Veterans’ Substance Abuse: Opioid Epidemic in the Military

Written by: Editorial Staff

Last updated on March 17, 2021

America has been facing an epidemic of opioid overdoses, both from prescription opioids and illicit opioids such as heroin. Military veterans, too, have been caught up in the opioid epidemic and often face substance abuse problems and, by extension, risk of overdose.¹

In fact, more than one in 10 veterans who seek care in the U.S.  Department of Veterans Affairs (VA) meet the criteria for a substance use disorder diagnosis.²

Posttraumatic Stress Disorder (PTSD) with which veterans often struggle seems to be part of the problem.³

Which Factors Contribute to Substance Abuse in Veterans?

A considerable proportion of recent veterans return home from conflicts overseas with substance abuse issues and mental health profiles that put them at high risk for adverse outcomes.⁴

Trauma and military personnel with PTSD face an even higher risk of developing Substance Use Disorder (SUD) and overdosing, especially from opioids such as heroin.⁵

For this reason, specialized veterans’ heroin treatment programs take an integrated approach to addressing PTSD and substance abuse in veterans.⁵

Additionally, for military veterans and active-duty military personnel alike, readjustment to civilian life comes with challenges which may include homelessness and unemployment and which correlate highly with substance abuse prevalence.⁴

What Is PTSD?

PTSD is a mental health problem that some people develop from emotional and psychological trauma caused by extraordinarily stressful events such as after experiencing or witnessing a life-threatening or traumatic event, like combat, sexual assault, natural disaster, etc.³

Symptoms may include:³

• Reliving the event or re-experiencing symptoms: memories of the traumatic event can come flooding back at any time, causing the person to relive the same fear and horror.
• Avoiding situations that remind you of the event: the person may avoid situations or people that trigger memories of the traumatic event.
• Negative changes in beliefs and feelings: the person’s perception of themselves or others changes because of the trauma. 
• Feeling keyed up (hyperarousal): the person is always alert and on the lookout for danger and may experience anger or irritability.

Frequently Asked Questions

What Is the History of Heroin Abuse in Veterans?

Opioid abuse is a common occurrence among veterans of war and many veterans progress to heroin abuse.⁶

Veterans endure stress during training and deployment, as well as upon returning home and trying to readjust to civilian life.⁶

Deployment in particular is associated with risky behaviors, including drug use.⁶ Members of the military with multiple deployments, combat exposure, and combat-related injuries are at greatest risk of developing substance use problems, including opioid abuse.⁶

These individuals may end up struggling with SUD, including addiction to opioids such as heroin, even upon returning home.⁶

The underlying problem is that while veterans may have initially been prescribed opioids for legitimate injuries or related pain syndromes, the dosage and quantity of pills they were prescribed was extremely high.⁴ 

As a result, many of these individuals progress to heroin use.⁴

What Percentage of Veterans Suffer from Heroin Addiction?

More than ten percent of veteran admissions to substance use treatment centers are for heroin (10.7%), which may imply that PTSD is one of the primary factors for heroin addiction among veterans.⁴

The overall opioid overdose rates of veterans increased from 14% in 2010 to 21% in 2016. This increase was mainly due to the rise in overdose from heroin and synthetic opioids, not from opioids taken for pain relief.⁶

What Are the Causes of Heroin Addiction in Veterans?

Veterans may be more likely to engage in risky polydrug use or to shift from prescription drug use to illicit drug use (e.g., heroin).⁴

Substance abuse and heroin addiction among veterans can be caused by the following factors or a combination thereof:⁴

• Exposure to trauma and PTSD
• Mental health illnesses
• Homelessness
• Unemployment
• Inability to readjust to civilian life and feeling disconnected from society upon returning home
• Prescription opioid misuse

Veterans can access Veterans Affairs (VA) mental health services for various needs, including but not limited to:⁷

• PTSD.
• Psychological effects of military sexual trauma (MST).
• Depression.
• Grief.
• Anxiety.

How Common Is Substance Abuse in Female Veterans?

Female veterans often face military sexual trauma caused by sexual assault or harassment, intimate partner violence, and issues with child care.⁵ 

Studies indicate that female veterans are:⁸

• Twice as likely as men to develop posttraumatic stress disorder.
• Twice as likely to have serious psychological distress.
• Likely to experience military sexual trauma, as approximately one out of five women veterans reports military sexual trauma.

Lifetime prevalence of SUD and PTSD is even higher for female veterans (13.9 %) than for their male counterparts.⁵

What Causes PTSD in Veterans?

Active duty and veteran members of the military are highly susceptible to trauma and its aftereffects.⁵ PTSD prevalence among veterans is considerably higher than that of the general population.⁵ 

Veterans may also struggle with common mental disorders such as depression, anxiety, and serious mental issues which may co-occur with substance use disorder. PTSD in veterans can be caused by:⁵

• War zone stress reactions and experiences faced in direct combat.
• Military-related trauma exposure outside of direct combat, such as during deployment to war zones where individuals may witness horrific acts of violence and/or be potential targets of violence.

