“80 percent of veterans returning home from major wars…suffer from PTSD” (Waters Edge Recovery). Throughout recent years, more and more of United States soldiers have been returning home suffering from PTSD, making it an important topic of discussion. Some of the symptoms that the men and women coming home from war are dealing with may be “nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged” (Nebraska). According to the video “PTSD Patients and Alcohol Abuse” posted by Waters Edge Recovery, about 30 percent of soldiers that suffer from PTSD also suffer from substance use disorder (SUD).   Alcohol and drug abuse by veterans and soldiers suffering from posttraumatic stress disorder has a negative impact on the treatment and recovery of said mentally ill men and women.

One near death experience is enough to cause PTSD, but engaging in life or death situations repeatedly for months at a time takes a toll on a person’s mental and psychological health. For soldiers in combat this is a reality, as the men and women who are fighting for the America are constantly in mentally difficult scenarios. Being put in these situations creates a living environment that is extremely stressful. Those who experience longer and more frequent tours of duty often suffer from increased rates of PTSD (Marvasti). In addition, the adrenaline rush one may experience during high intensity situations while in war can often lead to dependence on the “high” soldiers feel from this rush. In Jamshid Marvasti’s book, it is explained that the experiences and situations these soldiers witness and take part in leave a long lasting impact on the soldiers’ psychological state. Witnessing or participating in unnecessary violence or abusive acts may leave soldiers questioning themselves and may lead to feelings of immense guilt. The soldiers may relive these experiences repeatedly in their minds and dreams.

Posttraumatic stress disorder is a mental disorder that may be present in men or women who have experienced or witnessed life-threatening events. Some examples of events that may trigger PTSD include military combat, natural disasters, terrorist incidents, and serious accidents. In some instances, PTSD and its symptoms may be severe enough to be present for much of one’s life, and there is a high chance that one’s daily life will be significantly impaired (Nebraska). According to the U.S. Department of Veterans Affairs, posttraumatic stress disorder may cause one to have trouble falling asleep, or may cause one to wake up frequently throughout the night. PTSD causes one to feel “numb”, and one may cut him or herself off from others. Those dealing with PTSD may constantly feel angry, irritable, and depressed. Dealing with PTSD may make one feel like he or she is always “on guard”. These intense feelings that people with PTSD suffer from are often extremely difficult to deal with alone. Veterans may have difficulty discussing these experiences with other people, as well as difficulty reaching out for help. This feeling of helplessness can sometimes lead veterans suffering from PTSD to abuse drugs and or alcohol. 

According to the detailed book titled War Trauma in Veterans and Their Families, by Jamshid Marvasti, mental disorders following war trauma usually develop in three phases following severe psychological hardship. The first phase, the immediate phase, occurs during or right after one endures a traumatic event. Preexisting mental disorders may get worse, acute stress disorder may arise, and one may start to abuse drugs or alcohol. The second phase is known as the delayed phase, and usually takes place one to two weeks after exposure to the mentally shocking trauma. In this phase, substance abuse may worsen, and one may become depressed, anxious, and even psychotic. The third and final phase is known as the chronic phase, and may arise months or years after the traumatic event has occurred.  Symptoms become much more severe in this phase. When in the chronic phase, one abuses or is dependent on alcohol or drugs, suffers from mood and psychotic disorders, and is now attempting to cope with full-blown PTSD. Homelessness is also very prevalent among veterans and is often seen as an event of the chronic phase, as according to the Veterans Administration, thirty-five percent of homeless individuals are veterans. 

In some instances, people who are attempting to cope with the symptoms of PTSD may have issues related to drugs and alcohol before and after actually being diagnosed with the disorder. Even if one does not have a problem with alcohol and drugs before a traumatic event, the eventual result of PTSD heightens the risk that he or she will develop a drinking or drug problem (PTSD Substance Abuse Veterans). Substance use disorder, or SUD, is the severe abuse of drugs or alcohol on the body. There is a strong relationship between the two disorders in both men and women. When dealing with physical pain, relationship problems with family and friends, and problems with functioning normally on a day to day basis, one may feel like alcohol or drug use may make him or her feel better. When struggling with sleep, one may medicate with alcohol in attempt to help fall asleep or stay asleep, “but drugs and alcohol change the quality of your sleep and make you feel less refreshed” (PTSD Substance Abuse Veterans). Drug and alcohol use helps one continue to avoid bad memories, people, and places related to a traumatic event. Drinking or using drugs may distract someone with the disorder for a short time, but can result in PTSD lasting longer, and may make it harder to concentrate, lessen productivity, and impair one’s enjoyment of life (PTSD Substance Abuse Veterans). 

