PTSD and Alcoholism in Veterans

“There’s a group of people coming to kill all of us right now.” In his talk about dealing with PTSD after his 2009 tour in Afghanistan, Brandon talks about the terrifying realization he had during his first days of combat. The experience left him with the kind of emotional turmoil that makes everyday situations trigger intense outbursts.

Brandon’s story is, unfortunately, all too common among the ranks of veterans. And often it leads to substance abuse. What is the link between veterans and alcoholism? And is alcoholism a VA disability? Let’s find out more.

Alcoholism in Veterans: Invisible Wounds

Most of us can’t imagine the horrors of war. But for thousands of veterans, the sights and sounds of extreme fear, pain, and death were once an everyday reality. Understandably, it leaves wounds — physical ones, but invisible ones as well.

The roots of veteran alcohol abuse are often connected to the trauma left behind after the gunshots have ceased and the dust has settled on the battlefield. Life has moved on, but something in the mind clings to the horrors of the past, trying to make sense of them. 

What Is PTSD?

In The Evil Hours: A Biography of Post-Traumatic Stress Disorder, David Morris writes about the devastating effects of PTSD. It can make it feel as if we’re stuck in time, unable to find our “groove” for years on end:

“Trauma destroys the fabric of time. In normal time you move from one moment to the next, sunrise to sunset, birth to death. After trauma, you may move in circles, find yourself being sucked backwards into an eddy or bouncing like a rubber ball from now to then to back again ... In the traumatic universe the basic laws of matter are suspended: ceiling fans can be helicopters, car exhaust can be mustard gas.”

In psychological terms, post-traumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event. It can have many causes and can manifest in different ways, often leading to alcoholism in veterans and others who experience it.

Causes of PTSD

As New York Times columnist David Brooks writes in “The Moral Injury,” 

“People generally don’t suffer high rates of PTSD after natural disasters. Instead, people suffer from PTSD after moral atrocities. Soldiers who’ve endured the depraved world of combat experience their own symptoms. Trauma is an expulsive cataclysm of the soul.”

For veterans, traumatic experiences such as combat exposure, military sexual trauma, or the loss of comrades can trigger symptoms of PTSD. 

Symptoms of PTSD

The main feature of PTSD is that the memories persist, intruding on our daily experience of life and making it difficult to move on. 

The symptoms of PTSD may include a number of psychological traits and patterns:

• Flashbacks. One of the most common and devastating symptoms, flashbacks bring us back to the trauma-causing event. They can happen at any time — a memory, a conversation, something we see in the news, or even a particular smell or taste can serve as a trigger. All of a sudden we’re back on the battlefield, our life flashing before our eyes.
• Nightmares. The trauma we experience in real life often haunts our dreams, causing nightmares that add to the stress during the day and sometimes rob us of much-needed sleep.
• Hypervigilance. In Trauma and Recovery: The Aftermath of Violence — From Domestic Abuse to Political Terror, Judith Lewis Herman writes: “After a traumatic experience, the human system of self-preservation seems to go onto permanent alert, as if the danger might return at any moment.” We might feel the need to “sleep with one eye open” all the time, watching for signs of danger coming around the corner. With the “fight or flight” response of the autonomic nervous system activated at the slightest provocation, we find ourselves in a state of hyperarousal.
• Avoidance of reminders of the trauma. We might develop a habit of avoiding subjects related to our past trauma altogether. It’s the brain’s way of keeping us safe, but it can become counterproductive, getting in the way of our daily activities.
• Negative changes in mood and cognition. We might notice shifts in our overall energy levels, mood, and ability to keep up with life. Tasks that used to be automatic might get more difficult, while small things set us off, causing angry outbursts or crying spells.

How Common Are PTSD and SUD in Veterans?

Research shows that alcohol use disorder (AUD) is very common in veterans. Part of the reason has to do with simple demographics: AUD is more common in males. Around 90% of veterans who receive AUD care from Veterans Affairs (VA) are male — a percentage that matches the overall gender composition of the veteran population, which is predominantly male. According to the NIH, 65% of those seeking help for substance abuse disorder(SUD) report alcohol as their “drug of choice.” However, some might be hesitant to admit to using other drugs because of the stigma or possible impact on their military careers.

As for PTSD, at least 7% of veterans are likely to experience it. However, this is probably an underestimate. If we dig deeper and look at the statistics related to recent wars, the numbers are even higher. As it turns out, 15% of veterans who participated in Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF) experienced PTSD in the last year. And 29% (almost a third!) will experience PTSD at some point in their lives. Understandably, PTSD is also 3 times more likely in veterans who were deployed (i.e. went overseas and saw combat) than those who were not. 

The numbers tend to be higher among women. In 2021, there were 6 million veterans using VA care. Out of them, 10% of males and 19% of females were diagnosed with PTSD. Unfortunately, the reason has to do with the prevalence of sexual trauma that adds to the burden women often face in the military. The numbers are staggering: as many as 1 in 3 women (compared to 1 in 50 men) receiving VA services reported sexual trauma related to their time in the service. 

With over 2.5 million soldiers deployed to Afghanistan or Iraq, since September 11, 2001, PTSD has been called an “epidemic” among veterans. The implications are devastating: according to the UNC School of Medicine Institute for Trauma Recovery, “1 veteran commits suicide in the U.S. every 80 minutes.”

Alcoholism VA Ratings

The VA uses a system of ratings to classify combat-related disabilities. They are expressed as percentages, with higher values indicating a higher level of disability (and possible compensation).

Some of us might be wondering, what is the “PTSD with alcohol use disorder” VA rating? And is alcoholism a VA disability in the first place? 

