Post-traumatic stress disorder, brain trauma, and alcohol abuse occur more often among veterans than the general population. Within this distinct social group, there are additional risk factors for alcohol abuse and addiction, such as having been in combat and being male and Caucasian. Alcohol addiction is more difficult to recognize and treat in veterans, and taking preventive measures is critical for the health and well-being of the people who fought for our country.
A study by Bray and Hourani found frequent heavy drinking in the military was 18% on average between 1980 and 2005. Hispanic and non-Hispanic Caucasians were more likely to have drinking problems than African Americans. Military rank correlated with frequent heavy drinking significantly; rates were six times higher among low-ranking than high-ranking officers. Officers in the Army, Navy, and Marines reported heavy drinking more frequently than those in the Air Force. A study by Stahre et al. found younger military members were more likely to drink heavily.
A study by the Department of Psychiatry and Behavioral Sciences of the Medical University of South Carolina found that extensive combat exposure was linked to a higher risk of problematic alcohol use. Veterans with high levels of exposure were more likely to binge-drink and drink heavily (54.8% resp. 26.8%) than other veterans (45% and 17%). These former service members also face the highest risk of developing alcohol problems and frequently demonstrate a co-occurring triad of pain, traumatic brain injury (TBI), and Post-Traumatic Stress Disorder (PTSD), which makes alcohol problems worse. Moreover, setbacks in civilian life such as divorce, job loss, and financial problems push as many as 13 percent of all veterans toward alcohol.
A population-based study of 88,235 veterans returning from Iraq, published by the National Institute on Alcohol Abuse and Alcoholism found that 12 to 15 percent of veterans demonstrated problematic alcohol use in the few months after returning from combat. These findings suggest that alcohol abuse occurs among many combat veterans and highlight the significance of understanding the relationships between alcohol abuse and stressful military experiences.
According to findings of the above study, alcohol use disorder (AUD) is more common among male than female veterans (10.5% for men vs. 4.8% for women). It is also more common among single veterans under 25. However, incidences of AUD are becoming more frequent among women. Diagnoses among female veterans increased by 81% from 2005 to 2010. Within the group of female veterans, those with AUD also report higher rates of military sexual trauma, childhood sexual abuse, and domestic violence than those without. Women with PTSD face a particularly great risk of developing AUD.
A study of data collected through the National Survey on Drug Use and Health found that veterans were more likely than active service members to drink in general (56.6% vs. 50.8%) and to report heavy drinking (7.5% vs. 6.5%, both statistics over a period of a month). Interpersonal, professional, and legal problems ensuing from alcohol use are about 50% as likely among binge drinkers and heavy drinkers.
According to the National Institute on Drug Abuse, men and women in the military drink more than civilians. 47% of active duty service members reported binge drinking in 2016, up from 35 percent a decade earlier. Every fifth serviceman reported binge drinking every week in 2008, and 27 percent of servicemen with high combat exposure reported drinking heavily and / or binge drinking on a regular basis that year.
A study by Ames and Cunradi (2004) found that heavy drinking rates were significantly higher among male army members between 18 and 25 compared with male civilians of the same age (32.2 percent vs. 17.8 percent). The researchers also established this tendency with women – females in service drank more heavily than similarly aged female civilians (10 vs. 5.5 percent). Stressful service-related events could also contribute to the significantly elevated rates of problem drinking.
The demands of military service, anxiety, fear, long-term separation from loved ones, and physical and psychological trauma can make even a highly resilient person vulnerable to alcohol use disorder. Physical and psychological causes such as traumatic brain injury and PTSD are quite common among veterans.
The Substance Abuse and Mental Health Services Administration estimates that about 7 percent of U.S. veterans struggle with a substance use disorder. Every fifth military member who has served in Iraq or Afghanistan suffers from PTSD, traumatic brain injury, or depression, all of which predispose to alcohol abuse and addiction. Moreover, mental health and substance abuse problems are the main cause of hospitalizations among U.S. troops.
The high incidence of TBI among veterans presents an additional risk of developing alcohol use disorder. According to neurologists, TBI can disrupt prefrontal circuits that are responsible for impulse control, reward attribution, and emotional regulation. A study commissioned by Michigan State University Department of Surgery of military personnel deployed in Afghanistan and Iraq reported prevalence rates of TBI of 15.2-22.8% with concurrent alcohol abuse.
