Substance Use Basics

In order to help a veteran who’s struggling with substance misuse, you’ll first need to have a firm understanding of the issues at hand. 

What is a substance use disorder?

A substance use disorder is a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.

Why is it considered a chronic brain disease?

Substance use disorders are a medical problem. The regular use of alcohol and/or other drugs produces changes in the brain which strongly reinforce the behavior of drug use, teaching the person to repeat it.

How do substance use disorders change behaviors?

People who are addicted to alcohol and/or other drugs have changes in their brain that causes changes in the following areas:

  • Judgement
  • Decision-making
  • Learning
  • Memory
  • Behavioral Control
  • Substance use disorders are often tied in to mental health and co-occurring conditions such as anxiety, depression, and PTSD.

Is alcohol and drug misuse a choice?

In most cases, the initial decision to drink or use substances is a choice. However, after continued use, changes in the brain can seriously impair one’s ability to control their use.

What are the signs/symptoms?

Signs and symptoms of substance use disorders can vary depending on the substance (e.g. marijuana, cocaine, etc) and the method in which the substance was used (e.g. injection, smoking, etc.). However, there are some general signs and symptoms of substance abuse to be aware of:

  • Increased tolerance to the substance
  • Difficulty sleeping or sleeping too much
  • Changes in hygiene – dental issues, skin changes, wearing dirty clothing
  • Sudden change in weight (loss or gain)
  • Poor performance in school and/or at work
  • Drastic changes in social network and relationships
  • Noticeable lack of energy
  • Increased irritability or aggression
  • Issues with finances – asking to borrow money, spending more money than usual, not paying bills on time
  • Glazed or bloodshot eyes
  • Acting defensive when asked about substance use

What are some of the common ways it can be treated?

Inpatient Treatment

In-hospital care for urgent (acute) substance or mental health related problems. Inpatient care is sometimes needed for withdraw symptoms for alcohol and/or opioid use disorders or suicidality.

Intensive Outpatient Program (IOP)

Intensive outpatient programs, sometimes referred to as partial day programs, are often clinic-based, and provide a combination of medical and psychosocial care (group therapy, individual sessions), educational lectures, and family support. These programs typically run for at least three hours a day, three or more days a week, for 3-6 weeks.

Medication Assisted Treatment (MAT)

Medications used for the treatment of addiction can help in the painful and challenging process of withdrawal and detox by reducing cravings and symptoms of withdraw. By treating the physical dependence on the substance, medications can help the individual move forward with their recovery. Examples include methadone and buprenorphine for opioid addiction, nicotine replacement for stopping tobacco use, and medicines to help inhibit alcohol cravings and/or use.

Mutual Support Groups (Self-Help Groups)

Mutual support, or self-help groups, are comprised of members who are also working on their recovery, are voluntary, and are meant to help veterans and families support one another throughout the lifelong process of maintaining recovery. Examples of mutual support groups include well-known groups such as Alcoholics Anonymous (AA), 12-Step Groups, and SMART Recovery. Individuals often obtain a sponsor for ongoing peer support and encouragement.

Residential (Live-In) Treatment Programs

Residential programs are live-in programs where veterans receive intense supervised treatment, which can include medical and/or psychosocial treatment in a residential setting. Residential programs often have longer lengths of stay. These types of programs provide veterans with structure to develop a strong foundation for recovery.For example, Community Living Center (CLC) – CLC’s are short-term homes for veterans who require temporary assisted care

Outpatient Treatment

Treatment services offered at a clinic or treatment center. Services can range from medication assisted treatment, group, individual or family therapy. Some programs include ongoing drug testing, in order to help individuals, stay on track.

Sober Living Home

Sober living homes are group residences (house, apartments, condos, etc.) for people who are adjusting to life after drugs/alcohol. Individuals living in sober living homes must follow specific rules (such as attend AA or other mutual-support meetings, contribute to the home by doing chores, provide community service, etc.). Sober living homes are meant to help individuals live independently with their peers without using drugs or alcohol.