While alcoholism doesn’t “count” as a primary VA disability, its aftereffects (as well as the PTSD that might have led up to it) do. For example, if a veteran receives a 50% disability rating for PTSD, that number could go up to 70% as a result of AUD-related health effects. 

The Link Between Alcohol Misuse and PTSD

Research has shown a strong association between PTSD and alcoholism in veterans. According to studies, veterans with PTSD are more likely to develop alcohol use disorder compared to those without PTSD. 

The relationship between PTSD and alcoholism is complex and multifaceted, with several factors coming into play:

1. Impaired Coping Skills

There’s a lot of guilt that comes with combat-related PTSD. As Brooks writes in “The Moral Injury,” 

“Many veterans feel guilty because they lived while others died. Some feel ashamed because they didn’t bring all their men home and wonder what they could have done differently to save them. When they get home they wonder if there’s something wrong with them because they find war repugnant but also thrilling. They hate it and miss it. Many of their self-judgments go to extremes … The self-condemnation can be crippling.”

Added to the guilt are many other emotions, including fear, anger, and hopelessness. Intrusive memories, nightmares, and hyperarousal can make the challenge of dealing with these difficult feelings appear insurmountable. 

We need coping strategies to overcome challenges as heavy as PTSD and AUD, but it’s not always obvious what we should do. Without adequate resources or access to psychological help, alcohol or drugs might seem like the easiest “quick fix.” 

As a central nervous system depressant, alcohol temporarily slows down our thinking and dulls our reflexes, creating an illusion of relaxation. However, the effect is only temporary: the emotional pain and psychological distress might fade into the background for some time, but usually come back stronger once the boozy haze wears off.

2. Neurobiological Factors

As veteran Jake Wood writes in Among You: The Extraordinary True Story of a Soldier Broken By War, experiencing combat and PTSD changes something in the very biology of our emotional landscape:

“You are no longer human, with all those depths and highs and nuances of emotion that define you as a person. There is no feeling anymore, because to feel any emotion would also be to beckon the overwhelming blackness from you. My mind has now locked all this down. And without any control of this self-defense mechanism my subconscious has operated. I do not feel anymore.”

This emotional “dullness” is a classic sign of dopamine depletion, which can be a symptom of PTSD and alcoholism alike. The “feel-good chemical” is part of the brain’s reward system, which normally makes activities such as socializing, eating, or pursuing romantic interests enjoyable. 

Traumatic experiences can cause neurological shifts in our reward system (as well as in our natural endorphin levels) that make it hard for us to experience joy. It makes all the more sense why alcohol — which boosts dopamine and endorphins in the short term — seems like a solution. However, over time the brain produces less of the neurochemical to rebalance itself, leading to dependence and addiction. The result? Both PTSD and alcohol misuse become further entrenched and more difficult to overcome.

3. Social Isolation 

Last but not least, one of the most crippling effects of living with the memories of active combat is the fact that it can be an incredibly lonely experience. Most of us haven’t experienced it directly, and while we might be able to empathize at a human level, it’s not the same. Heartbreaking as it is, our gestures of empathy are simply not enough. As veteran Jake Wood writes in Among You: The Extraordinary True Story of a Soldier Broken By War, “I feel no emotional connection to these outwardly human gestures. I am not there, because I never left Afghanistan.”

As a result, veterans can fall into a downward spiral of isolation, retreating from life rather than trying to find connection and meaning. Once alcohol is in the picture, the spiral turns into a vortex: drinking to cope with the trauma only increases the isolation, fueling addictive behavior as time goes on. (To find out more, take a look at “How Do Loneliness and Alcohol Fuel Each Other.”)

The Way Out of PTSD and AUD

While PTSD and AUD alike can seem like an impossible trap, there’s light at the end of the tunnel. Many have made it out to the other side. That said, it takes some hard work — but it can absolutely be done! Here are some ideas to start with.

1. Seek help. There’s no shame in asking for help — in fact, it’s a sign of strength. As Joan Beder writes in Advances in Social Work Practice with the Military, “The key to reducing stigma is to present mental health care as a routine aspect of health care, similar to getting a checkup or an X-ray.” Getting help should be the norm, not the exception, and it should always be actively encouraged. After all, there are lives at stake — lives that were so bravely put on the line on the battlefield.
2. Find a community. There’s strength in numbers, and battling PTSD and AUD is no exception. Both conditions can be extremely isolating, so getting support from others can make a world of difference, providing that crucial bit of hope that recovery is possible. 
   
   There are many support groups for veterans out there, including organizations such as the Veterans Health Administration (VHA) and Veterans of Foreign Wars (VFW), which can provide valuable resources for PTSD and AUD while fostering a sense of community. You’re not alone!
3. Build a new life, step by step. While it’s certainly easier said than done, it’s possible to find peace, joy, and a source of meaning after a struggle with PTSD and AUD. The key is taking small steps: rediscover old hobbies, take classes in subjects you’re interested in, and listen to podcasts or audiobooks to spark curiosity. 
   
   Start with a few minutes a day devoted to activities that enrich your life and help you tap into new sources of meaning. It might feel awkward at first, but don’t worry! Any step in the right direction is a victory worth celebrating.

With these steps, you can start your journey to rediscovering life and redefining your place in it. And remember, Reframe is here to support you every step of the way!

PTSD, AUD, and Hope

In the end, it’s crucial to remember that both PTSD and AUD are medical conditions. And while it’s our responsibility to address them, it’s never our fault if we find ourselves struggling. We should never feel alone in the process — let’s not lose sight of the fact that recovery is possible, and there’s so much hope and joy waiting for us.