By: John S., Help For Our Heroes Alumnus

As the War on Terror wages on and migrates from country to country with no real end in sight, we are in the middle of a war on our own soil.  Substance abuse is at an all-time high and shows no sign of digressing.  Nowhere is this more evident than among our veterans and military personnel returning from combat.  Following a war that has stretched nearly 20 years, the number of service members diagnosed with Post Traumatic Stress Disorder (PTSD) has significantly increased, with these warriors unaware that this is the cause of their symptoms.  These soldiers simply mask the problem with drugs and alcohol; it is this deadly combination of drugs and trauma that is plaguing our Veterans and causing rapid increases in not only substance abuse, but also homelessness, suicide, and overdoses. 

As a result of social media and an outcry from the veteran community, awareness about this growing epidemic has been raised as of late.  The question now is how to treat these issues.  Do we address them separately or together?  Which one do we treat first?  Do we treat with psychiatric meds, through therapy, or both?  Do we use conventional therapy or something new?  With this new awareness has come an outpouring of new approaches to both substance abuse and PTSD, many of which have no real long term data on effectiveness.  As all this is going on, we are losing Veterans to these issues at a staggering rate with no end in sight.

According to the United States Department of Veterans Affairs more than 2 out of every 10 Veterans with PTSD also has a Substance Dependence Disorder, and 1 out of every 3 veterans seeking treatment for substance abuse also has PTSD.  Additionally, 1 out of every 10 Veterans returning from our latest wars in Iraq and Afghanistan reports a problem with drugs or alcohol. These numbers are based solely on those Veterans who actually sought treatment or care from the VA and do not account for Veterans who are either unaware that they have a problem due to a culture of drinking established while in the service, or are too proud and stubborn to come forward and ask for help. As awareness and treatment options continue to grow, these Veterans continue to fall through the cracks. 

The stigma attached to both of these mental illnesses make many people, not just Veterans, weary of coming forward. The increase in these and other mental health issues have led the VA and its doctors to begin prescribing antidepressants and SSRIs to treat PTSD in large numbers. Unfortunately, the lasting effects of this form of treatment are hard to know because such a high percentage of Veterans eventually drop out of treatment. One reason for this could be that SSRIs are known to be more effective in acute PTSD as opposed to chronic PTSD, which so many veterans suffer from.  So with no real solution coming from prescription medicine, many Veterans are turning to self-medicating with drugs and alcohol.  If pharmacology isn’t the answer for many Veterans, there has become a growing need for treatment centers with the capability of treating both substance abuse and PTSD concurrently.  

With awareness increasing not just on the crisis facing Veterans but society as a whole, there has been a push for not-new nonconventional approaches as well.  When it comes to conventional treatments, cognitive behavioral psychotherapy and drug or alcohol treatment are more likely to reduce PTSD symptoms and substance use than just receiving treatment for one of these issues.  Some other conventional treatments bring relief to patients with PTSD including EMDR (Eye Movement Desensitization and Reprocessing), Prolonged Exposure Therapy, and Cognitive Processing.  Some new, less conventional and often times controversial types of therapy include Ketamine Therapy, Psychedelics such as psilocybin, and even the club drug MDMA.  All these have been reported to improve the lives of people with severe depression and PTSD.  The problem is a lack of evidence-based findings to back this up, and the possible unknown, long-term effects of some of these drugs.  Some of these drugs also come with a propensity for abuse which may not be the best thing for someone already struggling with addiction.  

It’s hard to really say what is working when it comes to addressing the problems plaguing our Veterans.  With pharmaceutical companies deep in the pockets of not just our government and the Veteran’s Affairs people, but also very possibly the publications and experts, it’s also hard to differentiate the true from the false.  I personally have found some statements on this issue cited as truths in the VA handbook to be blatantly false.  On numerous occasions, I was told by the local VA I had to first deal with my addiction and drug use before they would allow me to go  into a PTSD program.  At the same time, the VA handbook clearly says, “Substance use illness must never be a barrier for treatment of patients with other mental health conditions.” With that being said, and with continuing awareness being brought to the issue of addiction and PTSD, I think things are slowly moving forward and funding is beginning to come in and make a difference.  

As someone who has been through treatment and now with an interest in helping others with these issues, I believe if we keep fighting and don’t give up things will get better.  For the first four years that I was out of the Marine Corps, I was stuck in a vicious cycle of homelessness, VA psych wards and treatment centers; and although I was routinely given tools to deal with my addiction and PTSD, I was unwilling to believe there was any way out. Only when I became willing to listen did I realize there was hope and that people just like me who had thrown away their families and everything else were actually recovering. I came to realize that what I was lacking in my life, since combat and the Marine Corps was PURPOSE, and although I apply the many tools and lessons I learned in treatment now, it wasn’t until I realized I still had a purpose in life that I began to believe I could recover.  No matter what you’re struggling with it is my belief that with a small amount of HOPE and some PURPOSE you can begin to change and get better.