Addiction Treatment for Veterans

Veteran-specific treatment differs in three concrete ways: the people in the room, the conditions treated alongside the substance use, and how it gets paid for. Everything else is the same clinical work.

You do not have to choose between VA care and private care. VA runs its own substance use programs, and it also pays for community providers when certain criteria are met [1][2]. Many veterans use both at different points.

How common is this? NIDA’s DrugFacts on substance use and military life says more than one in ten veterans have been diagnosed with a substance use disorder, slightly higher than the general population [18]. It also reports that a 2017 study examining National Survey on Drug Use and Health data found that, compared to their non-veteran counterparts, veterans were more likely to use alcohol, 56.6% against 50.8% in a 1-month period [18]. The same study found veterans more likely to report heavy use of alcohol, 7.5% against 6.5% in a 1-month period [18].

This page covers what veteran-specific care changes, and what it does not. It covers PTSD, moral injury and military sexual trauma. It covers how VA benefits, community care, TRICARE and CHAMPVA fit together, what our own campuses publish about treating veterans, and who can be told that you are in treatment. For the wider picture of what treatment involves, start with our overview of addiction treatment and our walkthrough of what the rehab process is like.

What Veteran-Specific Treatment Actually Changes

Start with what it does not change. The evidence base is the same. Medication works the same way. A group is still a group.

What changes is the fit.

The cohort. A veterans track means the group has shared reference points. Deployment. Rank structure. The specific dislocation of coming home. Nobody has to explain what a unit is, or translate what happened into civilian language before they can say it.

The co-occurring picture. Veteran treatment is built expecting post-traumatic stress disorder, chronic pain and traumatic brain injury to be in the room, not to be surprises. VA treats substance use alongside related conditions including PTSD and depression [1].

The staff. Clinicians working with this population have usually seen the patterns before: the sleep problems, the hypervigilance, the prescribed opioid history that turned into something else.

The paperwork. Benefits, service connection, community care approval. A program that sees veterans regularly knows how those pieces move.

The records. Federal confidentiality rules give substance use disorder patient records their own protection. Records held by a program those rules cover may be used or disclosed only as the rules permit, and they are otherwise shut out of federal, state and local proceedings [12]. Any disclosure that is made has to be limited to the information needed for its purpose [12]. Our guide to rehab confidentiality covers how consent, court orders and medical emergencies work.

None of that makes the treatment easier. It removes friction that costs people weeks.

PTSD, Moral Injury and Substance Use

The link is not a theory. VA explicitly offers treatment for conditions related to substance use problems, and names post-traumatic stress disorder and depression among them [1].

The practical shape it takes is familiar. Sleep goes first. Alcohol or a prescribed sedative starts as the thing that makes sleep possible. Then it becomes the thing that makes daytime possible. By the time anyone calls it a problem, two conditions are braided together.

Moral injury is a different thread from PTSD, though it often travels with it. VA’s National Center for PTSD describes moral injury as the distressing psychological, behavioral, social and sometimes spiritual aftermath of exposure to events that violate deeply held moral beliefs, and notes that PTSD includes additional symptoms such as hyperarousal that are not central to moral injury, so it is possible to have moral injury without meeting the criteria for PTSD [10]. Guilt and shame sit at the center of it, and the Center distinguishes them: guilt involves distress and remorse about the event itself, while shame is when the belief about the event generalizes to the whole self [10]. It also names an inability to self-forgive as another hallmark reaction [10]. None of that responds well to a treatment plan that only addresses the drinking.

Military sexual trauma is a third thread, and VA names it separately. VA uses the term to mean sexual assault or sexual harassment experienced during military service [13]. It covers any sexual activity during service in which you were involved against your will or were unable to say no [13]. Anyone can experience it, whatever their age, sex, sexual orientation, background or branch of service [13]. VA says MST-related care is free and confidential for veterans and other former service members, no matter how long ago the experience occurred [13]. The person to ask for is the MST Coordinator at a VA health care facility [13].

