Medication-Assisted Recovery Journeys for Veterans

Key Takeaways

• Veterans face a higher risk of substance use disorders (SUDs) due to service-related challenges, with younger veterans being particularly susceptible.
• PTSD and SUDs are closely linked in veterans, with those suffering from PTSD at increased risk for developing SUDs.
• Physical injuries during service can lead to chronic pain, which is often managed with opioids, increasing the risk of SUDs among veterans.
• Medication-Assisted Treatment (MAT) combines FDA-approved medications with counseling and behavioral therapies to treat opioid use disorders effectively.
• Access to MAT for veterans is facilitated by the VA and supported by various programs and grants, but barriers to access still exist.
• Support systems, including family, friends, healthcare professionals, and peer support groups, are critical for the recovery of veterans with SUDs.
• The VA is actively enhancing support for veterans undergoing MAT, with increased funding and resources in the proposed fiscal year 2024 budget.

Why Veterans Struggle With Substance Abuse

Veterans are uniquely susceptible to substance use disorders (SUDs) due to a myriad of service-related challenges. Research indicates that younger veterans, aged 18 to 49, are more likely to experience substance abuse, including alcohol and drug use disorders, compared to their older counterparts. This is attributed to factors such as the prevalence of chronic pain from injuries sustained in service, the psychological impact of untreated post-traumatic stress disorder (PTSD), and the difficulties associated with reintegration into civilian life after military service. SAMHSA’s 2022 National Survey highlights these trends among veterans.

Substance abuse in veterans is closely linked to mental health disorders such as PTSD, depression, and anxiety. This is compounded by a higher likelihood of homelessness, chronic pain, and an increased risk of suicide. The VA and other organizations offer various treatments and interventions, but access remains a critical issue, particularly for female and LGBTQ veterans who may face additional barriers.

PTSD’s Influence on Substance Abuse in Veterans

The National Center for PTSD acknowledges the prevalence of co-occurring Post-Traumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD), indicating that some veterans may use drugs or alcohol as a means to cope with PTSD symptoms. Concurrent treatment for both conditions is recommended and has been found beneficial.

Statistics reveal that veterans are at a heightened risk for developing SUDs if they struggle with PTSD. This risk is compounded by factors such as the stress of deployment, exposure to combat, and the challenges of reintegration into civilian life. The link between physical injuries, chronic pain, and SUDs is also notable.

Alarmingly, a significant portion of veterans with a probable mental or substance use disorder do not engage in treatment, highlighting a critical gap in care. Research published in PubMed Central shows that the estimated prevalence of PTSD among U.S. veterans is higher than in the general population, with certain subgroups, such as female veterans and younger veterans, showing particularly high rates.

Physical Injuries Influence on Substance Abuse in Veterans

Veterans who sustain physical injuries during their service face a heightened risk of developing SUDs, particularly when chronic pain management involves opioid prescriptions. Studies indicate that veterans with mental health diagnoses, such as PTSD, are more likely to receive opioid prescriptions, often at higher doses and with a greater risk of early refills, than those without such diagnoses. This pattern of prescription can unfortunately lead to opioid use disorders and a range of adverse outcomes, including hospital admissions and overdose. 

Studies have found that physical injuries, such as lumbosacral spine disease, headaches, and lower extremity joint problems, are common among veterans with PTSD, further complicating their risk for SUDs. The interplay between chronic pain and mental health issues like PTSD often results in a higher likelihood of alcohol use disorder (AUD) as well. 

The prevalence of illicit drug use, such as marijuana, is comparable between veterans and civilians, with cannabis use disorders rising significantly among veterans. Additionally, the veteran population is more likely to use tobacco, which has been linked to increased cancer-related deaths among this group. 

Medication-Assisted Treatment for Veterans

Medication-Assisted Treatment (MAT) is a progressive approach to combating opioid use disorders (OUD) that combines the use of FDA-approved medications with counseling and behavioral therapies. This holistic strategy has proven effective in sustaining recovery and addressing the complex needs of individuals with OUD. MAT is designed to normalize brain chemistry, block the euphoric effects of opioids, relieve physiological cravings, and stabilize body functions without the negative effects of the substance used.

Recent regulatory changes, such as the permanent introduction of ‘take-home’ methadone doses and the expansion of telemedicine for prescribing MAT medications, have significantly increased access to treatment. States have also taken action to improve access to MAT by establishing grants, requiring health insurers to cover MAT without prior authorization, and exploring reimbursement through Medicaid programs.

Key MAT Medications

The primary medications used in MAT target opioid addiction and are designed to alleviate withdrawal symptoms, reduce opioid cravings, and block the euphoric effects of opioids. Here is an overview of the key medications:

• Methadone: An opioid agonist that reduces cravings and withdrawal symptoms without the euphoric ‘high’ associated with opioid abuse. Methadone is typically dispensed daily in a controlled clinical setting.
  
• Buprenorphine: A partial opioid agonist that helps to minimize withdrawal symptoms and cravings. It can be prescribed by certified healthcare providers and is available in various forms, including sublingual tablets, films, and implants.
  
• Naloxone: An opioid antagonist used to reverse opioid overdoses. It can be administered via intranasal spray or injection and is often combined with buprenorphine to prevent misuse.
  
• Naltrexone: Another opioid antagonist that blocks opioid receptors and is used to prevent relapse. It is available in oral form or as a monthly injectable suspension known as Vivitrol.
  

By mitigating the physiological effects of addiction, these medications allow individuals to focus on the behavioral and psychological aspects of recovery through counseling and therapy.

Benefits and Risks of MAT for Substance Use Disorders

The efficacy of MAT is well-supported, with research indicating that it significantly increases treatment adherence and reduces illicit opioid use compared to non-medication approaches. This dual treatment modality can also curb the transmission of infectious diseases like HIV and hepatitis C, which are commonly associated with substance misuse.

