PTSD and Substance Abuse in Veterans: Why They’re Linked, and How Treating Both Together Changes Everything
By Dr. Narine Arutyounian, M.D., Medical Director
Clinical contribution by Ritsa Fistes, LMFT, Clinical Director
Healthy Living Residential Program, Santa Clarita, CA
If you are a veteran, or you love one, you may already know this pattern by heart. The drinking that started as a way to sleep. The pain pills that outlasted the injury. The nights that end at 3 AM with a mind that will not stand down. For many veterans, PTSD and substance abuse are not two separate problems; in fact, they are two halves of the same story, and that is precisely why treating only one of them so often fails.
As the Medical Director of a 12-bed residential detox and treatment facility in Santa Clarita, I have treated many veterans over the years, and I want to say something clearly at the outset: substance use in this population is not a character flaw. It is a predictable response to a specific set of experiences, and it responds to treatment when the treatment addresses the whole picture.
In this article, I will walk through why PTSD and substance use are so tightly connected in veterans, the warning signs that the connection has taken hold, what integrated treatment actually looks like, and how programs like VA Community Care can help eligible veterans access residential care at private facilities like ours.
How Common Is Substance Abuse Among Veterans?
The numbers tell a consistent story. According to the National Institute on Drug Abuse, more than one in ten veterans has been diagnosed with a substance use disorder, a rate slightly higher than the general population, with alcohol the most commonly involved substance [1]. Moreover, peer-reviewed research on veteran substance use has linked it to elevated risks that deserve plain language: among military personnel, roughly 30 percent of completed suicides were preceded by alcohol or drug use [2].
The mental health side of the ledger is just as significant. RAND Corporation’s landmark Invisible Wounds of War study found that nearly 20 percent of service members returning from Iraq and Afghanistan reported symptoms of PTSD or major depression, yet only slightly more than half had sought treatment, often out of fear that asking for help would harm their careers or reputations [3].
Put those two findings together and you have the heart of the problem: a population carrying significant trauma, hesitant to seek care, and managing symptoms with the most available tool there is, a substance.
Why PTSD and Substance Use Are So Tightly Linked
The Self-Medication Cycle
PTSD is not simply “bad memories.” It is a measurable change in how the brain and nervous system process threat, producing hypervigilance, intrusive flashbacks, emotional numbing, and severe sleep disruption. Alcohol quiets a nervous system stuck in overdrive, at least for a few hours. Opioids blunt both physical pain and emotional pain. Stimulants cut through the fog of depression and exhaustion.
The relief is real, and that is exactly the trap. Each use teaches the brain that the substance works, while the underlying PTSD goes untreated and frequently worsens. Tolerance builds, doses climb, and what began as a coping strategy becomes a co-occurring disorder in its own right. Research on veterans confirms how often these conditions travel together: PTSD and substance use disorders co-occur at high rates in the veteran population, and each makes the other harder to resolve when treated alone [4].
The Pathways That Lead There
Different service experiences create different routes into the same cycle. The most common include:
Combat exposure and operational trauma. Prolonged deployment stress and the things witnessed in theater are the classic drivers of PTSD, and alcohol is the most common substance used to manage it.
Chronic pain and prescription opioids. Injuries sustained in service, and the physically punishing nature of military work, lead many veterans into pain medication dependency that began with an entirely legitimate prescription.
Military sexual trauma (MST). Experienced by both women and men, MST remains one of the most underreported drivers of PTSD and substance use in the veteran community, and it requires clinical care delivered with particular sensitivity.
The reintegration gap. Leaving a mission-driven environment with built-in structure, purpose, and brotherhood for civilian life can produce a loss of identity that depression and isolation rush to fill. Veterans experience higher rates of PTSD, substance use disorders, and major depression than the general population, and stigma within military culture remains a real barrier to asking for help [5].
Warning Signs the Cycle Has Taken Hold
For veterans and family members alike, these are the signals that self-management has crossed into something that needs professional treatment:
- Drinking or using to fall asleep, stay asleep, or quiet intrusive thoughts
- Needing more of the substance to get the same effect
- Avoiding people, places, or conversations that trigger memories, and using when avoidance fails
- Anger, irritability, or hypervigilance that loved ones have started to comment on
- Continuing to use despite consequences at work, at home, or with health
- A growing sense that the substance is the only thing holding the line
If several of these sound familiar, the answer is not more willpower. It is treatment that addresses the trauma and the substance use at the same time.
Why Treating Both Together Is the Standard of Care
For years, the conventional approach was sequential: get sober first, deal with the trauma later. Experience and research have shown the flaw in that thinking. Untreated PTSD is one of the most powerful relapse drivers there is, and untreated substance use blocks the stability needed for trauma work. Encouragingly, research in veterans shows that having a co-occurring substance use disorder does not prevent successful engagement in PTSD care; veterans with both conditions can and do benefit from evidence-based treatment [4], and studies of VA patients have found that a co-occurring substance use disorder did not hinder receipt of meaningful PTSD psychotherapy [6].
At Healthy Living, this integrated philosophy shapes every veteran’s treatment plan:
Medical detox comes first, safely. Years of alcohol, opioid, or benzodiazepine use create physical dependencies that carry real withdrawal risk. Our medical detox is supervised 24/7 by our board-certified physician-led team, with Medication-Assisted Treatment (MAT) administered by our LVN as clinically indicated, so the physical stabilization is handled with precision rather than endured as a gauntlet.
