Addiction Among Veterans and First Responders

I grew up in a military family and, for many years, worked as an addiction psychiatrist in a United States Department of Veterans Affairs (VA) hospital.

At the addiction treatment center in Jacksonville, Florida, where I am now the chief medical officer, we treat many veterans and first responders (police, firefighters, emergency medical technicians (EMTs), and, in fact, have a tailored program for them.

I mention all that as a way of saying I have the experience under my belt to discuss substance use disorder (SUD) among these two groups. I want to do that now, as there’s a lot of misperception and misinformation out there, that isn’t helpful to these amazing men and women.

Here are seven key points:

1. SUD rates tend to be higher among veterans and first responders—but often not much higher.

For example, a recent study found that 7.5% of veterans reported heavy alcohol use versus 6.5% of non-vets. That’s a noteworthy finding, given the many challenges these individuals routinely encounter in their jobs. They include:

• High daily stress levels.
• Moments of extreme personal danger.
• Catastrophic injuries to themselves and colleagues.
• Violent encounters with others.
• Great human suffering, and so on.

Experts believe these traumatic experiences have a cumulative effect over time, and many military personnel and first responders stay in their jobs for decades.

Which begs the question, how do the large majority of these people manage to sidestep the scourge of SUD?

I’ll take a stab at answering that right now, based on what I know and have witnessed with my family. It’s because of their rigorous training, commitment to public service, strong self-reliance coupled with a team mentality, and an intense focus on getting the job done no matter the obstacles.

2. Here’s how SUD sometimes happens.

The onset of addiction can take many paths, but a common scenario among vets and first responders looks like this:

To stay on task and focused at work and to remain “normal” around their loved ones, friends, and colleagues, some vets and first responders turn to recreational drugs or alcohol for stress relief.

This time-honored strategy of compartmentalization helps them relax, forget (at least temporarily), blow off steam, and generally cope with the intense stress that can come with the job. Often, that strategy works, or seems to, at least for a while.

But when the person seeking occasional solace in drugs or alcohol also happens to have the brain chemistry and mental makeup that makes them susceptible to addiction, that’s when the problems start. That’s when SUD gets a foothold.

3. Alcohol use—including bingeing—has always been part of the culture. It’s a work-hard, play-hard mindset.

That’s especially true in the military, but it’s also true among first responders. This often means that alcohol is an ever-present option during leisure time. It’s accessible and normal, and it’s largely encouraged.

In the end, those factors put people at higher risk of SUD.

4. Proper oversight by leadership is not always present.

Alcohol is not always the drug that is causing problems, especially with the younger veterans who come into our clinic. Many are dealing with chronic injuries they suffered when they were on active duty, and they became addicted to the prescription drugs they were given for them.

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Some admit to us that their prescription drugs weren’t well monitored by their military doctors and other superiors and were too easy to come by. They say that happened with sleep medications as well. Eventually, they get hooked, and their addiction follows them into civilian life.

5. Vets and first responders tend to be hesitant about seeking SUD treatment.

People from all walks of life struggle with that decision because the stigma around addiction and addiction treatment remains strong. Vets and first responders probably struggle more than most with the decision to get care.

Sometimes, the macho culture of their profession holds them back, along with their intensely self-reliant ethic. After the difficult hardships they’ve handled, many veterans and first responders don’t want to admit they can’t handle their drug or alcohol use. And they don’t want to admit that their drug or alcohol use is seriously affecting their lives.

Again, admitting you need help—and seeking it—is hard for everyone. But it’s especially hard for vets and first responders who have spent their entire lives stoic and self-reliant.

6. Veterans now have more and better treatment options.

Until 10 or 15 years ago, the two main options for addiction treatment were VA-run centers and clinics. Now, there’s another alternative. The VA has partnered with local facilities, centers, and individual providers based in the community. (Ours is one such center.)

This option helps lower one of the main barriers to treatment for vets, as many worry about confidentiality if they show up at a VA-run clinic. They think the military may be watching them and worry that they’ll lose their veteran benefits if they seek treatment at the VA facility.

As unfounded as those fears may be, community partners give vets another option outside the traditional VA setup.

7. A new type of therapy—peer support—is becoming more common for vets and first responders with SUD.

Many veterans and first responders are dubious about addiction treatment, especially the psychotherapy (talk therapy) part. They think someone who is not a vet or first responder isn’t going to understand them and won’t be able to help them.

To help them get the care they need and deserve, many centers now employ peer support specialists who’ve fought the battles, been through the wars, and gained sobriety.

As veterans or first responders, these trained specialists help patients navigate their treatment and serve as important role models. They often connect patients to resources and services during and after treatment.

We employ peer support specialists at our treatment center. They are a highly valued part of the care we provide our veterans and first responders.

Final thoughts on veterans and first responders

I’m feeling hopeful about the way veteran and first responder addiction treatment is slowly but surely improving. We certainly owe them that much.

There’s more public awareness that these men and women are not impervious to their difficult circumstances and need help occasionally, just like everyone else.