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Healing Trauma and Substance Use in Self-Medicating Veterans

Last Updated: February 9, 2024

Editorial Policy | Research Policy

According to the US Department of Veterans Affairs, about 7% of military veterans will grapple with post-traumatic stress disorder (PTSD) at some point in their lives. Exposure to combat, traumatic events and life-threatening situations can make veterans more susceptible to trauma-related behavioral and mental health challenges compared to the general population.

Regrettably, there's a robust link between trauma and self-medication. Research indicates that nearly 50% of individuals diagnosed with PTSD also contend with a co-occurring substance use disorder. Many experts believe this connection arises from the tendency to self-medicate — using substances as a temporary escape from the memories and emotions tied to traumatic experiences.

However, as the effectiveness of substances wanes, self-medication can develop into a full-blown substance use disorder. Untreated trauma and substance use disorders perpetuate a cycle of worsening mental and behavioral health challenges.

To effectively address these issues, clinicians often tackle both trauma and substance use concurrently. Treatment programs may even incorporate veteran support groups to personalize treatment. Fortunately, evidence-based treatments, offered through various modalities, can effectively aid self-medicating veterans on their path to recovery.

Understanding Self-Medication as a Response to Trauma

Veterans dealing with trauma may encounter a range of symptoms. According to the American Psychiatric Association, PTSD symptoms include:

  • Intrusive thoughts, which may involve disturbing dreams and vivid flashbacks
  • Avoidance of people, places or situations that may trigger distressing memories, events or emotions
  • Distorted thoughts about the traumatic event or an inability to remember it accurately
  • Mood swings

To cope with these symptoms, veterans may turn to drugs and alcohol. Substances might offer temporary relief by aiding sleep, providing comfort in specific situations or serving as a distraction from problems resulting from PTSD, such as strained relationships or employment issues. However, self-medication only perpetuates the cycle of avoidance.

While self-medication may initially provide momentary relief, PTSD symptoms generally worsen over time. This can disrupt sleep, alter mood and reduce the effectiveness of prescribed psychiatric medications. Evidence supports the most effective approach, which involves concurrently addressing both PTSD and substance use disorder.

A Holistic Approach to Care for Veterans with Trauma and Co-Occurring Substance Use Disorders

Veterans seeking treatment usually embark on a continuum of care tailored to their individual needs. They typically undergo assessments for substance use and psychiatric concerns to determine the most suitable level of care. In cases where veterans require structured and supervised recovery, clinicians may recommend residential or inpatient facilities.

If medically necessary, individuals may undergo supervised detox, safely withdrawing from substances. Many detox facilities employ medication-assisted treatment (MAT) to ensure a safe and comfortable experience. These acute care levels aim to stabilize individuals and prepare them for transitions into less intensive care.

While the specifics of each care plan depend on the veteran's needs, residential treatment may be followed by a partial hospitalization program (PHP), an intensive outpatient program (IOP), regular outpatient programs and aftercare services. Aftercare for veterans can encompass vocational training, ongoing medication management to address psychiatric symptoms and participation in veteran support groups.

Evidence-Based Interventions for Self-Medicating Veterans Dealing with Trauma

Throughout different levels of care, clinicians may employ a variety of treatments to address both substance use and trauma-related issues.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) has demonstrated effectiveness in treating co-occurring trauma-related disorders. During CBT sessions, clinicians explore maladaptive thinking patterns that may contribute to veterans' self-medicating behaviors. These trauma-focused psychotherapy sessions also help veterans process traumatic events and the associated emotions.

Exposure Therapy

Prolonged exposure therapy may diminish the emotional "triggers" associated with trauma. These sessions may involve repeated exposure to detailed images or virtual reality programs that evoke fear, distress and other negative emotions. The goal is to create a controlled, safe environment where veterans can confront their emotional reactions to trauma and learn to cope with their triggers progressively.

Eye Movement Desensitization and Reprocessing Therapy (EMDR)

EMDR, a trauma-focused psychotherapy, induces eye movement in veterans while discussing traumatic events. Thought to simulate REM sleep, EMDR is often effective in altering veterans' memories of traumatic events, reducing their emotional connection to these memories.

Family Counseling

Family counseling sessions involve loved ones in the treatment process. This approach helps loved ones understand the symptoms of trauma and substance use disorders while actively participating in aftercare planning. Evidence indicates that family involvement in treatment has the potential to enhance treatment outcomes among veterans.

Medication Management and Aftercare

In addition to counseling and psychoeducation, veterans may continue to receive medication to address symptoms associated with PTSD and substance use. Aftercare plans may include ongoing medication management and follow-up appointments with prescribing clinicians.

Other Forms of Treatment

Treatment for veterans may encompass individual counseling and group therapy with other veterans or individuals who have experienced similar traumatic events. Seeking Safety therapy, an evidence-based approach designed for individuals with PTSD and co-occurring substance use disorders, aims to reduce trauma and substance abuse symptoms while enhancing coping skills related to behavior, thinking and emotions.

Sources

U.S. Department of Veterans Affairs. “How Common is PTSD in Veterans?”><[…]pa[…] in Veterans?” Accessed November 8, 2023. 

McCauley, Jenna; Killeen, Therese; Gros, Daniel; Brady, Kathleen; & Back, Sudie. “Posttraumatic Stress ” Clinical Psychology (New York), 2012. Accessed May 24, 2023. 

American Psychiatric Association. “What is Posttraumatic Stress Disorder (P[…]order (PTSD?)” November 2022. Accessed November 8, 2023. 

Norman, Sonya; Wilkins, Kendall; Tapert, Susan; Lang, Ariel; & Najavitsd, Lisa. “A Pilot Study of Seeking Safety Therapy […]/OIF Veterans.” Journal of Psychoactive Drugs, March 2010. Accessed November 8, 2023. 

Thompson-Hollands, Johanna; Rando, Alora; Stoycos, Sarah; Meis, Laure; & Iverson, Katherine. “Family Involvement in PTSD Treatment: Pe[…]n Clinicians.” Administration and Policy in Mental Health and Mental Health Services Research, 2022. Accessed November 8, 2023. 

Tapia, Geraldine. “Review of EMDR Interventions for Individuals With Substance Use Disorder With/Without Comorbid Posttraumatic Stress Disorder.” Journal of EMDR Practice and Research, November 2019. Accessed January 24, 2024.