Trauma-informed therapy goes beneath the surface. Our licensed therapists, LMFTs, and certified counselors work from a trauma-informed lens beginning on day one, creating space in individual therapy to begin processing combat trauma, MST, grief, and moral injury, while group therapy rebuilds something veterans deeply miss: the experience of being understood by people who get it.
Structure that feels familiar. Veterans thrive with a defined daily rhythm. Our 30-day residential program runs on a full daily schedule, morning reflections, process groups, anger management, breathwork, mindfulness, yoga, art therapy, and evening AA/NA meetings, that channels military discipline into recovery rather than asking veterans to function without it.
Privacy without the institutional feel. With only 12 beds, our facility is a home, not a campus. For veterans wary of being processed through a large system, that difference matters enormously.
Using VA Community Care to Access Private Residential Treatment
One of the most practical questions veterans ask us is also one of the most important: can I use my VA benefits at a private facility? In many cases, yes. Under the VA’s Community Care program, eligible veterans can receive care from approved community providers when the VA cannot provide the needed care itself.
The VA’s published eligibility criteria include several pathways, and a veteran only needs to meet one [7]:
| You may be eligible for VA Community Care if… |
|---|
| The service you need is not provided at any VA health facility |
| The VA cannot schedule your appointment within 20 days for mental health or primary care (28 days for specialty care) |
| You live more than a 30-minute average drive from VA mental health or primary care (60 minutes for specialty care) |
| You and your VA provider agree that community care is in your best medical interest |
| The VA service available to you does not meet its quality standards |
VA approval is required before care begins, and the paperwork can feel like one more obstacle when you are already struggling. That is exactly where our admissions team comes in. We are experienced in helping veterans understand their options, gather documentation, and navigate the process, and we also accept most PPO insurance plans for veterans whose coverage runs through an employer or spouse. If you are not sure what your benefits cover, call us and we will find out together.
Recovery Is a Mission With a Team Behind It
Treatment does not end at discharge, and neither does our involvement. Aftercare planning is built into the final phase of every veteran’s stay, connecting outpatient services, AA/NA communities, sober living options, and veteran-specific support programs across Santa Clarita and greater Los Angeles. For veterans whose partner also needs treatment, we accept couples simultaneously, because family recovery and individual recovery reinforce each other.
And if you or a veteran you love is in crisis right now, do not wait for an admissions process. The Veterans Crisis Line is available 24/7: dial 988 and press 1, text 838255, or chat online, free and confidential [8].
Why Choose Healthy Living Residential Program
Healthy Living Residential Program is a 12-bed co-ed residential detox and treatment facility in Santa Clarita, California. We are DHCS licensed and JCAHO accredited, owned and operated by board-certified physicians and staffed by licensed therapists, LMFTs, certified counselors, and credentialed recreational therapists.
We serve the veteran community across Los Angeles County, the San Fernando Valley, the Santa Clarita Valley, and Southern California with the confidentiality, structure, and trauma-informed clinical depth that this population deserves. Our admissions team is available 24 hours a day, seven days a week, without judgment and with deep respect for your service.
You have already proven you can do hard things. Let this be the next one, with a team behind you this time.
Call us today at (661) 536-5562, 24 hours a day, 7 days a week. The next mission is yours, and we will be with you every step of the way.
Learn more about our Veterans program →
Related reading: First Responders and Addiction: Why the Bravest Among Us Struggle in Silence
Sources
[1] National Institute on Drug Abuse (NIDA). Substance Use and Military Life DrugFacts. https://nida.nih.gov/publications/drugfacts/substance-use-military-life
[2] Teeters JB, Lancaster CL, Brown DG, Back SE (2017). Substance use disorders in military veterans: prevalence and treatment challenges. Substance Abuse and Rehabilitation, Dove Medical Press. https://www.dovepress.com/substance-use-disorders-in-military-veterans-prevalence-and-treatment–peer-reviewed-fulltext-article-SAR
[3] Tanielian T, Jaycox LH, eds. (2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. RAND Corporation. https://www.rand.org/pubs/monographs/MG720.html
[4] Somohano VC, et al. (2024). Predictors of evidence-based psychotherapy initiation among veterans with co-occurring PTSD and substance use disorder. Frontiers in Psychiatry. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2024.1432361/full
[5] National Alliance on Mental Illness (NAMI). Service Members & Veterans. https://www.nami.org/service-members-and-veterans/
[6] Mansfield AJ, Greenbaum MA, Schaper KM, Banducci AN, Rosen CS (2017). PTSD Care Among Veterans With and Without Co-Occurring Substance Use Disorders. Psychiatric Services. https://scholars.duke.edu/publication/1514577
[7] U.S. Department of Veterans Affairs. Eligibility for Community Care Outside VA. https://www.va.gov/resources/eligibility-for-community-care-outside-va/
[8] Veterans Crisis Line. Free, confidential support for Veterans in crisis, 24/7. https://www.veteranscrisisline.net/
About the Author
Dr. Narine Arutyounian, M.D. is the Medical Director at Healthy Living Residential Program in Santa Clarita, California. She oversees the medical care of all clients in detox and residential treatment, including medically supervised withdrawal management and Medication-Assisted Treatment, and leads the physician-led team that provides 24/7 medical supervision at the facility.
Clinical contribution by Ritsa Fistes, LMFT, Clinical Director at Healthy Living Residential Program, who oversees the facility’s trauma-informed clinical programming, including individual and group therapy for veterans with co-occurring PTSD and substance use disorders.
