Rising to the clinical challenge of treating veterans with recurring PTSD and Substance Abuse dependence. Great accomplishments but room for progress on many aspects


Establishing a successful treatment strategy for veterans experiencing Post Traumatic Stress Disorder (PTSD) and Substance Abuse (SA) is a complex challenge and requires clinicians to recognize patient patterns and other factors which may contribute to successful outcomes. During recovery, this population may face relapse if treatment is not consistent and appropriate for their needs. Although progress has been substantial in this area, continued strife and conflict for veterans and current enlistees is very difficult to manage. As a result, expanded research and improved strategic approaches are necessary to integrate concurrent treatment alternatives for PTSD and SA to improve and stabilize recovery rates.


Veterans with Post Traumatic Stress Disorder and Substance Abuse face difficult challenges along the road to recovery. The experiences of war and strife are often too great to bear for many veterans; therefore, they turn to substance abuse as a coping mechanism. Clinical outcomes vary for this population group, with limited consistency in results in some communities and geographic areas. It is necessary to establish a clinical approach to improve recovery rates with minimal relapse and to determine how to treat these patients in a sensitive manner. The primary objective of this analysis is to determine how to improve treatment methods and alternatives for veterans with PTSD and SA in order to improve their overall health and wellbeing in a manner which is consistent with clinical and ethical guidelines. In particular, nurses play a critical role in collaborating with physicians and therapists to provide the necessary treatment with the intent to optimize recovery in a consistent manner to limit relapse as best as possible for this population group.

Background of the Problem

Veterans diagnosed with PTSD and/or SA experience many critical challenges in their ability to recover from these conditions, including but not limited to depression, suicidal thoughts, withdrawal from family and friends, unemployment, lack of self-esteem and confidence, and a high risk of relapse. Substance abuse impacts these patients in a dramatic manner, and prior research indicates that the surrounding environment may complicate recovery, but that cultural differences also play an important role in shaping recovery outcomes (Friedman, 2007). The large majority of research regarding PTSD is concentrated in advanced nations; however, this condition is common in many different countries throughout the world (Foa, 2009). Therefore, guidelines must be comprehensive in nature and should impact all types of population groups, even when cultural differences persist (Foa, 2009).

From a nursing perspective, it is important to demonstrate knowledge of PTSD and SA and to develop guidelines that are applicable to many cultures (Foa, 2009). In conjunction with this effort, theoretical perspectives must be considered to achieve consistency with the required treatments to reduce the risk of relapse (Foa, 2009). Veterans are a unique population group because they typically experience tragedy and shocking events, often on multiple occasions, that other segments of the population are unfamiliar with; therefore, they often respond to these events in the form of substance abuse, domestic violence, sexual abuse, and other forms of violence (Foa, 2009). During the treatment phase, nurses must work collaboratively with physicians and therapists in a manner which is consistent with treatment guidelines and recommendations so that veteran patients experience improved health and wellbeing, in spite of their difficulties (Foa, 2009).

The development of a successful nurse-based approach to veteran patient care for PTSD and SA requires a greater understanding of this population group and their potential responses to these conditions. For example, PTSD patients may be easily provoked even without duress and may resort to violent behaviors or increased substance intake (Back, 2012). It is the responsibility of nurses working with these patients to demonstrate compassion and patience with this group and to recognize what actions may provoke negative behaviors (Back, 2012). A study conducted by Najavits (2010) addresses the importance and difficulty of co-treating PTSD and SA to achieve optimal recovery, and clinicians who responded to a survey noted that they find this type of work with veterans a gratifying experience, which serves to drive their focus and commitment even further. At the same time, the study discounted several myths regarding treatment for these conditions, as nurses and other care providers without specialized mental health experience are fully capable of treating this patient population under a variety of circumstances (Najavits, 2010). Nonetheless, continued work in this area is required to ensure that veteran patients are treated in a collaborative, consistent, and respectful manner, and nurses working with these patients must be effective in demonstrating these characteristics in treatment settings (Najavits, 2010).

A number of different models are typically utilized to treat veterans with PTSD and SA, each under different conditions and with diverse results (Najavits, 2011). Some models are utilized more widely than others and have important benefits for this patient population (Najavits, 2011). The effectiveness of some models is more significant than others, so much of the focus is on these areas (Najavits, 2011). The most positive benefit from these models is that there are significant advantages in utilizing evidence-based practice to achieve desirable treatment results for veterans (Najavits, 2011). It is also evident that continued research and exploration into this area of study is required to facilitate effective outcomes and meaningful approaches to treat veterans facing these challenges (Najavits, 2011).

