Preventing Relapse in Veterans after Drug or Alcohol Treatment

Key Takeaways

• Relapse is the return to substance abuse after being drug or alcohol-free.
• Many veterans are at high risk for substance abuse and relapse because they have co-occurring PTSD.
• Relapse risk factors in veterans include social isolation, loss and grief, and mental health problems.
• A relapse prevention plan is important for anyone in recovery. 
• There are many treatment options for veterans seeking recovery from substance abuse, including medication, counseling, and mental health therapies.

What is Relapse?

Relapse refers to the return to substance abuse after being drug or alcohol-free.

It’s not uncommon for people battling addictions to relapse following treatment. Relapsing doesn’t mean treatment has failed. Instead, a relapse shows that additional and/or a different type of therapy is required.

Understanding relapse, triggers, and treatment are essential steps toward relapse prevention.

Common signs of relapse include:¹

• Change in attitude
• Increased stress
• Reactivation of denial
• Recurrence of withdrawal symptoms
• Behavior changes
• Social breakdown
• Loss of structure
• Loss of judgment
• Loss of control

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Relapse Risk Factors

One of the most common reasons for relapse is when someone isn’t prepared for recovery. Many assume they can reduce their recovery efforts in a few weeks or months after stopping substance use.

However, this assumption is incorrect. Understanding that recovery takes lifelong and ongoing effort to maintain is essential.

Psychosocial relapse risk factors include:²

• Low self-efficacy: a person’s belief in their ability to control their substance use
• Positive outcome expectancy linked to substance use: a person’s belief that substance use brings positive effects, such as sociability and decreased anxiety
• Lack of motivation for positive change
• Insufficient adaptive coping skills, especially in high-risk situations
• Inadequate social and emotional support
• Cravings 

Veterans may have risk factors that are specific to older populations, including:²

• Social isolation
• Loneliness
• Loss and grief
• Depression
• Comorbid medical conditions 

Triggers linked with past substance use also tend to be relapse risk factors. These triggers can activate an urge or craving to use substances, leading to a relapse.

Some triggers may be obvious to identify. For example, a friend visiting with a bottle of wine. However, triggers are usually unique to the person.

Triggers can sometimes be subtle, such as a memory of pleasure linked with past use of a substance.

People should receive suitable support and counseling addressing all their risk factors for a successful ongoing recovery.

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Why Are Veterans at High Risk of Substance Abuse?

Many veterans experiencing addiction have co-occurring post-traumatic stress disorder (PTSD). For veterans, this was once referred to as ‘shellshock’ and later ‘battle fatigue.’

PTSD can result from witnessing warfare or experiencing other significantly tragic or startling events. 

Most cases of PTSD are caused by combat. However, veterans may also develop the disorder following sexual abuse. 

Approximately 1 in 3 women and 1 in 50 men reported military sexual trauma from the U.S. Department of Veterans Affairs (VA) national screening program.⁴

Some symptoms of PTSD include: 

• Flashbacks
• Memory problems
• Low sense of self-worth
• Hopelessness
• Problems sleeping
• Relationship issues
• Aggression
• Self-destructive behavior, including self-harm or substance abuse

Reminders of any traumatic incidents experienced may trigger these symptoms. Many veterans turn to substance abuse to numb their pain and self-medicate.

What is a Relapse Prevention Plan?

A relapse prevention plan is essential for anyone in recovery. Having a plan helps people recognize behaviors that may point to relapse in the future. It also shows ways to combat those behaviors and get back on track.

Usually, a relapse prevention plan is written by someone in their treatment team and is shared with their support group. The plan provides a course of action for responding to cravings and triggers.

Relapse isn’t typically a spur-of-the-moment event. It’s a three-part process that includes:

1. Emotional relapse
2. Mental relapse
3. Physical relapse

A relapse prevention plan helps people to acknowledge and act upon certain events and feelings to avoid a physical relapse. Physical relapse is the stage when someone returns to substance use.

Relapse Prevention Tips

If you’re recovering from substance abuse, know that relapse is common. 

While it’s essential to recognize this, you can follow these tips to prevent relapse, including:

• Identify high-risk situations: Avoid being with certain friends or groups or visiting particular locations, like bars, restaurants, or sporting events. Make a list of these situations and devise a plan for how you can deal with these situations in advance.
• Seek support: Enlist the support of your family, friends, counselors, or coworkers. They can help you work through your problems, feelings, stress, support your goals, and look out for warning signs that signal a possible relapse. For example, ask your friends and family to stop you when speaking about drinking or using drugs. 
• Distract yourself: Take your mind off your cravings by distracting yourself. Take a hike, read a book, watch a movie, or meet a friend for lunch. Do anything other than sit there and allow your urges to fester.
• Take care of yourself: The tendency to relapse heightens if you’re not sleeping well or looking after your body and your emotions. Taking care of yourself reduces the likelihood of falling back into old habits.
• Make changes: If you’ve already relapsed once, consider how it happened. What can you do differently this time?

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Rehab Treatment Options for Veterans

The VA provides many treatment options for veterans seeking recovery from substance abuse. The services offered depend on a person’s specific needs.

Medication options include:³

• Medically managed detoxification to stop substance use safely and services to become stable
• Drug substitution therapies and newer medicines to treat cravings, including methadone and buprenorphine for opiate addiction
• Nicotine replacement or other medicines for stopping tobacco use

Counseling and therapy options include:³

• Short-term outpatient counseling
• Intensive outpatient treatment
• Marriage and family counseling
• Self-help groups
• Residential care
• Continuing care and relapse prevention 

The VA also provides treatment and support for health conditions related to substance use problems, including PTSD and depression.

Veteran Substance Abuse Programs

Veterans Alcohol and Drug Dependence Rehabilitation Program

1-877-222-8387
https://www.benefits.gov/benefit/307

Center for Women Veterans (CWV)

1-855-829-6636
https://www.va.gov/womenvet/

Veteran Substance Abuse Resources

If you or a loved one suffers from substance use problems, reach out for help.

Here are some organizations that can support veterans.

Veteran Crisis Line
Dial: 988 and press 1
Text: 838255
https://www.veteranscrisisline.net/ 

Suicide Crisis Line
988
https://988lifeline.org/ 

SAMHSA (Substance Abuse and Mental Health Services Administration)
https://findtreatment.samhsa.gov/ 

Find A Health Center
https://findahealthcenter.hrsa.gov/ 

NIAAA Alcohol Treatment Navigator
https://alcoholtreatment.niaaa.nih.gov/

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