If you are a veteran in crisis, or worried about one, VA says to call 988 and select 1, or to text 838255, and a Veterans Crisis Line responder will answer at any hour [11]. VA adds that you can also call 911, go to the nearest emergency room, or go directly to your nearest VA medical center, and that for that last route it does not matter what your discharge status is or whether you are enrolled in VA health care [11].

This is why sequencing matters, and why “get sober first, deal with the rest later” often fails this population. Treat the substance use alone and the thing it was managing is still there. Our guide to types of therapy sets out the approaches used for both.

Using VA Benefits Alongside Private Treatment

VA runs a full range of substance use care in-house. Its published list includes short-term outpatient counseling, intensive outpatient treatment, marriage and family counseling, self-help groups, residential live-in care, and continuing care and relapse prevention [1]. It also provides medically managed detoxification, and medications including methadone and buprenorphine for opioid use disorder [1].

To use that care, a veteran applies for VA health care, then raises substance use with a VA primary care provider or finds a VA substance use disorder program directly [1]. There is a separate route worth knowing: veterans who served in a combat zone can get free private counseling, alcohol and drug assessment and other support at one of roughly 300 community Vet Centers, without going through VA benefits first [1].

VA also offers evidence-based treatment at local medical centers and clinics, which may involve therapies, medication or both, with assessment and referral available through Vet Centers [3].

Families are on VA’s published list too. Marriage and family counseling is one of the counseling options it names, and it also lists special programs for veterans with specific concerns, including women veterans, returning combat veterans and homeless veterans [1].

Private treatment sits alongside this rather than replacing it. Some veterans go private because the level of care they need is not available locally. Some go because a residential bed is available sooner. Some use VA for ongoing care and a private campus for the acute episode. Ask both sides what they can do and on what timeline, then decide.

TRICARE, VA Community Care and CHAMPVA

Three different programs, three different rulebooks. People mix them up constantly, and the mix-up costs time.

VA Community Care is VA paying for care from a provider in its community care network [2]. Eligibility has two basic requirements [2]. You have to be enrolled in or eligible for VA health care. And you have to have approval from your VA health care team before you get the care, except for certain cases like urgent or emergency care [2]. On top of those, you need to meet at least one of six further criteria [2]. VA does not provide the service you need at any VA health facility [2]. Your state or territory has no full-service VA health facility [2]. You and your VA provider agree that community care is in your best medical interest [2]. VA cannot provide the service in a way that meets its quality standards [2]. VA cannot provide the care within its standards for drive and wait times [2]. Or you qualified under the 40-mile distance requirement as of June 6, 2018 and you live in Alaska, Montana, North Dakota, South Dakota, Wyoming, or another location that would still make you eligible under these requirements [2].

Read that list carefully, because the operative word is “before”. Advance approval is the part people skip.

TRICARE is defined on VA’s own CHAMPVA page as “the Defense Department’s healthcare program for service members and their families” [4]. It is separate from VA. Coverage detail depends on the plan option, so verify against your own.

CHAMPVA is the Civilian Health and Medical Program of the Department of Veterans Affairs, a cost-sharing program for certain family members [4]. It covers spouses, dependent children and survivors of veterans meeting specific service-connected disability criteria [4]. One rule catches people out: if you are eligible for or enrolled in TRICARE, you cannot get CHAMPVA [4].

Two federal protections apply to commercial plans underneath all of this. Parity rules limit how much more restrictive a plan’s substance use limits can be than its medical and surgical limits, including prior authorization [5]. Marketplace plans must cover substance use treatment as an essential health benefit with no yearly or lifetime dollar caps [6]. Parity has a scope worth knowing. It applies to non-federal governmental plans with more than 50 employees, to private employer group plans with more than 50 employees, and to individual-market coverage. Small-employer group plans are generally outside it, although non-grandfathered small-group and individual plans must cover mental health and substance use disorder services as an essential health benefit under the Affordable Care Act [5]. Our page on insurance coverage for rehab goes through the verification questions. For a figure to hold in your head while you ask them: our own cost page puts drug and alcohol rehab at $2,000 to $25,000 or more, and basic residential treatment at $2,000 to $20,000. Those are our published ranges rather than federal figures, and how much rehab costs sets out the rest.

