The transition from military to civilian life can be incredibly difficult, particularly for those who’ve seen active service. Many veterans turn to alcohol to cope, so it’s vital that support services are able to understand their experiences. DDN reports.
‘You feel that you’re weak for having it,’ says Paul, in one of the video interviews featured on the website of veterans’ mental health charity Combat Stress. ‘You feel you’re a freak for having it. I’d never heard of PTSD before.’
After joining the Royal Navy at 16 he’d served in the Falklands, where he witnessed horrific scenes including taking part in a casualty evacuation for some young soldiers who’d driven over a landmine, sustaining terrible injuries. ‘I couldn’t stop looking at them, and I never did get to find out whether they lived or not. I was an alcoholic when I came back.’
It is, however, ‘incredibly difficult’ to ask for help, he states, ‘because then you’re admitting that you’ve got a problem.’ Indeed, previous research by Combat Stress had found that many veterans were putting off seeking any help for their alcohol issues until they were in their 60s – and often even then only after having been admitted to hospital.
More than 60 per cent of the veterans the charity supports have been involved in two or more military operational tours, and there can clearly be a cumulative impact. The more tours someone does the more likely they are to experience something traumatic, but being in situations where letting their guard down even fleetingly could prove fatal can lead to a constant state of hyperarousal that’s impossible to shake.
Self-medication
This ongoing hypervigilance – especially around crowds or noise – is one of the main PTSD symptoms among veterans, and many will self-medicate with alcohol. ‘Up to 50 per cent of veterans referred to Combat Stress report problematic, hazardous or potentially dependent levels of alcohol misuse,’ its consultant clinical lead Dr Lee Robinson tells DDN – ‘predominantly as a means to cope or mitigate the impact of traumatic experiences during their service’.
Previous studies, such as one published by Sheffield Hallam University in 2017, found that treatment was far more likely to be successful if people were able to access veteran-specific services. WithYou now offers tailored support to veterans, and is the first drug and alcohol service provider to receive a Gold Award in the Ministry of Defence’s employer recognition scheme (ERS). Its team includes people who have military backgrounds themselves, while Change Grow Live has partnered with Liverpool John Moore’s university to evaluate treatment outcomes for veterans compared to non-veterans.
‘It’s true that some veterans are less likely to engage in non-veteran services due to the perception of stigma and lack of understanding of military history or trauma,’ says Robinson. ‘But a range of initiatives are improving the knowledge and confidence of non-veteran services, which should help those veterans get the help they need at the earliest opportunity. Understanding the military training, culture and the range of roles, deployments and experiences can certainly help provide the scaffolding to support successful outcomes.’
So does it usually take a long time for services to be able build up trust with veterans? ‘Not necessarily,’ he says. ‘All clinicians at Combat Stress are very experienced, and veterans know they’re attending a service that has a good understanding of their needs – they know we don’t judge the substance misuse, and understand it as a method of coping.’
Improved outcomes
There are also some optimistic signs that veterans are no longer leaving it so late to get help, with organisations working hard to raise awareness and encourage people to access support early – as that’s clearly related to better outcomes, he says. ‘Veterans are seeking help earlier and younger than before, although it can still take many years for a variety of reasons – of which pride and stigma may be a feature for some, but not all.’
The armed services have always had a big drinking culture, so it’s no surprise that the substance problems experienced by veterans have tended be with alcohol rather than drugs. Actual figures can be hard to come by, however, at least with relation to the UK. Unsurprisingly it seems to be something that the Ministry of Defence might be keen to play down, if possible. Its 2024 document, UK armed forces mental health: annual summary & trends over time, 2007-08 to 2023-24 states that ‘Despite media attention focusing on prevalence of PTSD and psychoactive substance misuse due to alcohol in the UK…these disorders remain low, with around 2 in 1,000 of serving UK armed forces personnel assessed at an MOD DCMH [Department of Community Mental Health]’ – although that relates to those still serving, rather than veterans.
A 2020 study by King’s College London, Mental health disorders and alcohol misuse among UK military veterans and the general population: a comparison study, however, found that the prevalence of alcohol misuse among UK veterans who’d served at the time of recent military operations was almost double that among non-veterans. Some Combat Stress clients also use cocaine or cannabis along with the alcohol, says Robinson, ‘and we’re seeing a rise in the number of ketamine users among the younger veterans’.
Supportive networks
Organisations like his also work hard to refer people to other services they might need, such as health, education or housing. ‘We offer supported referrals and warm handover where possible, rather than cold signposting, but will also recommend services where appropriate to do so,’ he says. ‘We have strong collaborative partnerships with other providers, and operate as a specialist provider within a supportive network.’ When it comes to housing, rates of homelessness among veterans do appear to be falling significantly, with their proportion among London’s single homeless population estimated to have dropped from more than 20 per cent in the late 1990s to 6 per cent just a decade later.
But it’s not just hyperarousal and trauma that veterans can struggle with. The feelings of guilt and shame can be overwhelmingly intense, particularly if they’ve witnessed the death or serious injury of friends or civilians and felt they were unable to help. Many veterans also describe the military as having been like a brotherhood, making it difficult to adjust to civilian life. The feeling that no one else can understand what they’ve been through – or even that it hasn’t been appreciated – can have a deeply isolating effect.
Loneliness and secrecy
‘Certainly, for a significant number of veterans, withdrawal, isolation and loneliness can be a consequence of attempts to cope with PTSD or complex PTSD,’ says Robinson – the latter defined as PTSD with additional symptoms such as difficulties in controlling emotions or problems with relationships. Loneliness of course can also be a ‘consequence of the secrecy that’s often around substance misuse’, he adds, as well as being ‘an important factor in risk to self-harm, suicide and accidental death’.
A powerful sense of pride is still one of the key features of military life, connected to which is a sense that if you do have problems then you ‘just get on with it’. Do people still feel that seeking help could be seen as a sign of weakness – by others or themselves? ‘Yes, unfortunately this is still a barrier for a number of veterans,’ says Robinson. This is why the charity’s support services and educational materials will always try to offer them a ‘different perspective’, he says. ‘That can make all the difference in taking that first courageous step.’ DDN