Alcoholism and Veterans: Prevalence, Causes, and Risks

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Among veterans, alcohol abuse is a significant concern, particularly for those who served in combat. Dealing with combat trauma or adjusting back to civilian life can lead to alcohol misuse, further exacerbating these problems as well as worsening alcohol-related issues. The good news is some treatments prove effective in treating alcoholism in veterans.

Veterans: Alcohol Abuse Prevalence

Veterans are more likely to use alcohol compared to the general population. A national study conducted in 2017 found that nearly 57% of veterans reported alcohol use compared to 51% of non-veterans. More veterans also reported heavy alcohol use compared to the general population, with rates of 7.5% and 6.5%, respectively.¹

Furthermore, this study found that 65% of veterans who entered a treatment program reported that alcohol was the substance they most frequently misused; this is almost double that of the general population.¹ There are a few reasons why veterans may use and misuse alcohol.

Why Veterans Use Alcohol

Researchers believe that alcoholism in veterans could occur for a few different reasons. They might use alcohol to deal with depression or trauma from active duty or sexual assault. There might also be genetic factors that can increase veterans’ risk for coping with alcohol use.

Coping with Trauma

Most of the research studies on veterans and mental health are with those who served in the Afghanistan and Iraq wars shortly after 2001. One survey of 3,147 U.S. veterans aged 21 years and older found that about 42% of them dealt with alcohol use disorder (AUD). Those veterans dealing with AUD also had significantly higher rates of mood and anxiety disorders, other substance addictions, suicide attempts, and current suicidal ideation compared to veterans without AUD.²

For combat veterans, in particular, rates of post-traumatic stress disorder (PTSD) are high. In a sample of 289,238 veterans of the Iraq and Afghanistan wars, almost 37% had mental health diagnoses, and of that 37% (106,726), most had multiple mental health diagnoses, largely PTSD and major depression.³

Another study of 329,049 Iraq and Afghanistan veterans found that female veterans were more likely to receive a depression diagnosis than male veterans, which may be related to female veterans having also reported experiencing sexual trauma while serving in the military.^4,5

Coping with Physical Injury

In addition to dealing with psychological pain, alcohol abuse in veterans may also occur to cope with physical pain. Rates of injury are also high among veterans, and a study of 141,029 Iraq and Afghanistan veterans found that 11% received pain medication, which could contribute to an opioid addiction.⁶

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Transitioning to Civilian Life

Reintegrating into everyday life can be extremely difficult for many veterans returning home from combat. Researchers examined data of 199 veterans who served in Iraq or Afghanistan and got referred for psychological assessment. Three out of four of these veterans reported some family problems within the past week, such as feeling like a guest in their home, their children acting afraid of them, or their children not being warm toward them.⁷ They may use alcohol to self-medicate such distressing feelings.

Genetics

Researchers think that genetics can play a role in alcohol misuse and PTSD for some veterans. One twin study of 6,099 members of the Vietnam Era Twin Registry found that genetics, as well as environmental factors, were associated with alcohol dependence and PTSD.⁸ This means that some people have particular genes that may make them more vulnerable than others to alcohol addiction as well as PTSD, particularly after trauma exposure.

Risk Factors for Alcohol Use Disorder in Veterans

Research has found that some veterans are more likely to develop an alcohol addiction than others. Studies found that these individuals are those who:^2,9

Were younger
Were male
Had a lower level of education
Had a lower income
Had a greater number of traumatic experiences
Had combat experience
Had another lifetime substance use disorder
Tended to severely misuse substances
Had a lower tendency to have a positive outlook on the world

However, it’s important to note that these studies did not necessarily confirm a causal relationship, but rather a correlation between these traits and alcoholism in veterans.

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Veteran Alcohol Use Dangers

A few major dangers are associated with alcohol use among veterans, including worsening of post-traumatic stress disorder (PTSD), violence toward a romantic partner, self-harm, and challenges with accessing services.

Worsening PTSD

The self-medication hypothesis is one explanation for why veterans use alcohol to cope. This hypothesis suggests that veterans drink alcohol to cope with distressing symptoms associated with PTSD. Researchers think that veterans use alcohol because it gives immediate relief from PTSD hyperarousal symptoms: being easily startled, having disturbed sleep, or being excessively vigilant.^10,11 Numbing unwanted or unpleasant feelings is another reason why veterans might use alcohol.¹⁰

The self-medication hypothesis can also explain the development of alcohol use disorder (AUD) among veterans: PTSD leads to drinking to cope, which can cause tolerance to alcohol, leading to consuming more alcohol to feel the same effects.¹⁰ And drinking ever increasing amounts of alcohol can lead to dependence, which contributes to the development of alcohol addiction.

