Veterans & Opioid Use Disorder

While the rate of opioid use disorder (OUD) among veterans is comparable to that of civilians, veterans can deal with some unique contributors to their risk of drug misuse and may experience some unique obstacles in their recovery.

Veterans are at greater risk of having significant injuries or traumas that may contribute to their risk of developing a SUD or an OUD. 

Risk Factors for OUD in Veterans

United States military veterans have been significantly impacted by the country’s opioid epidemic.[1] 

‍One study found that the risk of veterans developing lifetime OUD is similar to that same risk among non-veterans.[3] However, Veterans still have a unique set of risk factors that may increase their risk of getting opioid medications and subsequently developing a substance use disorder. 

First, many veterans suffer from injuries and may have chronic pain conditions. They are therefore at higher risk of eventually receiving an opioid prescription either short or long term. If opioids are overprescribed or a patient isn’t properly informed about their risks, this can lead to an opioid dependency or even an OUD. 

Second, many veterans experience significant mental health issues, which can contribute to their risk of developing opioid use disorder. Military life significantly increases a person’s risk of having a traumatic experience or developing a variety of disorders, such as PTSD and generalized anxiety, which increases their risk of a subsequent SUD or OUD. [1] 

Signs of Opioid Misuse in Veterans

The signs of opioid misuse in veterans are similar to those of opioid misuse in civilians.[2] Some early warning signs that a person may be misusing opioids include the following:

• Taking more of a prescribed opioid medication than instructed 
• Having cravings to use more opioids than prescribed
• Showing signs of withdrawal if they stop taking the drug for too long, such as sweating, feeling nauseous, and showing symptoms that are comparable to the flu despite not having the flu 
• Withdrawing socially 
• Becoming defensive or secretive when discussing their opioid use 
• Asking for prescriptions more frequently or from multiple doctors
• Continued drug misuse despite that use causing damage to a person’s health, safety, financial security, or personal relationships
• Significant changes to daily habits, including changing exercise routines, the hobbies one engages in, and the people one associates with
• Changes to sleep routines and being regularly drowsy
• Financial difficulties and behaviors, such as stealing, including from family and friends, as a result of feeling a need to purchase drugs regularly
• A decrease in libido (sex drive)
• A decrease in hygiene habits and generally appearing unwell and/or unkempt
• Unexplained weight loss [2]

Factors That Can Contribute to OUD Risk in Veterans

Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a mental health disorder that develops after experiencing either one or multiple traumatic events.[4] These events can happen directly to the individual, such as being wounded in combat or being the victim of sexual assault. While many people most associate PTSD with vivid flashbacks of traumatic events, this is not always the form it takes. Other signs can include difficulty remembering key parts of a traumatic event, negative thoughts about oneself or the world, distorted feelings like guilt or blame, or a loss of interest in enjoyable activities, or hypervigilance/being unable to relax particularly when triggered by memories of the traumatic event. Many people with PTSD struggle to control their anger and may have trouble sleeping. PTSD may increase a person’s risk of using substances like alcohol or opioids, which can potentially lead to dependency or even a SUD. 

Traumatic Brain Injury (TBI)

Veteran’s are also at high risk of traumatic brain injury or head trauma during their military service. Traumatic brain injuries are injuries to the brain that can often have lasting effects that aren’t immediately obvious.[5] A person can develop a TBI even if they don’t lose consciousness or have obvious external injuries. 

The exact symptoms a TBI causes will depend on the location of the injury, the type of injury, and how severe the injury is. Often, the full extent of a TBI’s effects takes time to manifest, with some symptoms taking days, weeks or even months to develop. Common signs of a moderate or severe TBI include:

• An inability to wake up from sleep
• Convulsions or seizures
• Enlargement of the pupil (dark center) of one or both eyes
• Headache that gets worse or will not go away
• Increased confusion, restlessness, or agitation
• Loss of consciousness, lasting a few minutes to hours
• Loss of vision in one or both eyes
• Numbness or tingling of the arms or legs
• Repeated vomiting or continued nausea
• Slurred speech
• Uncoordinated or “clumsy” movements

Chronic Pain

Chronic pain can occur for a variety of reasons, such as being injured in combat or as a result of certain health issues, such as cancer. Veterans are at risk for a number of chronic pain conditions, and chronic pain is a risk factor for opioid use and subsequent opioid dependency. 

While many instances of chronic pain may legitimately warrant the use of opioids to reduce a person’s pain to manageable levels, an opioid prescription does inherently increase a person’s risk of opioid misuse. This is why doctors have to be careful when prescribing opioids and should carefully explain the risks associated with opioid use and misuse with any patient to whom they prescribe these drugs. 

Treatment Options for Veterans Battling OUD

In recent decades, the VA has become very aware of the opioid use disorder epidemic among our veterans and currently provides a lot of options for treatment. Veterans can get help from the U.S. Department of Veteran Affairs in order to receive any evidence-based addiction treatments not just for opioid use disorder but also for most other types of SUD. [6]

For opioid use disorder in particular, the most effective treatment is usually Medication for Addiction Treatment (MAT). This approach combines the use of medication with addiction counseling and therapy. MAT includes the use of mainly two medications: Suboxone or Methadone. 

Regardless of whether medication is used, therapy is equally important for a comprehensive recovery plan. The VA has ample resources for veterans seeking cognitive behavioral therapy, group therapies, peer support, and individual therapy. 

Many veterans benefit from working with professionals who have experience working with veterans, as veterans often have unique experiences that can be very different from civilian experiences. If you are a veteran seeking addiction help and find a particular treatment provider does not connect well with you, it’s worth looking into treatment providers that have experience working with veterans in particular. Some facilities staff professionals who are veterans themselves. 

Other Resources for Veterans to Consider

Veterans have a number of resources specially tailored to them and their needs. 

One useful resource is the Veterans Crisis Line, available by dialing 988 and then pressing 1.[7] This is a 24/7, confidential phone line where callers can talk to someone who is trained to help veterans specifically. The professional can connect callers to further resources. The crisis line is free to use and doesn’t require the caller to be enrolled in VA benefits or health care to connect. It’s also available in chat and text form if you want to use this resource but don’t want to talk over the phone.

Another helpful resource is Military OneSource, a website that provides extensive online resource for veterans [8]

There are also various support groups that are dedicated to offering support, encouragement, and comradery to veterans. The U.S. Department of Veterans Affairs hosts information on their site on local groups veterans can access. Each major city or geographic area has listings for veterans service organizations, so look for what is available in your area.