Sarah is an officer in the U.S. Army and has been on active duty for over 9 months. While she has performed well during her time in Afghanistan, Sarah has had a difficult time coping with the transition into army life. Three months into her tour, she also experienced a traumatic incident when a fellow service member was killed in combat. Sarah has since sunk into a deep depression and is self-medicating with prescription stimulants during the day and alcohol at night.

The above story, while fictional, is an illustration of what some individuals go through as active military personnel. While substance abuse is a well-known issue amongst war Veterans, it is also a pervasive problem for those on active duty. These individuals are trained to be fit, healthy, and physically and mentally strong, which also means many do not ask for help out of fear of being perceived as weak.

Due to the difficulties of transitioning in and out of the military, many of these individuals turn to substances to cope. However, if you find yourself in this situation, it’s important to seek help and know that you’re not alone.

Risk Factors for Substance Abuse

Several risk factors contribute to the susceptibility of substance abuse and addiction amongst active military personnel.

Combat Stress

One of the most obvious risk factors when it comes to the military is combat stress. This refers to the emotional, mental, and physical strain of dealing with war and everything that occurs on duty. Combat stress plays a key role in the development of conditions like post-traumatic stress disorder (PTSD), depression, and anxiety.

Rates of depression, for example, can be 5 times higher among the military compared with the civilian population. A 2014 study in JAMA Psychiatry also indicates that as many as 1 out of 4 active military personnel have a mental health condition. The same study also showed that PTSD rates are 15 times higher than the regular population.

With these staggering statistics, it is no surprise that combat stress can lead many military personnel to turn to substances. Whether it’s coping with boredom or managing the anxiety of being constantly under threat, individuals on active duty can find the strain of combat to be difficult to deal with. However, there are preventative self-care measures you can take to minimize combat stress. The key is to adequately prepare and not delay help if it’s needed. Hiding combat stress will only make it worse.

Signs of Combat Stress

Some of the signs of combat stress include:

  • Physical and mental strain
  • Fatigue
  • Grief
  • Rage
  • Moral and emotional dilemmas
  • Feelings of failure, regret, and shame
  • Guilt
  • Concerns of disappointment
  • Feeling limited or restricted
  • Withdrawing from groups and friends
  • Diet changes
  • Mood swings
  • Loss of self-confidence
  • Difficulty eating, sleeping, or performing normal daily tasks

Factors That Can Worsen Combat Stress

  • Long-term deployment (six months or more)
  • Chronic lack of sleep
  • Physical injury
  • Witnessing the death of others
  • Personal or team loss during combat
  • Close calls or near misses
  • Carrying or handling human remains
  • Low trust levels between unit members
  • Thoughts of home or family situations
  • Previous mental health problems
  • Lack of experience

Increased Risk of Injury

Military personnel must endure high levels of strenuous activity, which means they are at risk of injury when they’re on duty. This increased risk through direct combat or intense physical activity also means that they are often prescribed opioid painkillers. These drugs are notoriously addictive and habit-forming, especially for military personnel who may also depend on the drugs for their relaxing effects. Chronic misuse of opioids can lead to addiction and other health consequences down the line.

Military Culture

The military culture poses another risk factor for military personnel. Drinking is an accepted and encouraged activity, especially as many people drink alcohol to unwind and cope with stressful circumstances. While many active military personnel describe themselves as “social drinkers,” over time this can lead to abuse and addiction. Alcohol will be present at celebrations, promotions, and other occasions, which is another way alcohol use is encouraged. Combining this drinking culture with stress, loneliness, and trauma can create a perfect storm for addiction.

Prescription Drug Use

Another issue in terms of military culture is the widespread use of prescription drugs — especially opioids. Between 2001 and 2009, for example, the number of painkiller prescriptions written by military doctors quadrupled.

While the military employs a strict “no drug” policy, opioids are often given for chronic or acute pain (e.g., on the battlefield). Studies also show that chronic misuse of these drugs has risen sharply compared with the general population. For example, active personnel with opioid prescriptions are said to be 3 times more likely to misuse them compared with those without a prescription.

Preventative Measures Before & After Combat

If you’ve recently enrolled in the military or you’re about to return to civilian life, there are preventative measures you can take when it comes to managing substance abuse.

Prepare for Deployment with Your Well-Being in Mind

Adequately preparing for deployment is one of the best ways to implement preventative measures ahead of time. Getting into positive habits that benefit your well-being will go a long way to minimizing combat stress and PTSD. It’s important to remember that transitioning in and out of the military comes with its own unique challenges, some of which can be difficult. Below are a few ways to actively prepare for deployment:

Become Familiar with the Deployment Health Assessment Program

To ensure that you’re physically and mentally fit for duty, the military has put together a pre-deployment health assessment. This is to be taken within 120 days of deployment and involves measuring your overall health and spotting any problem areas (if any). The benefit of the program is that you can use it as a benchmark to see where you’re at and to address any issues ahead of time. Going into active duty requires resilience, stamina, and more, so it’s vital that you’re as strong as possible.

Develop Healthy Sleep & Rest Habits

Sleep may be challenging while you’re on duty. However, if you’re able to develop healthy habits ahead of time and implement these into your daily routine, it can help you better manage stress. Make sure you’re not sleep-deprived in the weeks and months ahead of deployment and develop habits and strategies for getting sound sleep even in trying situations.

Maintain a Good Diet & Fitness Routine

While your military training will have put you in good shape, it’s important to keep up healthy routines before deployment and during active duty. Eating well will not only keep your immune system strong, but a good intake of vitamins, minerals, proteins, and fats will also benefit your mental health. When it comes to fitness, make sure you’re also incorporating relaxing activities such as stretching, yoga, or Tai Chi. Good health is a holistic endeavor, so try to implement a well-rounded diet and fitness routine.

