Jamie Clybourn, MCAP, ICAADC

Veteran’s Day began in 1919, originally called Armistice Day by President Woodrow Wilson, to honor those who fought in World War II. It was eventually expanded to include all US military veterans. One day of the year seems hardly enough to thank our veterans for the sacrifices they have made to ensure the freedom and sense of security that we enjoy every day. It begs the question, how much are we really doing to care for our nation’s veterans? According to recent studies, they are certainly facing higher rates of many social and medical issues, including substance use disorders, than non-veteran Americans. When treating veterans for addiction, we need be aware of other complicating factors that may be impacting their ability to maintain long-term sobriety. A holistic approach to treatment is necessary.

There are several reasons an individual may choose to enlist
in the military. For some, serving in the armed forces is a long standing family tradition based on honor and patriotism. For others, it could be a desire to explore the world and enjoy the other benefits of being a veteran, such as job security, an early retirement, opportunities for education, or access to VA healthcare services. Another reason may be to develop self-respect and a sense of discipline. But in some cases, young adults who enlist in the military are doing so to escape physical or emotional abuse, parental addiction or mental health issues, or poverty. These are the individuals who are especially vulnerable to developing substance use disorders as well as PTSD if exposed to significant stressors during their active duty.

A biological or environmental predisposition to substance use, mental health disorders, or early childhood trauma combined with a significantly stressful situation will drastically increase an individual’s likelihood of developing a substance use or mental health disorder. For combat veterans in particular, this means higher rates of PTSD than the general population. If you stop and think about it, what more stressful situation is there than war? Our troops have left their families and other support systems, and they and their new military family are facing the daily threat of being killed in action. In addition to vulnerability to developing PTSD and substance use disorders, veterans returning home after a long tour of duty can experience other difficulties. There are drastic differences between military and civilian life, especially for men and women who have spent their entire adult life in the military.

Veterans are exposed to numerous stressors during their re-adjustment period back into the civilian lifestyle. For one, the structure of their military lifestyle to which they have become so accustomed is suddenly gone. They are left with a lack of routine and a general sense of ambiguity. Transitioning from a predictable environment to an unpredictable one with many choices can be anxiety-producing. Many times, reconnecting with family members upon their return can also be difficult. Family members have adjusted their roles and daily activities while they’ve been away, so the veteran may feel a lack of purpose or value when he/she rejoins the family unit. The veteran may need to adapt to a new workplace where personal gain and competition, rather than camaraderie, is the mission of his/her colleagues. It is also important to note that unemployment rates for veterans are higher than that of non-veterans. Reasons for this may include poor health, employer discrimination, lack of interviewing skills, or a work history that is too highly specialized for a civilian job. Unemployment can lead to depression and anxiety, as well as increased substance use.

The suicide rate for veterans is alarmingly high, nearly double that of the general population. A primary risk factor for suicide
is substance abuse. Alcohol and drugs can not only increase feelings of depression and anxiety, they impair judgment and lower inhibitions, making a person more likely to act on suicidal ideations. Another suicide risk factor is physical illness and feelings of hopelessness. Due to the physical nature of many military occupations, veterans are prone to injury and/or illness. For combat veterans, traumatic brain injury (TBI) is a fairly common occurrence. A TBI can also increase impulsivity – another suicide risk factor. Easy access to weapons and comfortability in using
a gun, the most lethal method in a suicide attempt, are also risk factors. Given their training, veterans are typically very comfortable using firearms and there is a greater likelihood that they own a gun. Finally, isolation and experiencing a recent loss are factors that increase the risk of suicide. Upon return from active duty, veterans often report feeling cut-off from others and if they were in combat, they are likely mourning the loss of their peers.

It comes as no surprise that veterans with mental health disorders are more likely to develop a co-occurring substance use disorder. Alcohol and drugs are often used as a coping mechanism to deal with unwanted symptoms, which may include depression, intrusive thoughts, feelings of detachment, or nightmares. While substances may have a positive effect on their symptoms in the short term, continued use can lead to physical tolerance and emotional dependency, requiring medical detoxification followed by inpatient addiction treatment. Inpatient treatment can help veterans gain an understanding of their addiction, learn how
to cope with their symptoms in a healthy manner, and develop relapse prevention skills. They are also introduced to twelve-step programs that can serve as a sober support system upon their discharge from treatment.

Putting others’ needs before their own is second nature for a veteran, and therefore many veterans do not seek help. How do we help them overcome the stigma and misconceptions of addiction and mental health disorders? How do we let them know that recovery is possible and their lives matter? It starts with community outreach efforts by treatment providers and educating veterans on their options for treatment. Let them know they are not alone in their experience and allow them the same opportunities as those they have protected while putting their lives on the line. Take a moment this Veteran’s Day to honor a veteran by thanking them for the sacrifices they have made for us and ask how you can be of service to them.

Jamie Clybourn, MCAP, ICAADC is the Clinical Supervisor at Retreat at Palm Beach, where veterans are receiving the highest standard of care in addiction treatment. She received her BA degree in Psychology from West Chester University and her Master’s degree in Counseling from Gardner-Webb University. She has worked at Retreat Premier Addiction Treatment Centers since the opening of their Lancaster County, PA facility in 2011 and she has worked in the field of addiction treatment for over 16 years.