The leading cause of death among Veterans under 44 is not combat. It is not accident. It is an overdose – and the substances driving that statistic are the same ones quietly gaining ground in barracks, VA waiting rooms, rural Alaska towns, and the homes of people who served. Military substance abuse treatment exists because the substances affecting veterans are not just dangerous in the general sense. They are dangerous in ways shaped by deployment, trauma, chronic pain, military culture, and a healthcare system that has, at times, made the problem worse before making it better.
veterans and active-duty service members experience substance use disorders at higher rates than the general civilian population. According to the U.S. Department of Veterans Affairs, approximately one in ten veterans seen in VA primary care has an alcohol or drug problem. SAMHSA data consistently shows that veterans are more likely than non-Service members to report heavy alcohol use and are significantly more likely to have a co-occurring mental health condition alongside substance use. These are not moral failures or character weaknesses. They are the predictable downstream effects of what military service demands of the human body and mind.
This article walks through the most dangerous substances affecting veterans today – what each one does, why it disproportionately affects people who have served, and what the warning signs look like. If you are already at the point where you are looking for help, you can go directly to our Veteran addiction treatment program for a full overview of what residential care looks like at Hope Valley.
Alcohol: The Most Common and Most Underestimated Danger
Alcohol is the most widely used substance among veterans by a significant margin. It is also one of the most underestimated, partly because drinking is so normalized in military culture that chronic heavy use can go unrecognized for years – by the veteran themselves, by family members, and sometimes by clinicians.
Former and current military members are more likely than civilians to engage in heavy episodic drinking, and the reasons are layered. Alcohol is used to manage hyperarousal and sleep disruption – two of the most disruptive symptoms of PTSD. It blunts intrusive thoughts. It creates a chemical sense of social connection in environments where emotional intimacy is not encouraged. For many of them, alcohol was the primary available tool for self-regulation during and after service, and by the time they leave, the pattern is already established.
What makes alcohol particularly dangerous for veterans is not just the volume consumed but the reason it is consumed. When alcohol is functioning as a coping mechanism for unprocessed trauma, the dependency runs deeper than physical tolerance. Medical detox is only the first step. Without addressing what the alcohol was doing – managing anxiety, numbing memories, enabling sleep – the return to use is nearly inevitable.
Alcohol withdrawal is also medically serious. Unlike most substances, alcohol withdrawal can be life-threatening, producing seizures and delirium tremens in people with significant physical dependence. This is one of the reasons residential medical detox matters – it is not just about comfort, it is about safety.
If alcohol is the primary concern, our alcohol addiction treatment program for Veterans covers the full continuum from medical detox through residential treatment with trauma-informed care.
Opioids and Prescription Painkillers: The Pain-to-Dependency Pipeline
The opioid crisis in veterans is not identical to the general population opioid crisis – it has its own specific origin story. Veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) returned with musculoskeletal injuries, traumatic brain injuries, and chronic pain at rates that outpaced the VA’s capacity to treat the underlying causes. The solution, for a period, was prescriptions – opioids prescribed at high rates, sometimes alongside benzodiazepines, creating a polypharmacy situation that the VA itself has since acknowledged was contributing to overdose deaths.
Research published on PubMed and the National Library of Medicine shows that veterans receiving opioids for chronic pain are at significantly elevated risk for developing opioid use disorder, particularly when those prescriptions are for long-acting opioids or when they are combined with other CNS depressants. The transition from prescribed opioids to illicit opioids – particularly heroin and fentanyl – follows a well-documented pathway: the prescription ends or becomes harder to fill, and the physical dependency does not.
Medication-Assisted Treatment (MAT) – specifically buprenorphine and methadone for opioid use disorder – is among the most evidence-based interventions available. At Hope Valley, MAT is integrated into residential treatment for Service members when clinically indicated, because addressing physical dependency is a prerequisite for addressing everything else.
For more detail on how opioid dependency develops in veterans and what treatment looks like, see our opioid addiction treatment program.
Fentanyl: The Invisible Risk in Every Pill
Fentanyl is not a new substance, but the illicit fentanyl crisis is relatively recent and it has changed the risk calculus for every other substance dramatically. The CDC reports that synthetic opioids – primarily illicit fentanyl – now account for the majority of overdose deaths in the United States. The risk is not primarily from fentanyl sold as fentanyl. It is from fentanyl pressed into counterfeit pills that look identical to legitimate prescriptions – Xanax, Adderall, Percocet, Vicodin – and sold through informal markets.