Furthermore, alcohol misuse can block recovery from and even worsen symptoms of PTSD. To recover from PTSD, a person has to stop avoiding stressful situations that bring up trauma symptoms, helping them to relearn that the situations are now safe. However, alcohol misuse can interfere with taking this recovery step because the person wants to continue to avoid the situations and use alcohol instead.¹⁰

Violence Toward Partner

Data analyzed from 376 couples who participated in the National Vietnam Veterans Readjustment Study found that the higher number of drinks a male veteran consumed on one occasion, the greater his aggression toward his wife. Moreover, the link between hyperarousal in the veteran and violence toward his partner was stronger when he drank more and with greater frequency.¹²

Keep in mind, this study is a relatively small sample size, and the results don’t necessarily mean that male veterans are going to engage in domestic violence when they return home. Many factors influence intimate partner violence, and alcohol abuse can increase this risk.

Violence Toward Self

Depression and alcohol misuse are linked by various studies. Researchers did a statistical combination with 74 different research studies and found that depression was significantly linked with simultaneous alcohol use.¹³

It seems that if there is a link between depression and alcohol use, then alcohol use may also be associated with thoughts or acts of suicide or self-harm since this is a common depressive symptom. One study included over 16,000 veterans administration patients and found that alcohol misuse and PTSD contributed to self-harm for the female patients.¹⁴

In another study with a nationally representative sample from the National Health and Resilience in Veterans Study, veterans with both AUD and PTSD were more likely to screen positive for major depression, suicidal ideation, and having made a suicide attempt.¹⁵

Moreover, suicide deaths among active-duty military and veterans exceed the rate for the general population. In 2014, veterans made up more than 20% of national suicides.¹⁵

If you are struggling with thoughts of suicide, call the National Suicide Prevention Lifeline at 800-273-8255. Someone is available 24/7 to talk to you.

What Drugs Are Veterans Addicted To?

Alcohol is not the only drug used among the veteran population. Other drugs misused by veterans include:¹

Marijuana
Heroin
Cocaine
Opioid pain relievers
Tobacco
Vaping and e-cigarettes

Polysubstance abuse and addiction can be difficult to overcome, but there are many addiction treatment programs that have experience in treating addictions to more than one drug. Call our helpline at 800-948-8417 Who Answers? to find the right rehab for you.

Veteran Alcohol Use Disorder Symptoms

Given risk factors associated with alcohol use disorder (AUD) in veterans, it is vital to know what the AUD symptoms are so that you can get yourself or a loved one help.¹⁶

Symptoms of AUD include:¹⁶

Drinking a larger amount of alcohol or over a longer period than you intended
Having a persistent desire to cut down or stop alcohol use
Spending a great deal of time obtaining alcohol, drinking, or recovering from drinking alcohol
Experiencing strong cravings for alcohol
Continuing alcohol use despite failing to fulfill major obligations such as at work, school, or home
Continuing to use alcohol even if you have problems in your relationships as a result
Giving up important activities (social, occupational, or recreational) because of alcohol use
Repeatedly using alcohol in situations in which it is physically dangerous, such as driving while drunk
Continuing to drink alcohol despite it causing or exacerbating physical health problems
Developing a tolerance to alcohol such that you need to drink more to feel the same effects
Experiencing uncomfortable withdrawal symptoms if you stop using alcohol

Even if you have experienced just one of the above criteria, it is best to get an assessment from a mental health professional. The sooner you get help, the better your chances of recovery or keeping your alcohol misuse from progressing or becoming more severe.

Treatments for Veterans

Among 62,000 substance use treatment admissions of veterans, alcohol was found to be the most common substance of choice.¹⁷ There is hope for struggling veterans because treatments for alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD) are safe and effective.¹⁸

Treatments for Alcohol Use Disorder

Experts recommend both psychotherapy and medication to treat AUD. One recommended psychotherapy is cognitive-behavioral therapy (CBT), which involves changing unhelpful thoughts about alcohol use and the reasons why you use alcohol. CBT also involves learning and practicing ways to avoid alcohol use and manage stressors and triggers.¹⁸

Couples therapy is also often a part of treatment for AUD because of the impacts that alcohol use has on the relationship. Motivational enhancement therapy (MET) is often a large part of any substance use treatment because it involves increasing your motivation to reduce your use. And lastly, therapists often recommend attending a 12-step program such as Alcoholics Anonymous (AA) at the same time.¹⁸

Treatments for PTSD

Treating PTSD can involve medication and trauma-focused psychotherapy. Trauma-focused therapy can occur in various ways but generally involves exposure therapy. Exposure therapy helps you learn to manage your reactions to distress-triggering situations such that your distress is lessened in such situations.¹⁸

Treatments for Both AUD and PTSD

Though the current research lacks studies of concurrent psychotherapy treatment for PTSD and AUD in the veteran population, some case studies do provide some preliminary information.

One such study called “seeking safety” found improvement in a small number of female veterans with both PTSD and AUD. It involves CBT that targets both PTSD and alcohol use but is not trauma-focused. Given the lack of research on this treatment protocol, a therapist is not likely to recommend it as the first line of treatment.¹⁸

Another treatment for both PTSD and AUD is a type of trauma-focused therapy that involves 12 total 90-minute sessions that utilize both relapse prevention and exposure therapy. One veteran who received this therapy reported reduced alcohol use while in treatment, had a significantly lower PTSD score at the end of treatment, and maintained these improvements three months after the end of treatment. Couples therapy for PTSD and AUD also shows promise.¹⁸

Regarding medication for PTSD and AUD, not enough research with veteran populations exists, and results are mixed among the studies that do exist. However, combined psychotherapy and medication for both PTSD and AUD may be effective.¹⁸

There Is Hope for Recovery

Veterans made a lot of sacrifices to serve the country and, as a result, many deal with the consequences of stressors and traumas. However, treatments are available to help veterans heal from the trauma, transition back to civilian life, enhance their interpersonal relationships, and quit using alcohol.