One of the serious disabilities that a portion of these military members go on to develop is Chronic Traumatic Encephalopathy (CTE). It is characterized as behavioral and mood changes such as memory loss, irritability, depression, and aggression. In some cases, it can transform into a dementia-like condition.
Symptoms of PTSD include insomnia, flashbacks, memory difficulties, low self-esteem, hopelessness, trouble focusing, aggression, and self-destructive behavior. According to the self-medication hypothesis put forth by Jacobsen et al. (2001) and Khantzian (1999), cited in the above study, there is a direct link between alcohol use disorder and PTSD. More specifically, the relationship between increased risk of AUD and traumatic events is mediated by the occurrence of PTSD. Traumatic events lead to PTSD, depression, and other psychiatric disorders, and individuals suffering from these disorders are prone to turn to alcohol as a means of alleviating symptoms.
The National Center for PTSD reports that 60 – 80% of Vietnam War veterans getting treatment for PTSD also misused alcohol. War veterans with PTSD tend to binge-drink in response to traumatic memories. Veterans with PTSD over the age of 65 are at higher risk for a suicide attempt if they also have depression and drinking problems.
According to data of the U.S. Department of Health and Human Services (USDHHS), every fourth veteran has been diagnosed with PTSD, alcohol abuse, depression, or all three. Around 15% of veterans were diagnosed with PTSD, which is higher compared to the general population average of 10%.
According to statistics of NIDA, 0.8 of veterans received treatment for alcohol abuse in 2010. Every tenth former member of the military services reported heavy alcohol use weekly. The Drug Policy Alliance Report of 2009 found that 30 percent of Iraq and Afghanistan veterans had PTSD, traumatic brain injury, depression, or another cognitive disability. A fifth of them were also diagnosed with a substance abuse issue.
Frequent binge drinking can build up alcohol tolerance and increase a person’s dependence on alcohol over time. Alcohol does double damage to a veteran with PTSD, both intensifying and prolonging symptoms of the condition. Since alcohol is a depressant, it can exacerbate depression, sleeplessness, anxiety, and other symptoms of PTSD.
Research on former members of the military suggests that the relationship between alcohol abuse, combat exposure, and posttraumatic mental disorders may have a genetic basis. Much of this data comes from the Vietnam Era Twin Registry, a study carried out by McLeod et al. in 2001. This study involved a big sample of monozygotic and dizygotic twins who were in the army during the Vietnam era. By examining the relationships between alcohol abuse, combat exposure, and posttraumatic mental disorders among twin pairs that share identical (monozygotic) or non-identical (dizygotic) genes, scientists reached the conclusion that both alcohol use problems and PTSD were influenced by genetics.
However, the environment accounted for 50% of the variance in alcohol abuse. In other words, genetics and the environment play an equal role where alcohol abuse is concerned. Common genes partially account for the co-occurrence of alcohol abuse, combat exposure, and posttraumatic mental disorders. Genetic factors can predispose people to find themselves in combat situations and to develop symptoms of AUD, PTSD, and depression.
The US government implemented strict policies to reduce alcohol misuse in 1986, and heavy alcohol use did drop around this time – from 21 percent in 1981 to 17 percent in 1988 according to data of the Department of Defense Health Behavior Survey. There was another drop between 1988 and 1998, when the rate stood at 15 percent, and then it began to increase again. It was 18 percent in 1999, 19 percent in 2005, and 20 percent in 2008.
According to Bray et al., 2009 and Jacobson et al., 2008, these increases in alcohol use indicate a tendency to deal with the challenges of war and the stress and trauma it can cause. Easy access to alcohol on military facilities at reduced prices, including during “happy hours”, also plays a role. Preventive policies in the military are inconsistently enforced, and heavy alcohol consumption has traditionally been a cultural standard for socializing and recreation among members of the military.
A series of studies outlines how accepted and even ingrained heavy drinking has become (Ames et al., 2009, Schuckit, 1977). Alcohol is used to reward hard work, promote unit cohesion, and ease interpersonal conflict.
