Veterans and active-duty military are exposed to highly stressful or disturbing events that may lead to Post-Traumatic Stress Disorder (PTSD). Estimates show that 7% of veterans (compared to 6% for civilians) will have PTSD in their lifetime.
Prevalences are much higher with different eras—up to 29% with operations in Iraq and the Persian Gulf. PTSD is more common among female veterans (13%) compared to male veterans (6%). Military sexual trauma can happen to anyone but affects women more frequently [1].
Some factors in a combat situation may contribute to PTSD and other mental health problems, including military occupation or specialty, the politics around the war, where the war is fought, and the type of enemy faced [1].
Read on to learn more about the relationship between these two challenging conditions, treatment, and therapies.
Understanding PTSD and Addiction in Veterans
Many veterans use substances such as alcohol, prescription medications, or illicit drugs to self-medicate and manage the distressing symptoms of PTSD, including flashbacks, insomnia, aggression, and hopelessness [2].
Research indicates that more than 20% of veterans with PTSD have struggles with substance abuse and develop an addiction. Some studies have shown that number to be much higher.
And while cannabis use is the leading drug involved, according to SAMHSA, more than 10% of veteran admissions to substance use treatment centers were for heroin (10.7%), followed by cocaine at just over 6% [3].
Why PTSD and Substance Use Often Co-occur
PTSD and addiction frequently co-occur in military veterans, creating a complex and challenging cycle that requires specialized treatment. This relationship works both ways. There are a number of related elements to this:
- Self-Medication: Many veterans with PTSD turn to alcohol, opioids, or other substances to numb emotional pain, avoid traumatic memories, or cope with hyperarousal and insomnia.
- Brain Chemistry Changes: Trauma alters brain regions (like the amygdala and prefrontal cortex), increasing vulnerability to both PTSD symptoms and addictive behaviors.
- Overlapping Risk Factors: Combat exposure, military sexual trauma (MST), and moral injury increase the likelihood of both conditions.
- Withdrawal and Escalation: Substance use can worsen PTSD symptoms over time, leading to a destructive feedback loop.
Common Signs of PTSD in Veterans
- PTSD Symptoms:
- Intrusive memories, flashbacks, nightmares
- Hypervigilance, irritability, anger outbursts
- Emotional numbness, avoidance of triggers
- Survivor’s guilt or moral injury
- Addiction Signs:
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- Increased tolerance, withdrawal symptoms
- Failed attempts to quit despite negative consequences
- Risky behaviors (e.g., drunk driving, mixing substances)
- Social isolation or relationship strain
The Role of Residential Treatment Programs
Residential treatment centers (or rehab) are usually the highest level of care for addictions treatment, especially when there are co-occurring mental health disorders such as PTSD.
Veterans with co-occurring PTSD and SUD often face more severe symptoms and poorer treatment outcomes if both conditions are not treated together.
The recommended best practice is for integrated treatment approaches that address both PTSD and Substance Use Disorders (SUD) simultaneously. Studies show that veterans themselves overwhelmingly see a link between their symptoms and substance use [2].
What Makes Residential Care Effective
Residential care provides a structured, immersive, and supportive environment away from daily stressors and triggers. Trauma-Informed approaches and dual diagnosis care addressing both alcohol and drug use are central to the program. Core elements that make it effective include:
Safe Environment to Heal and Manage Triggers
- Removes access to drugs and alcohol.
- Provides a stable space for healing without external stressors.
- Helps minimize the severity of triggers and provides 24/7 support for Veterans to manage those triggers.
24/7 Medical and Psychological Support
- Supervised detox for safe withdrawal management.
- Psychiatric care for co-occurring disorders such as PTSD.
- Crisis intervention if needed.
Intensive Evidence-Based Therapies
- Trauma-focused therapies such as Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE), and Eye Movement Desensitization and Reprocessing Therapy (EMDR), in both individual and group settings
- Addiction therapies such as Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Motivational Interviewing (MI), among others, to address cravings and relapse prevention
- Dual Diagnosis treatment ensures both PTSD and addiction are treated together
Peer Support and Community
- Veterans connect with others who share similar experiences, reducing isolation.
- Group therapy builds camaraderie and accountability.
- Veteran-specific programs develop trust (e.g., VA inpatient, Home Base Program, Wounded Warrior Project).
Structured Routine and Discipline
- Reinforce healthy habits such as sleep schedules, nutrition, and exercise.
- Reduces impulsivity and provides stability, especially helpful for veterans accustomed to military structure.
Holistic and Alternative therapies
- Mindfulness, yoga, and meditation help regulate the nervous system.
- Adventure therapy (e.g., hiking, ropes courses) rebuilds confidence.
- Art and music therapy encourage non-verbal emotional processing.
Aftercare & Transition Planning
- A strong residential program includes discharge planning for:
- Outpatient therapy (VA or private).
- Sober living homes (if needed).
- Veteran support groups (e.g., AA/NA meetings for vets, Vet Centers).
Benefits of Programs for Veterans with PTSD
Among the many benefits of residential care, the following are especially helpful for veterans and active-duty military:
Why Residential Care Works Best for Some Veterans
- Severe PTSD/addiction cases may need round-the-clock care.
- Failed outpatient attempts may require a higher level of support.
- Moral injury or complex trauma benefits from intensive processing in a safe setting
- Specialized veteran-focused support understands military culture and the experiences of military members
- Community helps veterans develop trust and participate in mutually helpful peer support
- Purpose is restored through therapy and peer support, especially for reintegration into civilian life
- Reintegration tools are developed to assist in the transition from military to civilian life
What to Look for in a Veterans Residential Program
There are a number of important factors to consider when looking for a veterans residential program, including:
- Veteran-focused care: Programs should specialize in or have experience with veterans’ unique needs, including military culture and trauma.
- Integrated treatment: The facility should offer coordinated care for both PTSD and addiction.
- Qualified staff: Look for licensed professionals experienced in treating co-occurring disorders.
- Comprehensive support: Access to mental health services, medical care, and social support is essential.
- Inclusive and accessible environment: The program should be welcoming to all veterans, including those with disabilities or from diverse backgrounds.
- Accreditation and reputation: Choose programs with strong reviews, proper licensing, and recognized credentials.
- Aftercare planning: Effective programs provide support for transitioning back to independent living.
Start Your Journey with Miramar Health
Miramar Health is a veteran-owned and operated recovery program exclusively serving veterans. Our mission is to free veterans from America’s mental health and addiction crisis and to empower them to create a better future for themselves and their families.
We understand the complex nature of trauma and offer individualized treatment options that are specific to veterans. Take the first step to your recovery. You’re not alone. Reach out to our Admissions team today.
Sources
[1] US Department of Veterans Affairs. National Center for PTSD. How Common is PTSD in Veterans?
[2] Back, S., et al. (2014). Substance use disorders and PTSD: an exploratory study of treatment preferences among military veterans. Addictive behaviors, 39(2), 369–373.
[3] National Institute on Drug Abuse. 2019. Substance Use and Military Life DrugFacts.