Veterans, Anxiety & Addiction

WHAT YOU NEED TO KNOW

• Anxiety disorders are common among Veterans and can reduce emotional health, sometimes leading to or worsening substance use disorder
• Common anxiety disorders include generalized anxiety disorder, PTSD, social anxiety, OCD, and panic disorder, and several often overlap
• Anxiety and substance use frequently co-occur; in one study, 82 to 93 percent of OEF and OIF Veterans with a substance use disorder also had a co-occurring mental health condition
• Anxiety is highly treatable with therapy like CBT and ACT, medication, or both, and integrated treatment for co-occurring conditions improves outcomes
• Call any time for free, confidential help available 24/7

If you are a Veteran living with anxiety, you may often feel nervous, uneasy, or tense. Anxiety disorders are relatively common in the Veteran community, and they can reduce emotional health and day-to-day functioning, sometimes leading to substance use as a way to cope. If you or someone you know is a Veteran facing both anxiety and addiction, please know that both can be treated, and help is available.

What is Anxiety?

Everyone experiences feelings of anxiety from time to time. Anxiety is a normal response to stress and situations where you feel threatened, whether the threat is real or imagined.³

For most people, symptoms of anxiety resolve over time, but if they don’t, you may have an anxiety disorder.³ There are different types of anxiety disorders that can cause different symptoms, but they can all have a negative impact on your life and affect the way you feel and function.

Types of Anxiety Disorders

Some of the common anxiety disorders include:

• Generalized anxiety disorder (GAD), which is characterized by chronic worry and tension.¹ It is a common anxiety disorder among Veterans, and commonly co-occurs in Veterans with post-traumatic stress disorder (PTSD).²
• PTSD, which involves a variety of unpleasant and distressing symptoms that can develop after exposure to a traumatic or life-threatening event, including military combat.⁴
• Social anxiety, previously known as social phobia, which means you have excessive fear, worry, and tension in social situations.¹
• Obsessive-compulsive disorder (OCD), which involves unwanted, intrusive, and recurrent thoughts and compulsive, or uncontrollable, behaviors.⁴
• Panic disorder, which is characterized by frequent and unexpected panic attacks.¹

Veterans, Anxiety & Substance Abuse

Anxiety and substance abuse may occur together.⁵ Substance use can sometimes be a way of self-medicating symptoms of anxiety.⁵ However, some people develop mental health conditions like anxiety because of substance use.⁶

Researchers know that there is a correlation between anxiety and SUD, but it’s not always clear which came first; interactions between each disorder can influence the other.⁷

• One study found that 40% of Veterans had PTSD also had GAD.²
• Another study that examined GAD in Veterans found that 9.7% of Vietnam Veterans and up to 15% of Iraq and Afghanistan Veterans reported having symptoms of GAD.²
• One study found that 19.4% of Veterans who had depression also had an anxiety disorder. 33.2% also had symptoms of PTSD, and 23.2% also had an SUD.⁸
• In a study of Veterans presenting for first-time care within the VA health care system, around 11% met criteria for SUD.⁹
• In a study of Veterans who served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), 82%–93% of Veterans with an SUD were also diagnosed with a co-occurring mental health disorder.63% of OED and OIF Veterans were diagnosed with an SUD and met criteria for PTSD.⁹

While co-occurring disorders can be challenging to overcome, Veterans who receive integrated mental health and addiction treatment were reported to experience improved outcomes, according to one study.⁸

Causes & Risk Factors of Anxiety

Different factors can cause or influence the development of anxiety disorders. Some of these can be unique to Veterans, such as the nature of their work and exposure to dangerous or life-threatening situations. Other, more general factors can also play a role.

Researchers believe that an interplay of genetic and environmental factors can lead to the development of an anxiety disorder.¹⁰ Causes and risk factors can include:

• Stress.^{10, 11}
• Physical trauma.¹¹
• Being naturally shy.¹⁰
• Genetic influences, such as having a family member with an anxiety disorder.¹⁰
• Physical health conditions, such as thyroid problems or heart arrhythmia.¹⁰
• Caffeine, certain medications, or substance use.¹⁰

Signs & Symptoms of Anxiety

Each anxiety disorder has its own unique signs and anxiety symptoms.

Generalized anxiety disorder symptoms include:¹⁰

• Being restless or wound-up.
• Feeling easily tired.
• Trouble concentrating.
• Irritability.
• Headaches, muscle aches, stomach aches, or unexplained pains.
• Excessive worrying.
• Having sleep problems, such as difficulty falling or staying asleep.

PTSD causes groups of symptoms that fall into the following categories:^{13 symptoms}

• Intrusion, such as intrusive thoughts or memories.
• Avoidance, such as avoiding things that remind you of the traumatic event.
• Altered cognition and mood, such as being unable to remember aspects of the trauma.
• Altered arousal and reactivity, such as having angry outbursts or reckless, self-destructive behaviors.

Social anxiety causes symptoms primarily in social situations; symptoms include:^{10 SAD}

• Blushing, sweating, or trembling.
• Pounding or racing heart.
• Stomach aches.
• Being stiff or speaking with a very soft voice.
• Avoiding eye contact or being very uncomfortable around people you don’t know.
• Excessive self-consciousness or fear of judgement from others.

Panic disorder can cause side effects of anxiety that occur during an intense episode of fear, or panic attack. Symptoms can include:¹⁰

• Pounding or racing heart.
• Sweating.
• Trembling or tingling.
• Chest pain.
• Feeling of impending doom.
• Feeling like you’re out of control.

OCD causes compulsive, uncontrollable, and repetitive behaviors, such as handwashing or checking things, in response to distressing thoughts.¹²

How is Anxiety Treated?

Anxiety disorders can be treated with a variety of therapeutic approaches. It is often treated with medication, psychotherapy, or a combination of both.¹⁰

Medication can alleviate symptoms, but it does not treat the causes of anxiety.¹⁰ Psychotherapy can help address underlying causes and reduce symptoms.¹⁰ Therapies can include methods such as:¹⁰

• Cognitive behavioral therapy (CBT), which can help a Veteran address thoughts and behaviors that lead or contribute to anxiety
• Acceptance and commitment therapy (ACT), which can help teach Veterans self-soothing techniques to reduce anxiety and manage stress.

These therapies are available in many rehab facilities and local VA medical centers to help Veterans struggling with anxiety disorders.¹⁴

Is Anxiety a VA Disability?

The military now provides disability ratings for mental health disorders, which are based on a scale of 0–100%, depending on your symptoms.¹⁵ You or the Veteran are paid a monthly amount based on your rating and whether you have dependent family members. To qualify for this monthly stipend, you will need to have a formal diagnosis.^{16 top}

Ratings can vary depending on your diagnosis, functioning, and other factors.

For example, if you have a diagnosed anxiety disorder but you don’t experience symptoms that interfere with functioning, you may receive a 0% rating. If you have PTSD that interferes with your social interaction and job functioning, you may receive a rating of 30% or more, depending on your symptoms.¹⁵ Specific payout information may vary from year to year and person to person.

Insurance & VA Coverage for Co-Occurring Disorder Treatment

Anxiety, and anxiety alongside a co-occurring substance use disorder, can be treated through the Veterans Affairs. When a VA facility cannot meet a Veteran’s needs, it may refer the Veteran to a community care provider, such as American Addiction Centers. Several AAC facilities partner with the VA for Community Care Provider programs, including Desert Hope Treatment Center and Recovery First Treatment Center. To learn about these Veteran-specific programs, call , explore VA benefits for addiction treatment, or verify your coverage in minutes.