Despite its benefits, access to MAT remains limited for many due to insufficient funding for treatment programs and a shortage of qualified providers. Safety is another important consideration, as MAT requires careful monitoring to mitigate potential side effects and ensure it is tailored to individual patient needs.

The choice of medication — whether methadone, buprenorphine, or naltrexone — depends on a patient’s specific circumstances and should be made in collaboration with healthcare providers.

VA Support for Veterans’ MAT

The U.S. Department of Veterans Affairs (VA) supports the use of MAT for veterans, providing access to medications that can significantly lower the risk of relapse and substance-related mortality.

Access to MAT for veterans is facilitated through various programs and grants, such as the SAMHSA grant funding and initiatives by the Rural Community Toolbox, which aim to expand services and improve treatment outcomes. The VA and other organizations endeavor to remove barriers to MAT, ensuring that veterans receive the comprehensive care they deserve.

MAT Access Barriers

Despite significant efforts to improve healthcare services for veterans, barriers to accessing MAT remain. One of the key legislative efforts to enhance access is the Veterans Accessibility Advisory Committee Act of 2024, which aims to improve accessibility within the Department of Veterans Affairs.

Furthermore, the National Defense Authorization Act (NDAA) for Fiscal Year 2024 has introduced updates that could benefit Service-Disabled Veteran-Owned Small Businesses (SDVOSBs) by increasing government contracting goals and streamlining the certification process. This legislative change may indirectly support veterans by recognizing their economic challenges and promoting their financial well-being.

Successful MAT Outcomes

Real-world examples of MAT’s effectiveness can be seen in the stories of veterans who, after returning from service with both visible and invisible wounds, find solace and recovery through this integrated approach. MAT programs, often provided through VA medical centers, offer a structured path to recovery, acknowledging the complex interplay of PTSD, physical injuries, and substance abuse many veterans face.

Success in MAT for veterans is not just about overcoming substance abuse; it’s about regaining control of their lives, restoring relationships, and finding new purpose post-service. The VA’s support, along with community and peer networks, plays a crucial role in these success stories, providing a comprehensive ecosystem that fosters long-term recovery and well-being.

Each story of a veteran reclaiming their life from the grips of addiction reinforces the critical role of MAT in the journey to recovery. It’s a testament to resilience, a tribute to the courage of those who’ve served, and a reminder of the ongoing support needed to maintain sobriety and thrive in civilian life.

The Critical Role of Support Systems in Veteran Recovery

A robust support system is not just beneficial, but critical to the success of their recovery. Such systems encompass a wide range of individuals and groups, including family members, friends, healthcare professionals, and peer support groups, all of whom provide different forms of support that are vital during the recovery process.

Family and friends often provide unconditional love and understanding, offering emotional and practical support that can be a cornerstone of recovery. The role of peer support groups is also significant; they offer a platform for sharing experiences and coping strategies. These groups can include fellow veterans who understand the specific struggles faced during and after service, which enhances the relevance and impact of the support provided.

Professional healthcare teams are another essential component, offering medical and therapeutic interventions tailored to individual needs. Recovery community centers (RCCs) and recovery coaches (RCs) extend additional resources such as recovery coaching, employment assistance, and educational linkages, embracing multiple pathways to recovery and thereby accommodating individual preferences and needs.

Support systems provide a multifaceted network of care that can significantly reduce feelings of isolation, increase treatment retention, improve relationships with social supports, and ultimately decrease rates of relapse. For veterans, whose experiences often include complex trauma and physical injuries, these support systems are not just helpful, but indispensable for a successful transition to civilian life and sustained sobriety.

Future of MAT for Veterans’ Recovery

The VA is actively enhancing its support for veterans undergoing MAT. The proposed fiscal year 2024 budget reflects a commitment to bolstering the healthcare services provided to veterans, including those with substance use disorders who may benefit from MAT. A significant increase in mandatory funding, amounting to $182.3 billion, represents an 8.1% rise from the previous year, aiming to fulfill the sacred obligation of supporting veterans and their families.

Leading veterans service organizations, including DAV (Disabled American Veterans), PVA (Paralyzed Veterans of America), and the VFW (Veterans of Foreign Wars), have applauded the proposed budget for its efforts to strengthen the VA’s capacity to provide essential care and benefits. 

The Importance of Community and Peer Support for Veterans in Recovery

Community and peer support play a pivotal role in the recovery journeys of veterans. Peer support providers, often veterans themselves, share their own recovery experiences to guide and assist others. The Veterans Affairs Peer Support Program exemplifies this approach, offering volunteer and employment opportunities for veterans to support their peers.

Programs like the Growing Veterans Peer Support Training and the Military Veteran Peer Support (MVPS) initiative further illustrate the structured efforts to train and deploy peer supporters. These programs not only empower veterans to support one another but also create a community of acceptance and mutual aid.

Moreover, the Vets4Warriors program adapts to the unique needs of transitioning service members, providing peer support tailored to individual experiences. These programs not only assist in substance abuse recovery but also address co-occurring issues like PTSD, demonstrating the holistic benefits of community and peer support for veterans.

MAT Programs for Veterans

For those seeking alcohol addiction treatment, The Recovery Village Indianapolis Drug and Alcohol Rehab stands as a beacon of hope. Located within the heart of Indy, we offer a comprehensive array of treatment options, including medical detox, inpatient care, partial hospitalization, and intensive outpatient services. 

When you or a loved one are ready to embark on the path to recovery, our Recovery Advocates are here, ready to assist. Reach out to learn more about our tailored treatment programs, designed to cater to your specific needs and situation.