Understanding the link between PTSD and substance use disorders in Veterans

PTSD and substance


PTSD can occur in any individual who has experienced a traumatic event, whether it be through combat, physical or sexual assault, natural disaster or childhood abuse. A Veteran may be diagnosed with PTSD when they’ve been exposed to a traumatic event such as witnessing actual or near death situations, the loss of someone close to them, significant threats to their own or another’s life, and other events that could induce intense fear, helplessness and horror.

Some Veterans attempt to cope with their PTSD through self medication with drugs and alcohol. Prolonged usage of ingesting chemical inebriants can wind up creating more harm in the long run, and a Veteran could develop what is known as a substance abuse disorder. When this occurs, it becomes completely necessary to find treatment that adequately addresses both diagnoses, not just one or the other.

The truth about PTSD/substance abuse disorder frequency for Veterans

Stats from VA’s National Center for PTSD:

  • Roughly 20 percent of Veterans seeking treatment for PTSD also have a substance abuse disorder.
  • Almost 1 out of every 3 Veterans seeking treatment for substance abuse disorder also has PTSD.
  • The number of Veterans who smoke is almost double for those with PTSD.
  • In the Iraqi and Afghanistan wars, roughly 10 percent of returning veterans had a problem with alcohol or other drugs.
  • Women with PTSD were 2.48 times more likely to meet criteria for alcohol abuse or dependence and 4.46 times more likely to meet criteria for drug use and dependence than women without PTSD.
  • Men with PTSD were 2.06 times more likely to meet criteria for alcohol abuse or dependence and 2.97 times more likely to meet criteria for drug use and dependence than women without PTSD.
  • The National Vietnam Veterans Readjustment Study found that 74 percent of Vietnam Veterans had comorbid substance abuse disorder and PTSD diagnoses.
  • From 2003 to 2013 the number of Veterans with comorbid substance abuse disorder and PTSD in VA care increased more than three-fold.

There is a significant and vital need to advance our understanding and accessibility for treatment of co-occurring PTSD and substance abuse disorder. Approximately 50 percent of individuals seeking treatment for substance abuse disorder nationwide meet the criteria for PTSD, and individuals diagnosed with both disorders have overall poorer treatment results than those without one or the other. Individuals with both disorders also have additional psychiatric and functional problems related to medical, legal, financial and social situations.

Treatment options for Veterans with PTSD/substance abuse disorder

Examining empirical studies has revealed a number of treatment options showing promising results. There is no single approach or program for the treatment of co-occurring PTSD/substance abuse disorder diagnoses, so Veterans should be encouraged to seek help through a number of programs, including primary care and behavioral health as well as any setting such as outpatient, intensive outpatient or residential. The important component of recovery in this instance is that shared decision making occurs between treatment providers and Veterans to determine the best suited path to recovery.

The most promising methods involve some form of clinical assistance and though not always necessary, pharmacotherapy has demonstrated positive results in this field.


Multiple studies have demonstrated that structured psychotherapy can create positive outcomes for veterans seeking comorbid treatment for PTSD and substance abuse disorder. Individuals with PTSD and substance abuse disorder can safely engage in and reap benefits from trauma-centered, cognitive behavioral therapies such as prolonged exposure therapy and cognitive processing therapy. Research also shows that patients with substance abuse disorder and PTSD who received cognitive behavioral therapy for both disorders were more likely to reduce their symptoms than patients who only received therapy to address one of those disorders.

Medication assisted treatment

Several studies have found positive results for comorbid treatment involving the use of SSRIs (selective serotonin reuptake inhibitor) in addition to psychotherapy. Using a combination of prolonged exposure therapy and naltrexone was more effective in reducing drinking after residential treatment than either method separately. An important study on the use of benzodiazepines for Veterans with alcohol problems found no evidence of positive outcomes and could potentially create harmful effects.

Next steps for Veterans seeking treatment

There are many different treatment options available if you are seeking treatment for co-occurring PTSD and substance abuse disorder. The first step is to talk with a VA health care professionalor get in contact with a VA PTSD or VA substance abuse disorder program. Fortunately, the VA Uniform Mental Health Services Handbook requires that all VA medical centers provide access to either prolonged exposure and cognitive processing therapy for Veterans with PTSD. It also states that Veterans cannot be denied access to mental health residential treatment programs based on length of abstinence and that opioid replacement therapies such as methadone and buprenorphine also be made available.

Here are resources you can access to begin finding treatment.

There also drug and alcohol rehab centers around the country that offer advanced cognitive behavioral therapies to treat substance abuse disorders. Call your nearest treatment center to find out what kinds of therapies they offer, and what options are available for you.