Where Veterans Can Get Care With Us

Start with what our campuses publish about themselves. Three of them name military veterans, in their own words, among the people they shape treatment around. Here is what each one says.

• The Recovery Village Umatilla, Umatilla, Florida. Its own page says: “We proudly welcome both in- and out-of-state clients and tailor our services to accommodate military veterans, members of the LGBTQ+ community and the elderly” [14].
• The Recovery Village Cherry Hill at Cooper, Cherry Hill, New Jersey. Its what-to-expect page says: “Our facility proudly welcomes people from all backgrounds, and we customize treatment plans to meet a variety of mental and physical needs, including those of military veterans, members of the LGBTQ+ community, the elderly and more” [15].
• The Recovery Village Palm Beach at Baptist Health, Lake Worth, Florida. Its what-to-expect page publishes that same sentence, word for word, written for South Florida [16].

Those sentences are a commitment to fit treatment around a veteran. That is a different thing from a veterans-only group, and the two are worth telling apart before you travel. Whether a campus currently runs a veteran cohort, and who else is in it, is a question for admissions.

Some veterans reading this are also fire fighters, dispatchers or first responders. The IAFF Center of Excellence in Upper Marlboro is our Maryland campus, and it admits IAFF-member fire fighters, dispatchers and first responders; if that is you, start there.

The levels of care differ by site, so ask which levels a campus holds before you go. If the labels are unfamiliar, our guide to levels of care sets out the five treatment levels, and medical detox has a page of its own. Our guides to inpatient rehab and outpatient rehab set out what each of those asks of a person’s week. Our nationwide directory lists the rest of our campuses.

Peer Groups and Why Cohort Matters

The cohort argument is simple, and it is mostly about time.

In a mixed group, a veteran spends the first sessions translating. What a deployment schedule does to a marriage. Why the chain of command shapes how you ask for help. Why “just talk to someone” lands badly when talking to someone was a career risk.

In a veterans group, none of that needs preamble. The room already holds it. That changes what gets said in week one instead of week five.

There is a second effect that matters more over time. Peer credibility. Advice about sleep, about anger, about how to handle a civilian manager, carries differently from someone who has done it. Federal guidance describes substance use disorders as chronic illnesses, and says individuals with substance use disorder may require long-term or multiple episodes of treatment to achieve long-term recovery [7]. Over that kind of timescale, the people you met in treatment are part of the infrastructure.

Medication, Chronic Pain and Opioid Histories

A large share of opioid problems in this population start with a legitimate prescription for a real injury. That history changes the treatment conversation, and it should.

Federal research guidance describes treatment with methadone, buprenorphine or naltrexone as the standard of care for opioid use disorder [7]. VA publishes “medically managed detoxification” among its medication options, alongside “drug substitution therapies and newer medicines to reduce cravings (like methadone and buprenorphine for opiate addiction)” [1]. Medication is also available for alcohol use disorder [7].

The pain does not disappear because the medication changes. A treatment plan that stops the opioid without addressing the underlying pain is not a plan. Ask how pain will be managed during and after withdrawal, and who owns that decision.

There is a second reason that gap matters, and it is the one to take seriously. MedlinePlus states it plainly: “Withdrawal reduces the person’s tolerance to the medicine, so those who have just gone through withdrawal can overdose on a much smaller dose than they used to take” [17]. The same page adds that most opioid overdose deaths occur in people who have just detoxed [17]. So going back to what used to be an ordinary amount is far more dangerous after a break than before one. If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental-health crisis call or text 988.

One more thing about withdrawal. Federal guidance defines detoxification as managing acute intoxication and withdrawal, and states plainly that detoxification “is not substance abuse treatment and rehabilitation” [8]. Our explainers on medical detox and medication-assisted treatment cover what follows it.