Avoid Substances & Temptations

Being deployed can be stressful, which means it can be tempting to turn to substances like alcohol or tobacco to relax. However, getting into unhealthy habits before deployment can make you susceptible to substance abuse and more vulnerable to mental health conditions like anxiety, depression, and PTSD. Ensuring that you’re healthy while you’re deployed is one of the best weapons in your arsenal against combat fatigue and other stresses.

Reach Out to Family and Friends

Being away on active duty will mean extended periods away from your loved ones. Where possible, spend as much time as you can with your friends and family before you leave. This may sound like an obvious point, but it can be easy to lose sight of how meaningful these interactions are until you’re gone. Connecting with friends and family will remind you of what’s important and their support can keep you grounded while you’re on duty.

Learn to Recognize the Signs of Addiction

Another preventative measure you can take before, during, and after active duty is to educate yourself on the signs of addiction. Substance addiction is often characterized by compulsive and chronic behavior, even when that behavior has negative consequences. If you find yourself unable to think about anything but your substance of choice, it can be a sign of addiction. Other signs to watch out for include:

  • Tolerance: when your body is used to a substance and requires larger amounts to achieve the desired effects.
  • Withdrawal: if you experience symptoms such as nausea, tremors, nervousness, cold sweats, or agitation when you stop drugs or alcohol, these are withdrawal signs.
  • Remorse: occurs if your drug use has led you to feel guilty or sad, even though you are taking the substance to feel better.
  • Relapse: this happens if you try to stop taking the drug but find yourself going back to it due to intense cravings or withdrawal symptoms.

Ease Back into Civilian Life

One of the biggest challenges that military personnel face is transitioning back into civilian life. While many are excited to see their loved ones, the contrast between military and civilian life can be stark and distressing. Life in the military is highly structured, and the experiences that individuals have on the battlefield can leave long-lasting scars. With many personnel developing PTSD, depression, and substance dependencies, all while coping with the trauma they experienced on duty, resuming a “normal life” can be difficult.

However, hope is not lost. There are ways to ease back into civilian life and make this transition as easy as possible. These include:

  • Seeking help for mental health issues such as PTSD, depression, and anxiety.
  • Seeking help for substance abuse/addiction (if necessary).
  • Spending quality time with friends and family.
  • Connecting with other Veterans for community and support.
  • Pursuing education or job training at your own pace.
  • Maintaining a healthy diet and exercise routine.
  • Giving yourself time to adjust, reflect, and relax.
  • Regularly visiting your doctor and other mental health professionals for ongoing physical, mental, and emotional support.
  • Consulting with financial planners to manage earnings and next steps.
  • Finding ways to use your unique, transferrable skills from the military for employment, or to help others in the community.

The Importance of Seeking Help

While it may seem best to just “soldier on” with your problems, the fact is that you owe it to yourself and your colleagues to seek help. Ensuring that you are physically and mentally well can save your life, as well as theirs. It doesn’t do you any good to suffer in silence when help and resources are available. If you’re struggling with substance abuse and/or mental health issues, there are several things you can do:

Speak to Your Commanding Officer

In some cases, you may need to speak to your commanding officer, especially if you’ve tested positive during a drug test. Your commanding officer and military medical personnel can refer you to treatment and assessment, where needed. You may even want to read the military policy for substance abuse treatment.

Contact a Substance Abuse Center

Other options include contacting the Substance Abuse and Mental Health Services Administration (SAMHSA) national helpline. Agents are available 24 hours a day, 7 days a week, and they can connect you with treatment options and rehab centers across the U.S. They can recommend detox centers, inpatient or outpatient rehab facilities, and sober living arrangements.

Other resources include:

  • Veterans Crisis Line/Suicide Hotline: 1-800-(273)-8255 or send a text message to 838255
  • Resources for the homeless in your community:
  • U.S. Department of Veterans Affairs:
  • FREE VA online resource for military members concerned about their drinking:
  • VA/DoD Clinical Practice Guidelines for the Management of Substance Use Disorders:
  • Military One Source:


If you or a loved one are struggling with substance abuse, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.

You can also find a list of treatment centers near you on our website to help get you on the path to recovery.

Key Sources

National Alliance on Mental Illness. (n.d.). Veterans and Active Duty.

National Institute on Drug Abuse (NIDA). (2019). Substance Use and Military Life.

Committee on Prevention, Diagnosis, Treatment, and Management of Substance Use Disorders in the U.S. Armed Forces. (2013). Substance Use Disorders in the U.S. Armed Forces. National Academies Press.

Medical Disclaimer

At, we are dedicated to helping people recover from problematic substance use and associated mental health disorders. If you or a loved one are struggling with addiction to drugs or alcohol, you are not alone. Information on treatment and support options is readily available through the National Helpline of the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-4357. To further assist you along the path to recovery, the treatment center locator on our website allows you to easily find rehabilitation programs and services in your local area.

We provide our readers with factual, evidence-based content concerning the causes and nature of addiction, as well as available treatment options. However, this informative content is intended for educational purposes only. It is by no means a substitute for professional medical advice, diagnosis, or treatment. With regard to any addiction-related health concerns, you should always seek the guidance of a qualified, registered physician who is licensed to practice medicine in your particular jurisdiction. You should never avoid or delay seeking professional health care advice or services based on information obtained from our website. Our authors, editors, medical reviewers, website developers, and parent company do not assume any liability, obligation, or responsibility for any loss, damage, or adverse consequences alleged to have happened directly or indirectly as a result of the material presented on