For veterans, this matters for a specific reason. Veterans who have chronic pain, anxiety, or sleep problems and who do not have consistent access to VA care or whose prescriptions have been reduced or discontinued may turn to informal markets for the medications they were previously prescribed. They believe they are buying the same thing they were taking legally. In a significant percentage of cases, they are not. The counterfeit pill market has made every illicit pharmaceutical purchase a potential fentanyl exposure, and fentanyl at even microscopic doses can cause respiratory failure in someone without opioid tolerance.
This is one of the reasons that fentanyl deaths among veterans are rising even among people who would not identify as having an opioid problem. The substance is now present across the supply chain in ways that were not true a decade ago.
Methamphetamine: Rising Fast, Especially in Rural Populations
Methamphetamine use among veterans has increased substantially over the past decade, and the increase is most pronounced in rural areas – exactly the kind of geographies where many veterans settle after service, including Alaska. The availability of low-cost, high-purity meth supplied through West Coast trafficking networks has made it the dominant stimulant in rural markets where opioids may be less available or where someone is specifically seeking a stimulant rather than a depressant.
The connection to military experience is not accidental. Hypervigilance – the state of chronic threat-scanning that is adaptive in combat and disabling in civilian life – creates a nervous system that is already running hot. Sleep deprivation is nearly universal among Service members with PTSD. Methamphetamine addresses both in the short term: it matches the hyperaroused state rather than fighting it, and it eliminates the need to confront what is waiting in sleep. For some veterans, the appeal is not about getting high. It is about feeling functional in a way that nothing else has enabled.
The problem is that methamphetamine accelerates and deepens the neurological damage that trauma has already begun. Prolonged meth use produces structural changes in the brain – particularly in the prefrontal cortex and dopamine system – that worsen the very symptoms it was being used to manage. The cycle becomes self-reinforcing in ways that are genuinely difficult to interrupt without structured residential treatment.
Our meth addiction treatment program is designed for exactly this population – veterans in rural communities where access to care is limited and the problem has often progressed further before help is sought.
Benzodiazepines: Prescribed for Anxiety, Dangerous in Practice
Benzodiazepines – Xanax, Klonopin, Valium, Ativan – are prescribed to veterans for anxiety, PTSD hyperarousal, and sleep disorders at significant rates. They work quickly and reliably in the short term. The problem is that they were not designed for long-term use, and the veteran population using them for anxiety and PTSD is frequently using them long-term.
Physical dependence on benzodiazepines develops faster than most prescribers communicate to patients. More critically, benzodiazepine withdrawal is, like alcohol withdrawal, potentially life-threatening – the two share a mechanism and similar withdrawal profiles. Attempting to stop benzodiazepines abruptly after long-term use without medical supervision can cause seizures.
The polypharmacy problem in veterans is particularly acute with benzodiazepines. The combination of opioids and benzodiazepines is one of the most dangerous drug combinations in existence. Both suppress respiratory drive. Together, they lower the threshold for fatal overdose dramatically. Veterans on both classes of medication are at elevated risk for accidental overdose even when taking medications exactly as prescribed.
Any Service member tapering off benzodiazepines should do so under medical supervision. Benzodiazepine dependency is addressed as part of co-occurring disorder treatment at Hope Valley.
Polysubstance Use: The Pattern Nobody Talks About
One of the most important things to understand about substance use in veterans is that most Service members with a substance use disorder are not using one substance. They are using two, three, or more – often in patterns that are not random but functional. Alcohol to sleep. Stimulants to function during the day. Opioids for pain. Benzodiazepines for anxiety. Each substance is doing a job, and the combination creates a risk profile that is greater than any single substance would suggest.
Polysubstance use is more difficult to treat than single-substance use, for several reasons:
- Medical detox is more complex when multiple substances are involved, because withdrawal timelines and risk profiles overlap and interact
- Treating one substance without addressing the others leads to substitution rather than recovery
- The psychological underpinnings of each substance use pattern may be distinct and require separate clinical attention
- Standard treatment models designed around a single substance may miss the full picture
At Hope Valley, assessment at intake is designed to identify the full substance use picture – not just the presenting concern – because treatment that only addresses the identified substance while missing the others produces incomplete outcomes. This is especially important for Veterans and active duty members, where the relationship between substances and symptoms is often complex and has developed over years.
For Veterans with substance use alongside mental health conditions like PTSD, depression, or traumatic brain injury, our co-occurring disorders treatment addresses both simultaneously rather than requiring sequential treatment.