Veterans may not seek treatment for heroin addiction and other forms of SUD and mental health issues out of fear that this may compromise their career. They may also experience shame and embarrassment due to the stigma associated with seeking treatment for mental health and addiction to heroin and other opioids.⁵

In addition to PTSD, military personnel may struggle with other issues, including:⁵

• Childhood trauma.
• Military sexual trauma.
• Depression.

Opioid abuse, other forms of substance abuse, and mental health issues can be addressed in specialized treatment.⁵

Finally, veterans also face a high risk of suicide. The fact that they hesitate to seek treatment further aggravates this problem.⁵

How Does PTSD Contribute to Substance Abuse in Veterans?

Veterans struggling with PTSD often turn to excessive smoking, heavy drinking, or drug abuse, including heroin abuse, in an attempt to cope with the problem.⁹ 

As a result:⁹

• More than 2 of 10 veterans with PTSD also have SUD.
• Almost 1 out of every 3 veterans seeking treatment for heroin abuse and other forms of SUD also has PTSD.
• In the wars in Iraq and Afghanistan, about 1 in 10 returning war veterans seen in Veterans Affairs substance abuse programs struggle with alcohol or drug abuse.
• Veterans with PTSD and alcohol problems tend to binge drink. 
• Nicotine consumption among veterans with PTSD is twice that among veterans without PTSD.

What Are the Different SUD Treatment Options Available for Veterans?

Veterans with SUD and co-occurring disorders can seek different treatment options, including:¹⁰

• Individual intensive inpatient.
• Individual short-term outpatient counseling.
• Residential (live-in) care.
• Marriage and family counseling.
• Group therapy (self-help groups).

There are also specially designed programs for veterans with specific concerns (like female veterans, returning combat veterans, and homeless veterans).¹⁰

For veterans suffering from PTSD and SUD, treatment at heroin rehab centers should be concurrent, with emphasis on continuing care during rehabilitation and relapse prevention following the detoxification stage which addresses the withdrawal syndrome.⁹

In specialized veterans’ heroin treatment programs, SUD and COD are usually treated with a stage-wise approach, tailored to their stage of readiness for treatment.⁵

How to Find Heroin Rehab and Treatment for Veterans?

Active duty military personnel are often concerned if the military will find out that they go to rehab, as this may jeopardize their career.⁶

Zero-tolerance policies, absence of confidentiality, and mandatory random drug testing, all of which are designed to deter illicit drug use among military personnel, add to the stigma. This may discourage these individuals from seeking treatment for substance abuse and mental health issues.⁶

However, help from veterans’ heroin treatment providers is available, enabling them to seek treatment nationwide. 

Among the options available to veterans is heroin detox treatment through Desert Hope programs which are specifically catered towards veterans with substance abuse. In the event you enter a Desert Hope program, your co-pays and out-of-pocket expenses will not exceed what you would pay through the VA. Bills for copayments will be directly sent by the VA.

These programs are based on medically managed detoxification and associated stabilization services, as well as on medication-assisted treatment designed to reduce cravings, prevent overdose and facilitate rehabilitation.¹⁰

American Addiction Centers can verify your insurance coverage for veterans’ heroin abuse treatment, including your TRICARE plan coverage for substance abuse treatment.¹¹ Simply fill out the form or call our helpline for a confidential consultation, during which we can check your benefits. 

Sources

1. A. S. Bennett, L. Elliott, A. Golub. (2015). Veterans’ Health and Opioid Safety–Contexts, Risks, and Outreach Implications.
2. National Institute on Drug Abuse. (2020). Military Life and Substance Use.
3. PTSD: National Center for PTSD. (2020). PTSD Basics.
4. A. S. Bennett, L. Elliott, A. Golub. (2013). Opioid and Other Substance Misuse, Overdose Risk, and the Potential for Prevention Among a Sample of OEF/OIF Veterans in New York City. 
5. Substance Abuse and Mental Health Services Administration. (2020). TIP 42: Substance Use Treatment for Persons With Co-Occurring Disorders.
6. National Institute on Drug Abuse. (2020). Substance Use and Military Life DrugFacts. 
7. U.S. Department of Veterans Affairs. (2021). VA mental health services. 
8. U.S. Department of Veterans Affairs. (2021). Women Veterans Health Care.
9. PTSD: National Center for PTSD. (2020). PTSD and Substance Abuse in Veterans.
10. U.S. Department of Veterans Affairs. (2020). Substance use treatment for Veterans. 
11. TRICARE. (2018). Covered Services: Substance Use Disorder Treatment.