While some of those who suffer from PTSD feel as though alcohol helps to ease their pain and numb their disturbing memories, there are many studies that prove alcohol may make it more difficult to cope and deal with their difficult memories. For example, there is a recent study that was completed at Johns Hopkins University. This study modeled PTSD by administering fear training by exposing mice to various tones and electric shocks. After separating the mice into groups, one group of mice was given water, and the other group of mice was given water mixed with twenty percent ethanol. The scientists completing the study attempted to dissociate the mice’s negative response to hearing the tones by playing them without the electric shocks. The conclusion was that the mice who were given ethanol were more likely to have a negative reaction, freezing with fear, as opposed to the mice who were only given water (Jagannathan). This serves as evidence that suggests that alcohol use the night before therapy inhibits the effectiveness of therapy, thus prolonging PTSD. 

An additional study was published in the journal of Military Medicine, done by Abigail C. Angkaw, PhD, and seven other doctors, regarding the alcohol-related consequences of PTSD symptoms and medical health related quality of life (MHRQoL). The study sample included 205 combat veterans who had “at least light-moderate combat exposure” (Angkaw).  Before beginning the study, 43% of the participants self-reported that they consumed one to two drinks each drinking occasion, the rest drinking up to ten or more drinks. The experiment required participants to have consumed at least one alcoholic beverage in the last thirty days. Because this study was limited in that the researchers did not have access to veterans who were alcohol dependent, the end result showed little correlation between alcohol use and PTSD. Short-term results “indicate that alcohol-related consequences partially mediate the association between PTSD symptoms and low MHRQoL among veterans” (Angkaw). This means that initially, alcohol use reduces PTSD symptoms, therefore increasing MHRQoL. However, alcohol-related consequences lower MHRQoL. Thus, by increasing one’s alcohol intake and alcohol-related consequences in order to decrease PTSD symptoms, the outcome is that one will further decrease MHRQoL. While this study is limited in its ability to show causation between alcohol abuse and more severe PTSD symptoms, it was able to prove that increased alcohol consumption does have a negative correlation to one’s medical health related quality of life. 

There is a wide range of treatments available for those suffering from not only posttraumatic stress disorder, but also substance use disorder. In order to have a successful recovery, one should be treated for both PTSD and SUD. Evidence shows that treatment for co-occurring PTSD and SUD works, and there are treatment options that address both conditions. Currently, the most effective form of treatment for PTSD is cognitive behavioral therapy, or CBT. CBT is a type of counseling that is separated into two different subcategories, Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE). Cognitive therapy is an attempt to identify the causes of one’s stress and feelings of angst. Throughout this therapy, one learns how to cope with these negative feelings, and how to eventually replace the thoughts with more positive ideas. On the contrary, exposure therapy is when a patient discusses his or her experiences repeatedly with a therapist. The goal is to slowly begin to discuss more traumatic memories as one learns to cope with the less traumatic memories (Treatment PTSD). 

Other types of treatment options include Eye Movement Desensitization and Reprocessing (EMDR), medication, as well as various other therapy options. EMDR is similar to exposure therapy, in that one discusses his or her memories with a therapist, the goal being to change how one reacts to memories of trauma. The main difference between EMDR and exposure therapy is that the patient is asked to focus on following the therapists’ movements with their eyes. EMDR is still being developed, as there is disagreement in the medical community in regards to its effectiveness. Along with all previously mentioned treatment options, patients are often prescribed Selective Serotonin Reuptake Inhibitors (SSRIs), which are a type of antidepressant medication. The medicine increases levels of serotonin in one’s brain in order to decrease feelings of sadness and worry. Beyond formal treatment, there are always options of group therapy, involving other people suffering from PTSD, or with family (Treatment PTSD). 

