U.S. veterans are among the hardest hit by substance use disorder (SUDs), data suggests. According to the Pew Research Center, there are 20.4 million veterans, representing less than 10 percent of the total U.S. adult population. 

Gulf War-era veterans account for the largest share of all veterans in the country, and in 2015, there were 7.1 million who served in this era, spanning from August 1990 to the present. 

The share of those with military experience in the U.S. population is declining, and in 2016, nearly 7 percent of adults were U.S. veterans, which is down from 18 percent in 1980. The drop has coincided with a decrease in active duty personnel. 

Over the past half-century, the number of active duty members has dropped substantially from 3.5 million in 1968 to 1.3 million today. While the figures show a decrease in military need, which can be viewed as positive, the numbers are projected to decrease even further. 

Despite the drop in military numbers throughout the United States, the population is still struggling. The prevalence of substance use disorders (SUDs) in veterans is high, and an estimated two out of 10 struggle with an SUD. Further, one out of every three veterans who seek treatment for their SUD also has post-traumatic stress disorder (PTSD). 

The number of veterans who smoke nicotine is almost double for PTSD (six out of every 10) versus without PTSD (three out of every 10). War veterans with alcohol problems and PTSD binge drink, which is four to five drinks in a short period (one to two hours). 

Why is it that veterans are prone to developing substance use disorders? Let’s dig deeper and understand what causes veterans to develop drug and alcohol problems at a higher rate than the general population. 

Substance Use and Military Life

Those in active service can attest to the stresses of being deployed and the military’s unique culture. When someone is deployed for an extended period and fighting for their lives, it may lead to anxiety or PTSD that pushes a person to use drugs or alcohol to numb their pain. 

According to the National Institute on Drug Abuse (NIDA), deployment is associated with unhealthy drinking, smoking initiation, risky behaviors, and drug use. Although zero-tolerance policies deter drug use, it may also add to the stigma of seeking help, which could discourage someone from going to treatment. 

Half of the military personnel reported they believed mental health issues would adversely affect their military career if they sought help. Illicit drug use is low among active personnel, and misuse of prescription drugs and cigarette smoking has decreased over the years. Unfortunately, binge drinking rates have gone up and are much higher compared to the general population.

Service members are at risk of facing dishonorable discharge or criminal prosecution if they test positive for drugs, which often discourages illicit drug use. When active personnel leave the military, these protective influences no longer exist, and SUDs and mental health issues become a much larger concern. 

Most Common Drugs of Abuse For Veterans

Marijuana Prevalence Among Veterans

As mentioned earlier, an estimated two out of 10 U.S. veterans struggle with substance use disorders when they leave active duty. Marijuana accounts for veterans’ most common illicit drugs, with 3.5 percent reporting abuse, and 1.7 percent reporting illegal drugs other than marijuana in one month.

Cannabis use disorders increased by 50 percent for veterans treated in the Veterans Health Administration (VHA) system. Other illicit drugs are also of concern for some veterans. A government report notes that 10 percent of admissions to substance use treatment centers were for heroin (10.7 percent), with cocaine following closely at just over 6 percent.  

Prescription Opioids and Heroin Prevalence Among Veterans

An estimated four percent of active duty service members reported misusing one or more prescription drugs in the past year. There has been an in-depth discussion about the number of pain medications prescribed to injured or sick military personnel, especially during a medical discharge transition. 

In 2009, military physicians wrote an estimated 3.8 million prescriptions for pain medication, quadrupling the number in 2001. The past few years have shown a decrease in opioid pain relievers and the use of sedatives among active duty personnel. 

From 2011 to 2015, the number of service members that used pain relievers decreased by half. Despite the decrease, prescription opioids are misused more often than other drugs. 

As you might find with the general population, opioid use disorders in the military begin with opioid pain relievers following an injury while deployed. Due to these drugs’ addictive nature, especially when coupled with mental health struggles that some servicemen and servicewomen experience, a prescription for pain may lead to long-term addiction.

Many have unique issues related to pain management, and two-thirds report experiencing pain. An estimated nine percent experience severe pain, putting them at higher risk of accidental opioid overdoses. 

Alcohol Prevalence Among Active Duty Veterans

The most prevalent substance use disorder among veterans is alcohol addiction. Increased combat exposure involving trauma or violence experienced by service members resulted in a higher risk of problematic drinking. 

Across all military branches, an estimated 5.4 percent of personnel were heavy drinkers, compared to 6.7 percent in the general adult population. Binge drinking, however, was higher among active duty personnel at 30 percent compared to 24.7 percent of the general population. 

A 2017 study showed that veterans were more likely to use alcohol than their non-veteran counterparts (56.6 percent versus 50.8 percent in one month). Veterans also reported heavy alcohol use at 7.5 percent, while 6.5 percent of non-veterans engaged in a one-month period. An estimated 65 percent of veterans who enter treatment for substance use disorder reported alcohol as the most frequently abused substance, doubling that of the general population. 

Smoking Prevalence Among Veterans

Veterans are more likely to smoke and use tobacco products than non-veterans in all age groups. Nearly 30 percent reported smoking cigarettes. The high prevalence of tobacco use has caused a significant financial impact on the VHA, which costs an estimated $2.7 billion for smoking-related ambulatory care, hospitalizations, prescription drugs, and at-home health care. 

Addressing the Prevalence of SUDs in Veterans

Unfortunately, significant barriers inhibit those who need help to get the care they need. Some of these include gaps in insurance coverage, access to treatment, lack of confidential services, and negative consequences. 

Fortunately, there has been a call for broadened insurance coverage that includes effective outpatient treatments and equips healthcare providers to recognize and screen for substance use disorders. 

It allows them to refer patients to the appropriate evidence-based treatment they need. Addressing substance use disorders in the military will require a shift in culture and increased confidentiality so that drug problems aren’t stigmatized.

Fortunately, the prevalence of SUDs in veterans continues to trend downward due to better invention techniques and healthcare professionals’ screenings. It is a gradual process that seems to be having a positive effect, but we must continue to help our veterans succeed after serving their country.

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