Discharge Planning Back Into VA Care

The handover is the weak point, and it is worth being deliberate about.

Before discharge, there should be a written plan naming four things. Who the next clinician is, and when the first appointment is. What medication continues, and which prescriber owns it. What the VA side of the plan looks like, and whether any community care authorization needs renewing. What to do on a bad day, with an actual number to call.

Get the medication question settled first. A prescription started at a private campus and not picked up by a VA prescriber is the most common way a good discharge goes wrong. If a community care authorization covered the episode, confirm whether continuing care needs a fresh approval [2].

If a return to use happens, it is information rather than a verdict. Federal guidance is explicit that a return to use does not mean treatment has failed, and that it signals a need to speak with a doctor about resuming treatment, changing it, or trying another treatment [9]. Our walkthrough of the admissions process covers re-entry as well as first entry.

Frequently Asked Questions

Sources

1. U.S. Department of Veterans Affairs. Substance use problems. https://www.va.gov/health-care/health-needs-conditions/substance-use-problems/
2. U.S. Department of Veterans Affairs. Eligibility for community care outside VA. https://www.va.gov/resources/eligibility-for-community-care-outside-va/
3. U.S. Department of Veterans Affairs, VA Mental Health. Substance use treatment for Veterans. https://www.mentalhealth.va.gov/substance-use/index.asp
4. U.S. Department of Veterans Affairs. CHAMPVA benefits. https://www.va.gov/family-and-caregiver-benefits/health-and-disability/champva/
5. Centers for Medicare and Medicaid Services. The Mental Health Parity and Addiction Equity Act (MHPAEA). https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity
6. HealthCare.gov. Mental Health and Substance Abuse Health Coverage Options. https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/
7. National Institute on Drug Abuse. Treatment. https://nida.nih.gov/research-topics/treatment
8. Substance Abuse and Mental Health Services Administration. Detoxification and Substance Abuse Treatment, TIP 45 — Chapter 1: Overview, Essential Concepts, and Definitions in Detoxification. NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK64119/
9. National Institute on Drug Abuse. Drugs, Brains, and Behavior: The Science of Addiction — Treatment and Recovery. https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
10. U.S. Department of Veterans Affairs, National Center for PTSD. Moral Injury. https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp
11. U.S. Department of Veterans Affairs. Veteran suicide prevention. https://www.va.gov/health-care/health-needs-conditions/mental-health/suicide-prevention/
12. Legal Information Institute. 42 CFR § 2.13 — Confidentiality restrictions and safeguards. Cornell Law School. https://www.law.cornell.edu/cfr/text/42/2.13
13. U.S. Department of Veterans Affairs, VA Mental Health. Military Sexual Trauma: Effects and Veteran Resources. https://www.mentalhealth.va.gov/msthome/index.asp
14. The Recovery Village. The Recovery Village Umatilla Drug, Alcohol and Mental Health Rehab. Advanced Recovery Systems. https://www.therecoveryvillage.com/locations/umatilla/
15. The Recovery Village. What to Expect at The Recovery Village Cherry Hill at Cooper. Advanced Recovery Systems. https://www.therecoveryvillage.com/locations/cherry-hill/what-to-expect/
16. The Recovery Village. What to Expect at The Recovery Village Palm Beach at Baptist Health. Advanced Recovery Systems. https://www.therecoveryvillage.com/locations/lake-worth/what-to-expect/
17. MedlinePlus Medical Encyclopedia. Opiate and Opioid Withdrawal. National Library of Medicine. https://medlineplus.gov/ency/article/000949.htm
18. National Institute on Drug Abuse. Substance Use and Military Life DrugFacts. https://nida.nih.gov/publications/drugfacts/substance-use-military-life

This page is for general information and is not medical advice. Only a licensed clinician who knows your history can tell you what is right for you. If you or someone you know is in immediate danger, call 911. For free, confidential support 24/7, call or text 988.

Author

Kevin Wandler, MD

Chief Medical Officer, The Recovery Village