Despite the severe effects alcohol and drugs may have on the body, especially on someone who is suffering from posttraumatic stress disorder, there are studies being conducted on marijuana use and ecstasy use aiding in the treatment of PTSD. In late 2016, “the Food and Drug Administration gave permission…for large-scale, Phase 3 clinical trials to study whether MDMA, the pure form of the club drug known as ecstasy, can be used on PTSD patients. If these tests prove successful, MDMA could start being prescribed by psychotherapists as soon as 2021” (Pesce). Studies have shown that the active ingredient in ecstasy can help patients who suffer from social anxiety disorder. The same research group that conducted this study is also looking into whether or not MDMA can help ease emotional and psychological pain and trauma resulting from war. Besides the use of MDMA in experimental trials, the use of medical marijuana has also been implemented various states. According to the source “Using Cannabis to Help You Sleep” by Marcel O. Bonn-Miller, Kimberly A. Babson, and Ryan Vandrey, “PTSD is an explicitly approved condition for accessing medical cannabis in five states.” Medical cannabis is most widely used amongst those with high PTSD scores in order to aid in falling asleep and in staying asleep, and is also used for coping purposes in general. While marijuana use is still prohibited on a federal level, the drug’s sleep inducing effect can be seen as helpful to those suffering from nightmares, night terrors, and insomnia. 

Although MDMA has become a more widely used drug by those in search of feelings of emotional warmth, mental stimulation, and decreased anxiety, according to the National Institute on Drug Abuse, the use of ecstasy, or MDMA, the post-high effects can be quite the opposite. Reported undesirable effects post-MDMA use include feelings of anxiety, restlessness, irritability, sadness, aggression, and sleep disturbances (MDMA Abuse). These effects that come after the use of MDMA are exactly what PTSD patients are trying to avoid and recover from. Along with MDMA, the use of marijuana also poses several threats to one’s mental state. Similar to that of ecstasy, the use of marijuana may have pleasant effects such as feelings of happiness, calmness, and sleepiness. However, according to WebMD, there are quite a few negative effects that marijuana use can have on the mind and body. Some of these consequences include paranoia, anxiety, and depression. Just like MDMA, these are the same feelings PTSD patients are attempting to relieve themselves of. Besides these short-term effects, prolonged use and then stopping use can cause sleeplessness, one of the many reasons medical marijuana users claim to need the drug for. Why would someone who is trying to decrease these negative feelings engage in an activity that will eventually intensify all of those symptoms? 

With more and more veterans coming back home to the United States with signs and symptoms of posttraumatic stress disorder, alcohol and substance abuse in veterans is an important topic that must be addressed. Soldiers suffering from severe PTSD symptoms are turning to substance abuse in attempts to find a sense of relief from the severe negative feelings being dealt with, and the memories of traumatic experiences they lived through while in combat. The men and women in discussion are America’s heroes and deserve more than to be left in the streets struggling with drug and alcohol addiction, mixed with severe nightmares and anxiety, among other PTSD symptoms. These men and women experienced and lived through traumatizing events on a daily basis, when just one of these events would be enough to give a “normal” person symptoms of PTSD. As previously explained throughout the evidence mentioned above, alcohol and drugs have a significant impact on one’s mind and body. The effects of alcohol can interfere with therapy treatment, making it more difficult for mentally wounded veterans to heal and feel a sense of normalcy after a period of such anguish. In addition, the study done by Abigail C. Angkaw and other researchers provided evidence that while alcohol use may numb some of the symptoms of PTSD, eventually one’s quality of life will diminish. Beyond alcohol abuse, there are studies which suggest that the use of drugs, including marijuana and MDMA, can potentially provide relief to veterans suffering from PTSD. Angkaw and her fellow scientist’s research is contradictory to the research of the actual effects that drugs have on the body in the long term. Researchers are now claiming that these drugs can help individuals that are suffering from PTSD, but the long term effects of each drug show that the short term benefits of MDMA and marijuana use are not realistic. The short term relief that is felt by someone after using MDMA and marijuana does not outweigh the eventual negative effects that will mimic PTSD. As proven through the evidence portrayed throughout this paper, when veterans and soldiers suffering from posttraumatic stress disorder engage in the abuse of alcohol and drugs, their recovery process will be lengthened, quality of life lowered, and health diminished. 