What Makes Veterans Especially Vulnerable
The elevated rates of substance use among Veterans are not a mystery, and they are not the result of weakness. They are the predictable product of several intersecting factors:
The Neurobiological Impact of Trauma and Combat
Combat exposure and military sexual trauma produce measurable changes in brain structure and function – specifically in the amygdala, prefrontal cortex, and hippocampus. These are the same regions involved in threat processing, impulse control, and memory regulation. The brain changes that result from trauma make both substance use and substance use disorder more likely, and they make recovery harder without addressing the trauma directly.
Chronic Pain as a Gateway
Veterans carry a disproportionate burden of musculoskeletal injury, nerve damage, and chronic pain. Pain is one of the most consistent predictors of opioid use disorder, and it creates a legitimate medical need that can transition into physical dependency over time. The pain does not go away when the prescription does.
Military Culture and Help-Seeking
Military culture selects for and reinforces self-reliance, stoicism, and the suppression of vulnerability. These traits are adaptive in the field and disabling when someone needs to ask for help. The average time between the onset of a substance use disorder and treatment entry is years – and in Veterans, the additional cultural barriers extend that gap further. By the time someone arrives at treatment, the problem has typically been present for a long time.
Transition and Isolation
The transition from active duty to civilian life removes the structure, identity, and community that military service provides. For many Veterans, this transition period is when substance use escalates – there is no mission, no unit, and no clear sense of purpose. Isolation is a significant independent risk factor for substance use escalation, and Veterans in rural communities face isolation risks that urban Veterans may not.
The Insurance and Access Gap
Not all Veterans have consistent VA access, and not all VA facilities offer the full continuum of substance use disorder care. TRICARE coverage through TriWest provides an alternative pathway to private residential treatment for eligible Veterans and active-duty service members. Understanding what your coverage includes is often the first practical step toward getting care. You can learn about TRICARE addiction treatment coverage or verify your benefits online.
What Military Substance Abuse Treatment Looks Like
Effective military substance abuse treatment is not generic addiction treatment with a flag on the wall. It is treatment designed around the specific clinical presentations that Veterans bring – the interplay of trauma, chronic pain, moral injury, identity disruption, and the particular substances that have filled those gaps.
At Hope Valley, residential treatment for Veterans includes:
- Medical detox managed by clinical staff familiar with Veteran-specific presentations
- Trauma-focused therapy that addresses the underlying drivers of substance use, not just the use itself
- Medication-Assisted Treatment (MAT) when clinically indicated for opioid or alcohol use disorder
- Co-occurring disorder treatment for Veterans with PTSD, depression, TBI, or anxiety alongside substance use
- Peer support from clinicians and staff who have served
- Discharge planning that accounts for the realities of Veteran life after treatment
The clinical team at Hope Valley includes Veterans. This is not a talking point – it is a clinical decision, because the therapeutic alliance between a Veteran and a clinician who understands military culture from the inside is categorically different from care delivered by someone learning about that culture secondhand.
Hope Valley is CARF-accredited, located in Wasilla, Alaska, and built specifically for this population. For a full overview of the program, visit our Veteran addiction treatment page.
The Time to Get Help Is Before the Crisis
One of the hardest things about substance use in Veterans is that the same traits that made someone effective in service – the ability to push through pain, to minimize problems, to keep functioning under conditions that would stop most people – make it easy to delay getting help until the situation becomes a crisis. The overdose that nearly happened. The DUI. The relationship that finally ended. The job that was lost.
Treatment works better when it happens before the crisis. It is also harder to access in the middle of one. If the substances described in this article are familiar – as your own experience or as a family member’s – the window for easier intervention is now, not later.
TRICARE and TriWest cover residential substance use treatment for eligible Veterans and active-duty service members. If you are unsure what your coverage includes, verify your benefits online – it takes a few minutes and removes the uncertainty that keeps a lot of people from making the call.
For Veterans and Families Seeking Treatment
Hope Valley Health and Wellness accepts TRICARE and handles prior authorization, benefit verification, and travel coordination for Veterans across Alaska and the lower 48. Benefit verification is free and takes one business day.
Read next: Veteran Addiction Treatment at Hope Valley – What Residential Care Looks Like
Co-Occurring Disorders in Veterans: When PTSD and Substance Use Overlap
Hope Valley Health & Wellness is a CARF-accredited residential treatment center in Wasilla, Alaska, built specifically for Veterans and active-duty service members. Our clinical team includes Veterans themselves. We accept TRICARE and TriWest. Call (907) 318-2180 anytime or verify your benefits online.