Telemedicine

Telemedicine allows providers and patients to communicate remotely via a video/audio. Providers can provide group or individual therapy, assist in medication management, and perform assessments.

Talk Therapies (Therapy or Psychotherapies)

  • Cognitive Behavioral Therapy (CBT) – CBT can help veterans avoid relapse by learning new coping skills and by recognizing potential triggers.
  • Motivational enhancement therapy – This treatment option can be used to ensure that the veteran is dedicated and committed to their recovery

Alcohol

Alcohol use in the military is often accepted & expected. The military has a history of condoning and encouraging alcohol use to boost morale. Additionally, alcohol use disorders are the most common type of substance abuse among active military members. Alcohol abuse can impact personal life, professional goals, overall health, emotional well-being, and relationships with friends and family.

Signs and symptoms of an alcohol use disorder:

  • Not being able to control how much you drink
  • Not being able to quit drinking
  • Needing to drink more in order to feel the same effects (increased tolerance)
  • Feeling sick, anxious, and sweaty when you stop drinking
  • Spending a large amount of time drinking and recovering from drinking
  • Drinking instead of doing other activities
  • Continuing to drink even though it’s causing problems in your life, relationships, etc.
  • Hiding your drinking from others
  • “Blacking out” while drinking
  • Friends and family expressing concern about your drinking

Dangers of alcohol abuse in veterans:

  • For those veterans suffering from PTSD or other comorbid mental health conditions, risk of suicide increases greatly when combined with alcohol abuse
  • Continued alcohol use can cause physical and chemical changes in the brain which results in changes in both mood and behavior It can lead to stroke, high blood pressure, and irregular heartbeat. Also, fatty liver or alcoholic hepatitis.
  • There is a clear link between consumption of alcohol and the following cancers: liver cancer, breast cancer, esophageal cancer, head/neck cancer, and colorectal cancer
  • Weakened immune system making your body more susceptible to diseases such as tuberculosis and pneumonia

Marijuana

Many vets turn to medical marijuana or CBD as an alternative to pain medication as a treatment for chronic pain, or to help alleviate anxiety or symptoms of PTSD. Research suggests that marijuana can be harmful to individuals with PTSD and anxiety. Since 2009 cannabis use disorder has been the most common diagnosed substance use disorder. To date, there is not enough scientific studies to show that the benefits of marijuana outweigh the risks.

Signs and symptoms of marijuana use disorder

  • Lack of motivation
  • Nervous or paranoid behavior
  • Slow reaction time and bad coordination
  • Impaired memory and judgement; memory loss
  • Mood swings
  • Lung infections
  • Panic attacks
  • You only feel normal when you’re high
  • You have a constant urge to use marijuana

Dangers include

  • Short-term memory and learning impairment
  • Decreased ability to focus
  • Decreased coordination
  • Increased heart rate
  • Lung damage 
  • Increased risk for psychosis

Opioids

Active members of the military are more likely to get seriously injured, resulting in prescriptions of opioids to help manage the pain. Veterans typically are prescribed opioid prescriptions to help manage chronic pain. Additionally, younger veterans are among the most vulnerable population for experiencing opioid abuse.

Signs and symptoms of opioid use disorder

  • Taking your prescription when you aren’t in pain or taking more than prescribed
  • Increased irritability and/or depressed mood
  • Borrowing opioid prescriptions from others, seeing multiple doctors to get multiple prescriptions, and pretending to lose your medication in order to get more
  • Disorientation, distorted reality, and confusion
  • Social withdrawal
  • Problems at school and/or work
  • Increased risky behavior

Dangers of opioid use

  • Comorbidity with PTSD increases risk of suicide and accidental overdose
  • Experiencing nausea and vomiting
  • Weakened immune system
  • Slow breathing rate
  • Coma
  • When opioids are used intravenously, increased risk for HIV, hepatitis, or other infectious disease
  • Hallucinations
  • Clogged blood vessels and/or collapsed veins
  • Risk of choking

Other Drugs

To learn more about other drugs, such as cocaine, nicotine, and heroin, please visit the National Institute on Drug Abuse webpage.