If you are concerned about your alcohol use or that of a loved one, help is available. For assistance with locating treatment providers, please call 800-948-8417 Who Answers? 24/7 to speak with one of our recovery support specialists.

Resources

National Institutes of Health. (2019, October). Substance Use and Military Life DrugFacts.
Fuehrlein, B.S., Mota, N., Arias, A.J., Trevisan, L.A., Kachadourian, L.K., Krystal, J.H., Southwick, S.M., & Pietrzak, R.H. (2016). The Burden of Alcohol Use Disorders in US Military Veterans: Results from the National Health and Resilience in Veterans Study. Addiction, 111(10), 1786-1794.
Seal, K.H., Metzler, T.J., Gima, K.S., Bertenthal, D., Maguen, S., & Marmar, C.R. (2011). Trends and Risk Factors for Mental Health Diagnoses Among Iraq and Afghanistan Veterans Using Department of Veterans Affairs Health Care, 2002–2008. American Journal of Public Health, 99(9), 1651-1658.
Maguen, S., Ren, L., Bosch, J.O., Marmar, C.R., & Seal, K.H. (2011). Gender Differences in Mental Health Diagnoses Among Iraq and Afghanistan Veterans Enrolled in Veterans Affairs Health Care. American Journal of Public Health, 100(12), 2450-2456.
Mattocks, K.M., Haskell, S.G., Krebs, E.E., Justice, A.C., Yano, E.M., & Brandt, C. (2012). Women at War: Understanding How Women Veterans Cope with Combat and Military Sexual Trauma. Social Science & Medicine, 74(4), 537-545.
Seal, K.H., Shi, Y., & Chohen, G. (2012). Association of Mental Health Disorders With Prescription Opioids and High-Risk Opioid Use in US Veterans of Iraq and Afghanistan. Journal of American Medical Association, 307(9), 940-947.
Sayers, S. (2009). Family Problems Among Recently Returned Military Veterans Referred for a Mental Health Evaluation. The Journal of Clinical Psychiatry, 70(2), 163-170.
Scherrer, J.F., Xian, H., Lyons, M.J., Goldberg, J., Eisen, S.A., True, W.R., Tsuang, M., Bucholz, K.K., & Koenen, K.C. (2008). Post-traumatic Stress Disorder; Combat Exposure; and Nicotine Dependence, Alcohol Dependence, and Major Depression in Male Twins. Comprehensive Psychiatry, 49(3), 297-304.
Na, P.J., Norman, S.B., Nichter, B., Hill, M.L., Rosen, M.I., Petrakis, I.L., & Pietrzak, R.H. (2021). Prevalence, Risk and Protective Factors of Alcohol Use Disorder During the COVID-19 Pandemic in U.S. military Veterans. Drug and Alcohol Dependence, 225, 1-8.
National Institutes on Alcohol Abuse and Alcoholism. (n.d.). Alcohol and Stress in the Military.
American Psychological Association. (2020). APA Dictionary of Psychology.
Savarese, V.W., Suvak, M.K., King, L.A., & King, D.W. (2001). Relationships Among Alcohol Use, Hyperarousal, and Marital Abuse and Violence in Vietnam Veterans. Journal of Traumatic Stress, 14, 717-732.
Conner, K.R., Pinquart, M., & Gamble, S.A. (2009). Meta-analysis of Depression and Substance Use Among Individuals with Alcohol Use Disorders. Journal of Substance Abuse Treatment, 37(2), 127-137.
Gradus, J.L., Leatherman, S., Curreri, A., Myers, L.G., Ferguson, R., & Miller, Matthew. (2017). Gender Differences in Substance Abuse, PTSD and Intentional Self-harm Among Veterans Health Administration Patients. Drug and Alcohol Dependence, 171, 66-69.
Norman, S. B., Haller, M., Hamblen, J. L., Southwick, S. M., & Pietrzak, R. H. (2018). The Burden of Co-occurring Alcohol Use Disorder and PTSD in U.S. Military Veterans: Comorbidities, Functioning, and Suicidality. Psychology of Addictive Behaviors, 32(2), 224–229.
American Psychiatric Association. (2013). Substance-related and addictive disorders. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Publishing.
Substance Abuse and Mental Health Services Administration. (2015). Veterans’ Primary Substance of Abuse is Alcohol in Treatment Admissions.
Dworkin, E.R., Bergman, H.E., Walton, T.O., Walker, D.D., & Kaysen, D.L. (2018). Co-Occurring Post-Traumatic Stress Disorder and Alcohol Use Disorder in U.S. Military and Veteran Populations. Alcohol Research, 39(2), 161-169.