Dangerous drinking patterns impact not only the former military member, but also his or her family and friends. Alcohol abuse and addiction take a toll on all aspect of an individual’s life, including health, professional goals, and emotional well-being. Here are some of the direst consequences alcohol abuse can have.
Following retirement or a medical discharge from the military, professionals monitor veterans for any signs that they may harm themselves. Veterans who faced life-threatening situations or had multiple deployments are most likely to self-harm. This behavior is often related to psychiatric conditions that arise in the course of and after service, including PTSD, anxiety, and depression. The more a veteran drinks, the more likely they are to lose control over their emotions. Every day, nearly 22 veterans commit suicide.
Approximately 40,000 former members of the military are living on the streets of America today. After the government increased the number of shelters available to veterans between 2010 and 2016, the number of homeless veterans dropped by 47 percent. Alcoholism prevents a person from seeking and sustaining gainful employment. They then rack up debt and lose their property or become unable to pay rent. On the street, the veteran will continue turning to alcohol as a means of coping with his circumstances and as a source of energy. Many homeless veterans have no jobs or health insurance and go without food for days at a time.
About 140,000 veterans were incarcerated in a US prison in 2004. Sadly, this failed to resolve their alcohol problems. According to NIDA, substance abuse and addiction are major contributing factors to the incarceration of veterans. Nine percent of Afghanistan and Iraq veterans were arrested, a national survey found.
Problem drinking can increase the risk of domestic violence, assault, and child neglect or abuse. Domestic violence cases involving military staff increased by 33 percent between 2006 and 2011 alone. Alcohol misuse associated with domestic violence rose by 54 percent in the past decade. Between 2001 and 2011, incidences of child abuse associated with alcohol rose by 40 percent.
Alcohol misuse or abuse prevention efforts in the military are often synonymous with approaches to reduce harm. They are best described as efforts aimed at reducing negative repercussions associated with alcohol use without enforcing complete abstinence.
Prevention efforts in the military could include limiting the physical availability of alcohol, using social marketing approaches to decrease the occurrence of alcohol misuse, and creating safer drinking environments. The ultimate purpose is to reduce the total alcohol consumption in army structures to diminish the likelihood of alcohol-related problems.
One of the most important tools for limiting alcohol-related problems in the military is the ability to supervise both economic and physical availabilities of alcohol. Public health advocacy is also key to effective prevention strategies, and public awareness of alcohol misuse is vital to the implementation of successful strategies.
The reasons veterans don’t ask for help are multiple and varied. Hypermasculine military culture, social stigma, inability to recognize problem drinking, and lack of access to specialized care are the main ones.
Military culture values self-reliance very highly. Attempts to get help are seen as a sign of weakness, and veterans are encouraged to resolve mental health problems by themselves. Moreover, veterans sometimes feel the need to ‘shield’ relatives or friends from their personal struggles. This is a reason for and consequence of the social stigma of addiction treatment. It would help to integrate such treatment within the context of other mental health interventions. Instead of getting help at an ‘addiction clinic’, former military personnel could go to a mental health facility with a broader scope, which offers help for PTSD, anxiety, depression, family and couples therapy, etc.
As a consequence of military culture, their specific social position, and the unique challenges they face, veterans are often less likely than the general population to recognize the signs of alcohol use disorder. These include feeling compelled to drink, having increasing tolerance to alcohol, needing to drink to feel “normal”, and getting angry or irritated if alcohol is not accessible.
According to the Veteran’s Affairs (VA) Office of Rural Health, 41% of all veterans in the health care system reside in rural areas. These 3.4 million veterans have difficulty accessing care, especially mental health services.
Veterans struggling with alcohol use disorder may receive vocational rehab and training services to help them maximize their potential of obtaining long-term employment. The VA Department provides medical, social, vocational, and rehabilitation therapies and programs to eligible veterans struggling with AUD. Their addiction rehab program includes detox and psychiatric care.
A specialized veteran rehab center could prove pivotal to the outcome. The professionals employed at such centers understand this social group’s unique needs and provide medical supervision and structured group therapy, ensuring former members of the Armed Forces get the help they deserve.