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Substance Use Disorder in Veterans: Risks, Signs, and Treatment

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Headshot of Danesh Alam MD, DFAPA, DFASAM

Medically reviewed by Danesh Alam MD, DFAPA, DFASAM

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Substance use disorder in veterans is common and treatable. In SAMHSA's 2023 national survey, about 2.8 million veterans, or 14%, had a substance use disorder in the past year, and alcohol was the most common one. Risk is tied to PTSD, chronic pain, and combat-zone service. Therapy and medication both help. SAMHSA: 2023 NSDUH, veterans aged 18 or older

If you are a veteran or service member in crisis, or you are worried about one, contact the Veterans Crisis Line: dial 988 then press 1, or text 838255. It is free, confidential, and open 24 hours a day. You do not have to be enrolled in VA benefits or health care to use it. Veterans Crisis Line

We are publishing this on Veterans Day, but the information applies any day of the year.

How common is substance use disorder in veterans?

About 1 in 7 veterans had a substance use disorder in 2023. SAMHSA's National Survey on Drug Use and Health estimated that 14.0% of veterans age 18 or older, about 2.8 million people, met the criteria in the past year. Alcohol use disorder was the most common, at 9.1% (1.8 million veterans). Drug use disorders affected 6.4% (1.2 million). SAMHSA: 2023 NSDUH, veterans aged 18 or older

Younger veterans were affected more often. Among veterans ages 18 to 49, 21.2% had a substance use disorder, compared with 11.9% of veterans age 50 or older. SAMHSA: 2023 NSDUH, veterans aged 18 or older

Being a veteran does not, on its own, mean a higher rate. Once the survey adjusted for age, veterans were "just as likely to have a substance use disorder as non-veterans" (18.0% and 18.9%). SAMHSA: 2023 NSDUH, veterans aged 18 or older What differs is the set of experiences that can sit behind the drinking or drug use.

Why are some veterans at higher risk for substance use problems?

Several parts of military life are linked to heavier drinking or drug use: service in a combat zone, PTSD, chronic pain, brain injury, and the move back to civilian life. None of them applies to every veteran, and many veterans have none of them.

How are PTSD and substance use connected in veterans?

PTSD and substance use often occur together, and each can make the other worse. According to the VA's National Center for PTSD, veterans who have had PTSD at some point are 2 times more likely to have problems with alcohol and 3 times more likely to have problems with drugs than veterans who have not. VA National Center for PTSD: Substance use and PTSD

Most veterans do not have PTSD. About 7 in 100 will have it at some point in their lives, a rate close to that of the general population (6 in 100). VA National Center for PTSD: How common is PTSD in veterans?

For most people who have both conditions, PTSD comes first. Some people use alcohol or drugs to manage the symptoms. The VA points out that this backfires: alcohol makes sleep less restful, and drug use can increase irritability and the avoidance of emotions. VA National Center for PTSD: Substance use and PTSD If that pattern sounds familiar, see why PTSD can get worse.

Should PTSD and addiction be treated at the same time?

Yes. The VA states that "PTSD and substance use can be successfully treated at the same time," and that doing so works for both conditions. VA National Center for PTSD: Substance use and PTSD Its guidance to clinicians is that having one condition "should not be a barrier to receiving treatment for the other." VA National Center for PTSD: Treatment of co-occurring PTSD and substance use disorder in VA

For PTSD, the VA says trauma-focused psychotherapies are the most effective. Those with the strongest evidence are Cognitive Processing Therapy, Prolonged Exposure, and Eye Movement Desensitization and Reprocessing (EMDR). Ambrosia offers EMDR therapy and treatment for PTSD with a co-occurring substance use disorder.

Are veterans at higher risk for opioid problems?

Pain is the main link. Chronic pain is more common in veterans, and opioids have often been prescribed to treat it. Substance Abuse and Rehabilitation: Substance use disorders in military veterans In 2023, an estimated 598,000 veterans misused prescription pain relievers in the past year, and 1.8% of veterans had a pain reliever use disorder. After adjusting for age, veterans misused opioids at about the same rate as non-veterans. SAMHSA: 2023 NSDUH, veterans aged 18 or older

VA prescribing has changed. Between 2012 and early fiscal year 2020, the number of veterans who were dispensed an opioid through the Veterans Health Administration fell 56%. Journal of General Internal Medicine: Opioid prescribing in the Veterans Health Administration Our guide to chronic pain and addiction explains how both can be treated.

How is substance use linked to suicide risk in veterans?

Suicide rates are higher among veterans with a substance use disorder, which is one more reason not to wait on treatment. In 2024, 6,488 veterans died by suicide, an average of 17.7 a day. Among veterans who had recently used VA health care, the suicide rate for those with a substance use disorder diagnosis was 92.0 per 100,000, compared with 27.2 per 100,000 for those with no mental health or substance use diagnosis. VA: 2026 National Veteran Suicide Prevention Annual Report

Support is available at any hour. The Veterans Crisis Line serves veterans, service members, National Guard and Reserve members, and the people who support them. Dial 988 then press 1, text 838255, or chat online. Veterans Crisis Line Families can also review the warning signs for suicide.

What are the signs a veteran may need help with alcohol or drugs?

The clearest sign is that drinking or drug use keeps causing problems and continues anyway. The VA and Department of Defense patient guide lists these warning signs: VA/DoD: Substance use disorders guideline, patient summary

  • Using more, or more often, than you planned
  • Spending a lot of time using or recovering
  • A strong desire to use
  • Trouble keeping up with work or family obligations
  • Giving up activities you used to enjoy

Conflicts with family or friends, issues at work, and money trouble are common results. A health care provider can tell you whether your use fits the diagnosis.

