Our Focus


Alcohol and Substance Use Disorders (ASUDs)
ASUDs include the misuse, dependence, and addiction to alcohol and/or legal or illegal drugs. The severity of ASUDs encompasses problem use to dependence and addiction. ASUDS often result in significant impairment to daily life or noticeable distress, including health problems, disability, and failure to meet major responsibilities at work, school, and/or home.
  • In 2018, approximately 22 million people (12 years and older) had at least one ASUD.
    • An estimated 15 million people had alcohol use disorder, which equates to 5.4% of the population.
    • Approximately 2.7 million qualify as having an opioid use disorder.
  • In the military Veteran population,
    • Higher environmental stressors associated with combat level increase the likelihood of Veterans to engage in binge drinking by 54.8% compared to the civilian population.
    • At their first treatment at a VA healthcare facility, 11% met criteria for an ASUD diagnosis.

Types of Specific Focus

Alcohol Use Disorder (AUD)
A clinical diagnosis of AUD is made by meeting criteria including problems controlling intake of alcohol, continued use of alcohol despite problems resulting from drinking, development of a tolerance, drinking that leads to risky situations, or the development of withdrawal symptoms. Excessive alcohol use can increase a person's risk of developing serious health problems including issues associated with intoxication behaviors and alcohol withdrawal symptoms.
For more information: CDC - Alcohol Use
Opioid Use Disorder (OUD)
Symptoms of OUD include a strong desire for opioids, inability to control or reduce use, continued use despite interference with major obligations or social functioning, use of larger amounts over time, development of tolerance, spending a great deal of time to obtain and use opioids, and withdrawal symptoms that occur after stopping or reducing use. Opioids reduce the perception of pain but can also produce drowsiness, mental confusion, euphoria, nausea, constipation, and, depending upon the amount of drug taken, depressed respiration. Illegal opioid drugs, such as heroin, and legally available pain relievers, such as oxycodone and hydrocodone, can cause serious health effects in those who misuse them. Snorting or injecting opioids increase their risk for serious medical complications, including overdose.
For more information: Opioid Use Disorder
Post-Traumatic Stress Disorder (PTSD)
PTSD occurs when a person has difficulty recovering after experiencing or witnessing a traumatic event. The traumatic events may be physically or emotionally harmful, including life-threatening events. Such events include, but are not limited to natural disasters, serious accidents, acts of violence, and war/combat. PTSD effects approximately 3.5% of the US adult population every year.
For more information: PTSD
Depression is a medical disorder that negatively impacts how a person thinks, feels and acts. Symptoms include but are not limited to feeling sad or having a depressed mood, loss of interest in activities, changes in appetite or sleep, loss of energy, and difficulty concentrating. Depression effects about 6.7% of the US adult population every year.
For more information: What is Depression?
Anxiety Disorders
Anxiety disorders comprise medical disorders where an individual experiences excessive fear or anxiety. Anxiety disorders are the most common category of mental disorders. There are many types of anxiety disorders including, but not limited to specific phobias, social anxiety disorder, panic disorder, and generalized anxiety disorder. Specific phobias are the most common type of anxiety disorder, and effect about 8-12% of the US adult population every year.
For more information: What are Anxiety Disorders?
Co-occurrence in the Military Population
PTSD is commonly associated with and typically precedes the development of an ASUD. Substance use is often attributed to self-medicating for PTSD. Research has demonstrated that among Veterans with probable AUD, 20.3% met criteria for probable PTSD. Veterans with comorbid AUD and PTSD were more likely than Veterans with only AUD to screen positive for other psychological disorders (including major depression, suicidal ideation, and generalized anxiety disorder). Further, having comorbid PTSD and AUD makes veterans 3 times more likely than those with PTSD alone to have attempted suicide in their lifetimes. Given the high comorbidity of PTSD and ASUD and the greater symptom severity associated with having coexisting disorders, there is a critical need to treat PTSD and ASUD concurrently.
ASUD Treatment
Addiction is a treatable, chronic disease that can successfully be managed. Research has demonstrated that combining behavioral therapy with medications, where available, is the best way to ensure success for most individuals. Treatment approaches must be tailored to address each individual's drug use patterns and drug-related medical, psychiatric, and social problems. Treatment options include, but are not limited to, medication therapy, counseling, residential and outpatient treatment, case or care management, recovery support services, 12-step fellowship, and peer support (used alone or in combination).
Medications can reduce the cravings and other symptoms associated with withdrawal from a substance by occupying receptors in the brain associated with using that drug (agonists or partial agonists), blocking the rewarding sensation that comes with using a substance (antagonists), or inducing negative feelings when a substance is taken.
For many, the most effective behavioral health approach involves a combination of counseling and medication.
For more information: VA/DOD Clinical Practice Guidelines
  • Substance Abuse and Mental Health Services Administration (SAMHSA). Substance use disorders. Retrieved from https://www.samhsa.gov/data/sites/default/files/
  • Hoggatt, K. J., Harris, A. H. S., Washington, D. L., & Williams, E. C. (2021). Prevalence of substance use and substance-related disorders among US Veterans Health Administration patients. Drug and Alcohol Dependence, 225, 108791. https://doi.org/10.1016/j.drugalcdep.2021.108791
  • (NCDAS: Substance Abuse and Addiction Statistics [2023] (drugabusestatistics.org))
  • Teeters, J. B., Lancaster, C. L., Brown, D. G., & Back, S. E. (2017). Substance use disorders in military veterans: prevalence and treatment challenges. Substance abuse and rehabilitation, 8, 69-77.
  • Bray RM, Brown JM, Williams J. Trends in binge and heavy drinking, alcohol-related problems, and combat exposure in the U.S. military. Subst Use Misuse. 2013 Jul;48(10):799-810. doi: 10.3109/10826084.2013.796990. PMID: 23869454.
  • Nicholas CR., Wang JB, Coker A, Mitchell JM, Klaire SS, Yazar-Klosinski B, Emerson A, Brown RT & Doblin R. The effects of MDMA-assisted therapy on alcohol and substance use in a phase 3 trial for treatment of severe PTSD. ScienceDirect. 2022 April; vol 233. https://doi.org/10.1016/j.drugalcdep.2022.109356
  • Norman SB, Haller M, Hamblen JL, Southwick SM, Pietrzak RH. The burden of co-occurring alcohol use disorder and PTSD in U.S. Military veterans: Comorbidities, functioning, and suicidality. Psychol Addict Behav. 2018 Mar;32(2):224-229. doi: 10.1037/adb0000348. PMID: 29553778.
  • Substance Abuse and Mental Health Services Administration (SAMHSA). Substance use disorders. Retrieved from http://www.samhsa.gov/disorders/substance-use
  • Institute of Medicine. (2013). Returning home from Iraq and Afghanistan: Assessment of readjustment needs of veterans, service members, and their families. Washington, D.C.: National Academies Press.
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