Combat PTSD and Substance Use Treatment Process Recommendations

July 16, 2014 Harry Croft, M.D.

Unfortunately combat posttraumatic stress disorder (PTSD) and substance use disorders go hand-in-hand for many people. In 2008, almost 22% of Veteran’s Administration (VA) patients were also diagnosed with a substance use disorder and in those hospitalized for PTSD, 70% also had a substance use disorder. And research shows that those who are diagnosed with both disorders have poorer long-term outcomes than those who are diagnosed with either one alone.

However, there are treatment process recommendations that can improve the outcomes of combat PTSD and comorbid (co-occurring) substance use disorders.

Intake, Screening and Assessment of PTSD and Substance Use Disorders

It’s critical that all those that come in for mental health help at a VA center be screened for combat PTSD as well as substance use disorders. The three-item Alcohol Use Disorders Identification Test-Consumption is a simple was a screening for alcohol misuse (more on this alcohol-misuse test can be found here). More comprehensive screening for substance use disorders is often done by specialists and these specialists should also be able to diagnose combat PTSD during the comprehensive biopsychosocial assessment.

If you are diagnosed with a substance use disorder and combat PTSD, education on both disorders is key. Your doctor should be able to direct you to local resources but you can also review the information at the National Center for PTSD provided by the VA.

Treatment Planning for Combat PTSD and Substance Use Disorders

Substance use disorders commonly occur alongside combat PTSD and the process for treatment can be complex. Here are some treatment process recommendations.It’s important that a master treatment plan be created that takes into account both disorders and is created with input not only from the veteran but also from his or her family, if possible. One hurdle can be coordination between substance use disorder treatment providers and combat PTSD treatment providers. While it’s unfair that the burden of this coordination fall on the shoulders of the patient, it is the veteran’s best interest to facilitate this coordination whenever possible. Unfortunately, it seems that a culture change is still needed in the medical field to ensure this coordination happens on its own.

Treatment of Combat PTSD and Substance Use Disorders

The best treatments for combat PTSD and comorbid substance use disorder consists of initial treatments of:

  • A motivational interviewing style
  • An assessment of treatment-readiness
  • First-stage stabilization strategies such as Seeking Safety (specifically designed to deal with these comorbid conditions; more on Seeking Safety can be found here)
  • Other treatment programs with less evidence but that may be useful include: Concurrent Treatment of PTSD and Cocaine Dependence, Transcend, cognitive behavioral therapy for PTSD in addiction programs and Acceptance and Commitment Therapy

It’s worth noting that many clinicians recommend Seeking Safety but that this approach is not recommended by the VA, specifically.

Once initial stabilization of the two disorders have taken place, more in-depth therapies like prolonged exposure for combat PTSD and psychosocial interventions and pharmacotherapy for substance use disorders can occur.

Combat PTSD and Substance Use Disorder Treatment Process

While sometimes the process to treatment may seem overwhelming, the goal of treatment is to get you better and the steps taken are to facilitate that goal. See here for an in-depth read on the practice recommendations for the treatment of veterans with comorbid PTSD and substance use disorders.

You can also connect with Dr. Harry Croft on his website, Google+, Facebook,Linkedin and Twitter.

APA Reference
Croft, H. (2014, July 16). Combat PTSD and Substance Use Treatment Process Recommendations, HealthyPlace. Retrieved on 2024, June 20 from

Author: Harry Croft, M.D.

Dr. Harry Croft is a keynote speaker, consultant, and media guest and contributor specializing in the diagnosis and treatment of combat-related posttraumatic stress disorder (PTSD). He currently acts as a trainer and consultant to businesses with regard to veterans, PTSD, and employment-related issues.

Find Dr. Croft's book, I Always Sit with My Back to the Wall, here, and find out more about him on his website.

Mark Noo
July, 16 2014 at 2:34 pm

It just seems odd to me that people are just now starting to let the general public know that substance abuse is very often accompanied by varying degrees of a mental illness.
Blind pursuit of the disease model of addiction has stalled recovery research by at least 15 years. It has also confused the average citizen to the point they are unsure how to deal with a person they know who has a drug/alcohol problem.

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