Why don't more veterans get treatment?

Most veterans with a substance use disorder do not get treatment, and the main reason is that they do not think they need it. In 2023, 85% of veterans with a substance use disorder received no substance use treatment. Of those, 95.9% did not perceive a need for it. SAMHSA: 2023 NSDUH, veterans aged 18 or older

Stigma plays a part. Military culture places a high value on self-reliance, and researchers note that some veterans see professional help as a sign of weakness. Substance Abuse and Rehabilitation: Substance use disorders in military veterans

For people still serving, career worries are real. Each branch has its own rules on voluntary treatment and on when a command is notified. The VA/DoD patient guide, dated 2021, says command notification "may or may not have career implications." VA/DoD: Substance use disorders guideline, patient summary Check your branch's current policy.

How is substance use disorder treated in veterans?

Treatment usually combines talk therapy with medication when one fits, in a setting matched to how severe the problem is. The VA/DoD guide is direct on this: no single treatment is right for everyone. VA/DoD: Substance use disorders guideline, patient summary

Therapy. Approaches the VA lists for substance use include cognitive behavioral therapy, motivational enhancement therapy, contingency management, and relapse prevention. VA National Center for PTSD: Substance use and PTSD

Medication for alcohol use disorder. Three medications are approved in the United States: naltrexone, acamprosate, and disulfiram. NIAAA: Treatment for alcohol problems Our guide to medication for alcohol use disorder explains how each one works.

Medication for opioid use disorder. Buprenorphine, methadone, and naltrexone are the most common FDA-approved medications. SAMHSA notes that they are most effective for people who also take part in a treatment program. SAMHSA: Treatment options for substance use disorder Ambrosia's medication-assisted treatment program describes how medication fits into care.

Level of care. Options range from outpatient counseling and intensive outpatient treatment to residential care, with continuing care afterward. Some people start with medically managed detoxification. VA: Substance use treatment for veterans Do not stop heavy drinking suddenly on your own. NIAAA warns that alcohol withdrawal can be painful and even life-threatening, and advises seeking medical help to plan a safe recovery. NIAAA: Treatment for alcohol problems

How do veterans pay for substance use treatment?

The main routes are VA health care, VA community care, TRICARE, and private insurance. VA care and TRICARE are separate programs, each with its own eligibility rules.

  • VA health care. You may be eligible if you served in the active military, naval, or air service and did not receive a dishonorable discharge. VA: Eligibility for VA health care VA services include detoxification, outpatient and residential care, and medications. Veterans who served in a combat zone can also get free, private counseling and an alcohol and drug assessment at a community Vet Center. VA: Substance use treatment for veterans
  • VA community care. In some situations the VA pays for care from a provider in its community care network. You must be enrolled in or eligible for VA health care, and you need approval from your VA health care team before you get the care. VA: Eligibility for community care outside VA
  • TRICARE. TRICARE is the health program run by the Defense Health Agency. It covers services that are "medically necessary and considered proven," and special rules or limits apply to some types of care. TRICARE: Is it covered? Check the rules for your own plan before you start care.

Ambrosia's TRICARE page states that its Singer Island program is in-network with TRICARE. Before treatment begins, the admissions team confirms your eligibility and plan benefits, so you know what is covered.

How can family help a veteran with a substance use problem?

Family support can play a major role, and it starts with a direct conversation about what you have noticed. SAMHSA encourages families to talk directly with their loved ones about their concerns, to stay open to support groups or family therapy, and to look after their own health too. SAMHSA: Helping families cope with mental health and substance use disorders

You do not have to handle it alone. The Veterans Crisis Line also serves the people who support veterans, so you can call if you are worried about someone's safety. Veterans Crisis Line Vet Center services are available to family members as well, when taking part would support the veteran. VA: Vet Center eligibility

Therapy can also teach family and friends how to support recovery. VA/DoD: Substance use disorders guideline, patient summary Ambrosia includes loved ones through family therapy.

Frequently asked questions

Are veterans more likely than civilians to have a substance use disorder?

Not overall. In SAMHSA's 2023 survey, veterans were just as likely as non-veterans to have a substance use disorder once age was taken into account. Alcohol use disorder was more common among veterans who had served in a combat zone.

What is the most common substance use disorder in veterans?

Alcohol use disorder. In 2023, 9.1% of veterans had an alcohol use disorder in the past year, compared with 6.4% who had a drug use disorder.

Can PTSD and a substance use disorder be treated at the same time?

Yes. The VA's National Center for PTSD says the two can be successfully treated at the same time, and that having one should not be a barrier to treatment for the other.

Do I need to be enrolled in VA health care to call the Veterans Crisis Line?

No. You do not have to be enrolled in VA benefits or health care. Dial 988 then press 1, or text 838255.

Does TRICARE cover treatment for alcohol or drug problems?

TRICARE covers care that is medically necessary and considered proven, with rules that vary by plan. Check tricare.mil/sud for current details, or ask a provider's admissions team to verify your benefits.

Getting help at Ambrosia

Ambrosia's substance use program for veterans includes trauma-focused care, medication-assisted treatment, cognitive behavioral therapy, EMDR, dual-diagnosis care, and family therapy. When depression, anxiety, or PTSD is the main concern, see the veterans mental health program.

For free, confidential treatment referrals at any hour, call SAMHSA's National Helpline at 1-800-662-4357, in English or Spanish. SAMHSA: National Helpline

Help is available when you are ready

If you have questions about mental health or substance use treatment — for yourself or for someone you love — our admissions team can talk them through with you.

Call (888) 492-1633