opioid addictions due to their potential reliance on prescription painkillers for chronic pain treatment.

Recognizing PTSD Triggers and Symptoms in Veterans

Veterans contending with PTSD often encounter triggers that activate their symptoms. Triggers can be events or memories that evoke the onset of PTSD symptoms. For instance, loud noises reminiscent of explosions or gunfire can trigger symptoms like anger outbursts, heightened startle responses, or behaviors such as substance misuse. When PTSD symptoms emerge, they typically fall into the following categories:

Intrusion Symptoms

  • Unwanted intrusive thoughts related to the traumatic event
  • Disturbing nightmares associated with the trauma
  • Flashbacks that recreate the traumatic event
  • Intense stress triggered by reminders of the trauma
  • Physiological reactions upon encountering reminders of the trauma (e.g., elevated heart rate)

Avoidance Symptoms

  • Efforts to avoid triggers associated with the traumatic event
  • Attempts to suppress distressing memories or thoughts about the event

Changes in Mood

  • Inability to recall specific details of the traumatic event
  • Distorted negative thoughts, such as viewing the world as unsafe
  • Placing blame on oneself or others for the event
  • Consistently experiencing negative emotions like shame, guilt, anger, and fear
  • Loss of interest in previously enjoyed activities
  • Feeling emotionally disconnected from others
  • Inability to experience joy, happiness, or other positive emotions

Alterations in Arousal and Reactivity

  • Unexpected outbursts of anger
  • Engagement in self-destructive behaviors
  • Hyper-vigilance towards surroundings
  • Experiencing heightened startle responses
  • Difficulty concentrating
  • Disrupted sleep patterns

Effective Strategies for Veterans with Co-Occurring PTSD and SUD

Managing PTSD and substance abuse in veterans demands comprehensive strategies that tackle both conditions simultaneously. Several effective approaches are utilized to treat these conditions:

  • Therapies: Talk therapy, specifically cognitive processing therapy (CPT) and prolonged exposure (PE), play a pivotal role in treating co-occurring PTSD and SUD in veterans. These cognitive behavioral therapies (CBT) offer substantial benefits.
  • Medications: Medications can aid veterans in managing symptoms of both PTSD and addiction. Antidepressants are often prescribed to alleviate PTSD symptoms. Medications can also assist in managing withdrawal symptoms and cravings for drugs and alcohol.
  • Group Therapy: Group therapy is an essential component of treatment programs for veterans. Some treatment centers offer groups tailored specifically for trauma survivors, including veteran-only groups.
  • Inpatient Rehabilitation: In specific cases, veterans might benefit from embarking on their recovery journey with inpatient rehabilitation. These programs allow veterans to reside within a treatment facility, providing a controlled environment and separating them from triggers during treatment.

Supporting Veterans with Co-Occurring PTSD and SUD

If you know a veteran dealing with both PTSD and addiction, your support can be transformative. Here’s how you can make a difference:

  • Educate Yourself: Learn about their symptoms and triggers. This knowledge empowers you to provide additional support during exacerbations of symptoms and helps you recognize distressing situations to help them steer clear of triggers.
  • Practice Patience: Understand that living with PTSD can lead to changes in behavior and mood. Display patience and empathy, knowing that these changes are a result of their mental health condition rather than how they feel about you.
  • Encourage Seeking Treatment: Veterans with co-occurring PTSD and SUD achieve optimal outcomes when they engage in treatment. Encourage them to seek professional help and support them in scheduling and attending appointments.

Additional Resources for Veterans

For veterans seeking additional resources concerning PTSD, consider the following:

  • VA Benefits Hotline: Reach out to the toll-free number 855-586-2889 available from Monday to Friday, 8:00 a.m. to 9:00 p.m. ET.
  • The VA Mental Health Page: Explore information about VA programs and treatment options on the VA’s mental health page.
  • National Center for PTSD: Gain access to research publications and information about PTSD treatment through the National Center for PTSD’s website.
  • Explore expert information about mental health treatment after deployment on the website. This resource offers guidance on recognizing the need for assistance.

Get Specialized Veteran Support

The Recovery Village facilities have helped thousands of veterans overcome drug or alcohol addiction and co-occurring mental health needs. Our Veteran Advocates can help you navigate the VA on your behalf and help you enter treatment faster.


Mann, Sukhmanjeet & Marwaha, Raman. “Posttraumatic Stress Disorder.” National Library of Medicine, January 30, 2023. Accessed September 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.” Clinical Psychology (New York), 2012. Accessed September 6, 2023.

U.S. Department of Veterans Affairs. “PTSD and Substance Abuse in Veterans.” Accessed September 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.” Drug and Alcohol Dependence, January 2019. Accessed September 6, 2023. 

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

Dembek, Zygmunt & Chekol, Tesema. “The Opioid Epidemic: Challenge to Military Medicine and National Security.” Military Medicine, 2020. Accessed September 6, 2023.

National Center for PTSD. “Effective Treatments for PTSD: Consider Cognitive Behavioral Therapy (CBT) as First Line Treatment.” January 2015. Accessed September 6, 2023.