For female veterans, who are a much smaller population group at under 8 percent of the veterans population, it is necessary to examine their PTSD and SA treatment needs more closely (Nunnink, 2010). The large majority of these women experience combat firsthand; therefore, they are at a greater risk of developing one or both of these conditions (Nunnink, 2010). Additional research and evaluation is required with this population group in order to ensure that treatment methods and diagnostic techniques are appropriate and sensitive to meet their needs accordingly (Nunnink, 2010). Women as veterans must be treated with the same level of respect and commitment by nurses and other care providers as their male counterparts (Nunnink, 2010).

Strategy for Improvement

Finally, the development of a successful approach to treating PTSD and SA requires continuous innovation to achieve desirable outcomes. In a study conducted by Back (2010), it was noted that “if a patient with PTSD and a substance use disorder can achieve PTSD symptom reduction, he or she will likely also experience a reduction in substance use disorder symptoms” (p. 11). Under these conditions, it is important to apply these findings on a continuous basis in order to make all possible efforts to comprehensively treat these patients for both disorders (Back, 2010). These alternatives will encourage veteran patients to take the steps that are necessary to achieve success with these treatments and to determine how to best move forward with their lives (Back, 2010). The actions taken by nurses and other care providers must be consistent with these findings and should demonstrate the effectiveness of selected models and interventions which are specifically designed to treat veterans patients with PTSD and SA in a variety of settings (Back, 2010).

One recommendation is to establish follow up meetings with veterans patients to discuss issues and concerns of importance which could be a benefit to their long-term recovery. For nurses, examining the clinical areas of patient recovery is essential to prevent any future relapses. These developments will also provide patients with another layer of comfort and support that is necessary to recover in the best possible manner. These efforts will also support veterans and their ability to prevent negative behaviors and any other actions associated with completing treatment in a successful manner. Nurses who continue communication with these patients, even on an irregular basis, are likely to observe more successful results because patients experience a greater sense of comfort and understanding in regards to these conditions.


Veterans who suffer from PTSD and SA present many challenges for nurses and other clinicians and require effective treatment to improve recovery rates and to prevent relapse. It is important for nurses to recognize these challenges and to take the steps that are necessary to provide patients with a supportive and compassionate treatment environment. By treating the underlying condition and emotional consequences of PTSD and SA, it is more likely that these patients will effectively recover from these conditions on a permanent basis. Nurses must utilize models that work best for their needs and for the needs of their patients in an effort to produce the most desirable results. These professionals must also consider the level of progression of each patient and take the time that is necessary to provide full support and encouragement during this challenging period.


Back, S.E. (2010). Toward an improved model of treating co-occuring PTSD and substance  use disorders. American Journal of Psychiatry, 167(1), 11-13.

Back, S.E., Killeen, T., Foa, E.B., Santa Ana, E.J., Gros, D.F., and Brady, K.T. (2012). Use of an integrated therapy with prolonged exposure to treat PTSD and Comorbid Alcohol Dependence in an Iraq War Veteran. American Journal of Psychiatry, 69(7), 688-691.

Foa, E.B., Keane, T.M., Friedman, M.J., and Cohen, J.A. (2009). Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies. New York: The Guilford Press.

Friedman, M.J., Keane, T.M., and Resick, P.A. (2007). Handbook of PTSD: Science and Practice. New York: The Guilford Press.

Kato, N., Kawata, M., and Pitman, R.K. (2006). PTSD: Brain Mechanisms and Clinical Implications. Tokyo: Springer-Verlag.

Najavits, L.M., Kivlahan, D., and Kosten, T. (2011). A national survey of clinicians’ views of evidence-based therapies for PTSD and substance abuse. Addiction Research & Theory, 19(2), 138-147.

Najavits, L.M., Norman, S.B., Kivlahan, D., and Kosten, T.R. (2010). Improving PTSD/ Substance Abuse Treatment in the VA: A Survey of Providers. The American Journal on Addictions, 19, 257-263.

Nunnink, S.E., Goldwaser, G., Heppner, P.S., Pittman, JOE, and Nievergelt, C.M. (2010).  Female veterans of the OEF/OIF Conflict: Concordance of PTSD Symptoms and Substance Misuse. Addictive Behaviors, 35, 655-659.