Although military veterans comprise 6.4% of the US population, 1 in 4 suicides in America take the lives of veterans. One of the major risk factors for suicide in the veteran community and in society at large is substance abuse. Veterans who misuse alcohol or drugs are twice as likely to commit suicide as veterans who do not. One in ten veterans are believed to drink or use drugs in excess. Veteran substance abuse and suicide are both issues in and of themselves but substance needs to be dealt with if we are going to be able to reduce and eliminate suicide in the veteran community.
What Is Substance Abuse?
The “official” definition of substance abuse is the use of prescription drugs, over-the-counter drugs, illegal drugs, or alcohol in excess or for purposes other than how they are meant to be used. Opioid addiction is common among veterans because so many leave the service with conditions that cause chronic pain. This introduces the veteran to these addicting drugs. Many veterans suffer from depression or PTSD. They tend to self-medicate using alcohol or opioid painkillers. These substances give temporary relief of pain and anxiety but very commonly make depression worse and do not do anything useful for PTSD. Thus, substance abuse worsens other risk factors for suicide.
How Substance Abuse Relates to Suicide Risk
While a veteran may commit suicide by overdosing on opioids or another addictive substance the connection between substance abuse and veteran suicide is much more often not so direct. While veterans who abuse alcohol or drugs are twice as likely to commit suicide, they are more likely to be depressed, have financial or social problems, be socially isolated, and engage in high-risk and impulsive behaviors. Sometimes depression or financial and social problems come first and sometimes they are caused by excessive drinking or drug use. Either way there is a tendency for a veteran with troubles to try to drown their sorrows in drink or a drug-induced fog.
Substance Abuse Downward Spiral
Something that anyone who has taken narcotics for pain for had a couple of drinks too many knows is that these substances do not improve thinking but rather make issues in life easier to ignore but more difficult to navigate. With chronic use they tend to be depressants and thus cause the elevation of another major risk factor for suicide. Those who routinely and excessively use alcohol or drugs find that they achieve much faster relief of their anxiety, depression, fear, and other issues in their lives by using addicting substances. As anyone familiar with AA and similar treatment programs knows, “stinkin’ thinkin’” becomes the norm as the person rationalizes their drinking or drug use as a way of life, necessary, and “what everyone does.” The cascade of job loss, family breakup, social isolation, problems with the law, homelessness, and more only become issues to mask by drinking or using more. Within the haze of drug or alcohol use it becomes a natural choice to use suicide as a way to end the confusion, pain, and suffering.
Alcohol and Drugs in Active Duty Military
Very commonly substance abuse in veterans does not start during civilian life. Alcoholism and drug abuse are major problems facing active duty military personnel. Service members use drugs or alcohol to cope with the stresses in their lives. Dependence may come during active duty or in civilian life. Many who have been in combat use alcohol to celebrate victories with their comrades and then drink or use drugs alone in order to cope with post-combat stress. When this becomes a habit, it becomes self-reinforcing. The service member becomes dependent on the high or relaxation achieved with their substance of choice. While about 85% of those who seek help for substance abuse are using alcohol as their primary drug, a whole range of other substances are used as well.
The extreme levels of stress caused by combat create greater risks for substance abuse and alcohol use in particular. The need to appear competent, strong, and invulnerable is common in all branches of service and commonly makes the individual want to hide his or her fears and anxiety. Taking another drink or two or three becomes routine instead of finding someone to talk to or admitting one’s fears and concerns.
Does Substance Abuse Treatment Reduce Suicide Risk?
We know that successful treatment of depression, PTSD, and substance abuse are possible. Psychedelic medicines show great promise for all of these problems. We also know that when risk factors are improved, suicide risk goes down. A problem with substance abuse disorders is that people’s lives become complicated by work or loss of work issues, loss of family support, and social isolation. Whether these come before and cause substance abuse or come as a result, these issues need to be addressed as well. Thus, treatment of substance abuse can be a lifetime issue even when a person has been clean and sober for years. This writer had a friend, a vet, who went into law, became a judge, and drank until he had blackouts. He joined AA, became sober, and has continued to attend three meetings a week for nearly fifty years of sobriety. Good job, Ed.
