Post-traumatic stress disorder and substance use in military veterans

The current literature review evaluated the effectiveness of published treatments for military veterans with co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD). The review begins with a summary of background issues pertinent to the treatment of military veterans with PTSD/SUD. These include: estimates of the prevalence of PTSD/SUD in this population; existing arguments regarding treatment delivery; and the rationale for the review. This is followed by a description of the methods used to select and methodologically evaluate the research literature. Fifteen studies were selected for inclusion in the review and were grouped as follows: psychosocial SUD-only treatment; pharmacological SUD-only treatment; ‘present-focussed’ joint PTSD/SUD treatment; and combined ‘past-’ and ‘present-focussed’ joint PTSD/SUD treatment. The best available evidence for SUD-only treatments was for the effectiveness of disulfiram and naltrexone on alcohol use outcomes, for disulfiram on PTSD outcomes, and for the use of opiate substitution therapy with heroin-dependent veterans. The strongest evidence for present-focussed joint PTSD/SUD treatment was for the effectiveness of the ‘Seeking Safety’ protocol in reducing drug use. Preliminary evidence was found for the effectiveness of combined past- and present-focussed joint PTSD/SUD treatment adopting CBT-orientated approaches. The implications of these findings for further research and treatment delivery are discussed. The current paper presents a qualitative study exploring military veterans’ perspectives on the relationship between their use of alcohol and their experiences of post-traumatic stress. It focuses on participants’ motives for using alcohol and their perceptions of the impact of their use on their subjective experiences of post-traumatic stress. Six male participants were recruited from a treatment centre specialising in the treatment of military veterans diagnosed with PTSD. Each participant was interviewed separately using a semi-structured interview schedule and the resulting transcripts were analysed using Interpretative Phenomenological Analysis (IPA). The paper reports the findings of this analysis, and these are discussed in relation to relevant literature. The analysis suggested that participants had used alcohol to ‘self-medicate’ distressing post-traumatic stress symptoms. Participants’ accounts suggested that alcohol had been partially effective at blocking out, or reducing the intensity of symptoms in the short-term, but that longer-term use had led to an exacerbation in symptoms. Alcohol had also been used by some participants to facilitate dissociative states and to enable engagement in social and work activities. The study’s strengths and limitations, as well as implications for clinical practice and future research, are presented