Veterans and Co-Occurring Disorders

The term co-occurring disorders—also referred to as dual diagnosis or comorbidity—refers to a diagnosis of two or more mental disorders, including substance use disorders, at the same time. As more active duty service members see combat situations, more are at risk for developing co-occurring disorders.

Read on to learn about:

• What co-occurring disorders are.
• Common mental and substance use disorders military Veterans deal with.
• What is recommended for treatment.

Substance Abuse, Mental Health Struggles, & Veterans

Co-occurring disorders diagnoses can include:

Mood disorders, such as:

• Depression or bipolar disorder.
• An anxiety disorder like panic disorder or PTSD.
• Schizophrenia.

Substance use disorders, such as:

• Alcohol use disorder (AUD).
• Opioid addiction.
• Prescription drug use disorder.
• Stimulant use disorder—either prescription stimulants like Adderall and Ritalin, or illicit drugs like meth.

About 11 to 20% of service members returning from Iraq and Afghanistan struggle with both PTSD and depression, as these conditions frequently occur together.¹

In addition, 19.5% report experiencing a traumatic brain injury (TBI) during deployment, which can lead to mood and behavioral changes that contribute to the risk of developing PTSD, depression, insomnia, and substance use disorders.²

About half of the returning Veterans of just the wars in Iraq and Afghanistan have been treated by the Veterans Administration (VA) for symptoms of mental illness—30% of those Veterans report PTSD symptoms specifically.

Understanding how mental health struggles and substance misuse overlap among military Veterans is integral to identifying symptoms and the right treatment program as soon as possible.

PTSD & Substance Abuse in Veterans

Veterans are at a higher risk for a few specific co-occurring disorders, often connected with PTSD.

What Is PTSD?

One of the most prevalent mental health conditions diagnosed in Veterans is post-traumatic stress disorder (PTSD).

PTSD can be triggered by:³

• A serious accident.
• War or combat, specifically: Stress from being in a war zone, being wounded in action, and/or becoming a prisoner of war.⁴
• Natural disaster.
• Terrorist attack.
• Rape or other violent assault.

Military Veterans may have experience with more than one of the above and, consequently, Veterans with a substance use disorder (SUD) diagnosis often also have post-traumatic stress disorder (PTSD).

PTSD & Alcohol Abuse

Alcohol use disorder (AUD), heavy drinking, and binge drinking are a few of the most frequently reported types of substance misuse among Veterans in general.⁵  In one study, 12 to 15% of soldiers who were deployed to Iraq misused alcohol.⁶

Military Veterans who experience combat and a PTSD diagnosis were found to binge drink—which is considered 4 to 5 drinks, or more, in a 1- to 2-hour period.⁷ Over half of service members who had recently been deployed to combat zones binged alcohol.⁶

Another study found that alcohol use specifically among military Veterans increased the risk of:⁵

• Interpersonal violence.
• Declining health.
• Mortality.

PTSD & Marijuana Use

Statistics on the co-occurrence of marijuana and PTSD are hard to find, because service members who use illicit drugs like marijuana or heroin are dishonorably discharged and are no longer considered Veterans of the U.S. Armed Forces.⁶

However, as marijuana becomes a socially acceptable drug and is legalized in some states, the VA is tracking use rates more closely. Between 2002 and 2014, the number of Veterans diagnosed with PTSD and marijuana use rose from 13 percent to 22.7 percent.

Other Co-Occurring Disorders

Depression & Alcohol Abuse

Alcohol misuse is already known to be high among Veterans with PTSD, so this may contribute to increased rates of depression as alcohol changes brain chemistry.^5,6 Depression and alcohol use disorder are closely associated in general, not just among Veterans.

Heavy alcohol consumption among active-duty service members declined from the 1980s to 1990s but began rising again in the early 2000s. Binge drinking in this group rose from 35% in 1998 to 47% in 2008. These forms of drinking were closely associated with co-occurring mental illnesses, especially depression and PTSD.⁹

Other Anxiety Disorders, Insomnia, and Opioids

Misuse of opioid drugs, especially prescription painkillers, is rising among Veterans as it rises in the general population.

• Doctors prescribed opioids to 17.8% of Veterans with PTSD, and 11.7% with another mental health problem.⁵
• The percentage of Veterans receiving pain management with prescription narcotics increased from 17% to 24% between 2001 and 2009.⁵
• In the same timeframe, the number of opioid prescriptions written by military physicians more than quadrupled.⁵
• In another study of 343 Veterans, 35.3% reported aberrant pain management behavior, which included misusing prescription drugs, illicit drugs, and alcohol.¹⁰

Treatment for Veterans with Co-Occurring Disorders

The Veterans Affairs Administration is clear that the foundation of treatment for any mental or behavioral problem in Veterans is talk therapy, known in the industry as psychotherapy.¹¹

While some medical interventions—like antidepressant prescriptions or brief treatment with anti-anxiety medications—may be beneficial, medication-based treatments work best when combined with counseling.

The VA and other professional organizations recommend cognitive behavioral therapy (CBT) as the leading approach to treating co-occurring disorders, mental illnesses, and behavioral conditions among the general population as well as among Veterans. For veterans with PTSD, trauma-focused treatment like cognitive processing therapy (CPT) and prolonged exposure therapy (PE) appear to work the best.¹¹

Counseling that does not specifically deal with trauma is also beneficial in conjunction with therapy directed at PTSD. At the VA, this includes a program called Seeking Safety, which is an approach to psychotherapy that has been integrated with improved coping skills. It is often applied to treating co-occurring disorders among Veterans.

Military Veterans can reach out to facilities around the U.S. that cater to their specific needs—like Recovery First—for treatment. The VA also offers several different programs for Veterans suffering from PTSD or substance use disorder.

If you or a Veteran you care about is suffering from mental health and substance use disorders, recovery is possible. Call us today at to find out more about our specialized treatment programs for Veterans.