Understanding Substance Use Disorder
A substance use disorder (SUD), which is also known as a drug use disorder, is a condition in which the use of one or more substances leads to a clinically significant impairment or distress. Substance use disorders are a significant problem among our nation’s military veterans. Efforts to overcome barriers to those seeking treatment are needed so that veterans in need of services are able to access treatment and experience long-term recovery.
Statistics about Substance Use Disorder
- In 2014, an estimated 21.5 million Americans, ages 12 and older (8.1 percent), were classified with a substance use disorder.
- During the past year, within the adults who experienced substance use disorders and mental illness, rates were highest among adults ages 26 to 49 (42.7 percent).
- Within serious mental illness and co-occurring substance use disorders, rates were highest amongst ages 18 to 25 (35.3 percent) in 2014.
- More than two of 10 Veterans with PTSD also have SUD.
- Almost one out of every three Veterans seeking treatment for SUD also have PTSD.
- Following the wars in Iraq and Afghanistan, an estimated one in 10 soldiers seen in the VA have issues with alcohol or substance abuse.
What is Substance Use Disorder?
Substance Use Disorders are defined in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a pattern of use that results in marked distress and/or impairment, with two or more symptoms occurring over the year. The most prevalent types of substance use problems among male and female veterans include heavy episodic drinking and cigarette smoking. Among veterans presenting for first-time care within the VA health care system, 11 percent meet criteria for a diagnosis of SUD. Consistent with the general population, alcohol and drug use disorder diagnoses are more common among male than female veterans and are more common among non-married and younger veterans.
Symptoms of Substance Use Disorder
Substance use disorders span a wide variety of problems arising from substance use, and cover 11 different criteria:
- Taking the substance in larger amounts or for longer than intended.
- Wanting to cut down or stop using the substance, but not managing to.
- Spending a lot of time getting, using or recovering from use of the substance.
- Cravings and urges to use the substance
- Not managing to accomplish tasks at work, home or school because of substance use.
- Continuing to use, even when it causes problems in relationships.
- Giving up important social, occupational or recreational activities because of substance use.
- Continual use of substances, even when it causes a potentially dangerous situation.
- Continuing to use, even though it can worsen an existing physical or psychological problem.
- Needing more of the substance to get the desired effect (tolerance).
- Development of withdrawal symptoms, which can be relieved by taking more of the substance.
There are a number of services and interventions available to help reduce SUD’s among veterans. These include both behavioral and pharmacological treatments, and range on a spectrum from preventive screening to residential treatment programs.
- Psychotherapy-Evidence-based psychotherapies and behavioral interventions for the management of SUD’s typically involve short-term, cognitive-behavioral therapy (CBT) interventions. These interventions focus on the identification and modification of maladaptive thoughts and behaviors associated with increased craving, use, or relapse to substances. In addition, they may help reduce SUD’s by helping incentivize individuals to achieve and maintain abstinence (e.g., contingency management therapies), or increase their ability to successfully manage stress without substances.
- Mindfulness-This practice has been utilized as a way to increase the effectiveness of relapse prevention therapy by incorporating mindfulness-based meditation practices. It incorporates mindfulness-based meditation with relapse prevention techniques, and has a goal of decreasing the risk and severity of relapse to substance use following treatment. Mindfulness-based practices involve: identifying individual risk factors or common precursors to relapse, recognizing underlying reasons for maladaptive substance use, teaching meditation practices to increase awareness of and change one’s relation to challenging emotional, cognitive, and physical states arising from craving or withdrawal from substance use, and providing skills to tolerate these states.
- Hope For The Warriors is offering a six-week online program called Resilient Warrior, which is hosted by members of our Clinical Health and Wellness Team. Resilient Warrior is a course designed specifically for military and veterans to teach stress management and mindfulness techniques. Topics include relaxtion responses, sleep, resilience training, and stress management.
- Pharmacotherapy-Medications can help reduce withdrawal symptoms, which may serve as a trigger or reason for relapse if untreated. Medications can also be helpful in decreasing craving, which is also a potent trigger for increased substance use or relapse following treatment. There are three medications that are approved by the US Food and Drug Administration (FDA) for alcohol use disorders: naltrexone, acamprosate and disulfiram. Methadone, buprenorphine, naltrexone, and extended-release injectable naltrexone are approved by the FDA for the treatment of opioid use disorders. There are no FDA-approved medications for the treatment of cocaine or marijuana use disorders.
Self Help Groups
In addition to these behavioral and pharmacological interventions, veterans with Substance Use Disorders are encouraged to try self-help groups, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), which are free of charge and available in most cities. Participation in AA/NA can be particularly helpful as part of “aftercare” and ongoing engagement with services to help manage Substance Use Disorders.
There are a number of challenges that impact the veteran and their ability to receive help and get treatment for their Substance Use Disorder. These challenges are:
- Inability to access care because of location, medical facilities may be too far away.
- Military culture is a challenge for veterans needing treatment because their tough mindset makes it hard to admit defeat or weakness.
- Many veterans meet criteria for a dual diagnosis or co-occurring disorder, such as PTSD, depression, anxiety and adjustment disorders. Part of the reason this may be is because many treatment facilities only treat one diagnosis, even though there is strong evidence supporting the benefit behind treating the comorbidity. (Because of this, they are changing their attitudes about this form of treatment.)
- The stigma associated with seeking SUD treatment.
How HOPE Helps
Through Hope For The Warriors Clinical Health and Wellness programs, we are able to assist qualifying Post-9/11 veteran suffering from SUD and their families.
- Referrals and Admissions Assistance-The Care Team offers assistance to those seeking inpatient psychiatric services for PTSD, mTBI and associated disorders due to combat trauma. We provide referrals and assist the veteran and family in finding trauma-focused, evidence-based practices, and, ideally, assist in identifying family-focused programs.
- Travel Assistance-Hope For The Warriors can assist with securing travel to and from inpatient treatment by coordinating with veteran travel programs. During the veteran’s hospitalization, Hope For The Warriors will evaluate circumstances and needs to determine critical financial needs such as rent/mortgage and utilities.
- Family Counseling-The Clinical Health & Wellness team provides one-to-one psycho-educational counseling and supportive therapy services to the spouse and family members during the service member or veteran’s hospitalization. The counseling can be extended past hospitalization, by helping with common discharge concerns and the reintegration of the family unit.
Caring for a veteran family member comes with unique challenges. Nearly two-thirds of veterans receiving support from an informal caregiver cope with mental health or substance use disorders, compared with only one-third of civilians who receive this type of care. Also, nearly one-third of post-9/11 veteran caregivers are uninsured, compared to roughly 20 percent of civilian caregivers.
Here are some tips for the Caregiver:
Support is vital to the health of the caregiver and veteran they are caring for. There are many online peer support networks that can provide information, insight and resources.
The Hope For The Warriors Military and Veteran Caregiver Support Services program is able to provide support to include an online Facebook community, an online support group and in-person Wellness Workshops.
The VA caregiver support program offers many needed resources as well. It provides online materials about dealing with veterans’ conditions, along with peer support services, such as monthly phone calls that allow caregivers to connect with each other.
Hope For The Warriors is a family, united by our shared conviction of honor and service. If you are interested in further exploring and seeking support through our comprehensive support service, click here.
About The Author
Justin Gibson is a Master of Social Work Intern at Hope For The Warriors, he is getting his degree from the University of Southern California with concentration in Military Social Work. He is also a combat veteran of the United States Marine Corps and hopes to work with the military community once completed with his education.