How Prevalent is Substance Use Among Military Veterans?
Assistant Professor Jordan Davis is developing new digital mindfulness-based interventions to help address PTSD symptoms and substance abuse among military veterans.
Veterans face a number of unique challenges after they leave the military, one of which is learning to develop healthy habits as they re-assimilate to civilian life. Unfortunately, in the absence of effective coping mechanisms, veterans may turn to alcohol or drugs to numb physical pain or react to the psychological stressors that can result from time spent on active duty. As such, substance abuse among veterans has become increasingly commonplace.
The challenges of adjusting to life outside of the military are compounded for combat veterans, who may still be facing the physical or psychological effects of combat trauma. According to the U.S. Department of Veterans Affairs (VA), even if someone has never struggled with alcohol or drug abuse before, veterans are more likely to experience post-traumatic stress disorder (PTSD) due to the context of military service. This can increase the likelihood of developing an unhealthy reliance on substances or even substance use disorder (SUD).
At the forefront of research on military and veteran substance use is Jordan Davis, assistant professor of social work in the Department of Children, Youth and Families and affiliated faculty of the Military and Veterans Programs at the USC Suzanne Dworak-Peck School of Social Work. Davis spoke to us about his current research initiatives and the innovative digital intervention solutions he is developing for veterans struggling with substance abuse and PTSD.
USC Suzanne Dworak-Peck School of Social Work: How did you become interested in studying substance use among veterans?
Jordan Davis: I have always had an interest in at-risk populations including veterans, the homeless and youth who have experienced trauma, and the role that different behaviorial and neurocognitive factors play for these individuals. Ultimately, my colleagues and I are driven by a shared desire to positively impact these at-risk populations as much as we can.
USC: Why might veterans be at a higher risk of developing a substance abuse problem?
JD: There are a number of risk factors, but one of the most common is the experience of trauma paired with a lack of self-regulating skills, which include impulse control, emotion regulation and the ability to suppress aggression.
Combat veterans who have PTSD or any lasting trauma may experience hypervigilance, fear and aggression in response to flashbacks or perceived threats—and some veterans turn to alcohol and drugs to numb those feelings. Along with PTSD, research supports the idea that depression, anxiety and other mental health issues may contribute to and be worsened by substance use among veterans.
USC: What are the goals of your current research on PTSD and substance use among military veterans?
JD: Though we are currently waiting on grant approval and funding, my focus at the moment is on developing new digital tools that teach self-regulation through mindfulness-based relapse prevention (MBRP). With this goal in mind, my team recently partnered up with Jason Owen and Beth Jaworski, who are researchers at the National Center for PTSD and have developed a mobile app called Mindfulness Coach. Alongside a number of collaborators, we have adapted the app to include a focus on PTSD intervention as well as specific toolkits for users of both alcohol and marijuana.
The goal of the study is to collect data on veterans who screen for PTSD and substance use disorder, yet are unwilling or unable to receive treatment through the VA. Our aim is to measure the effects of the app in preventing relapse and helping users to develop self-regulating skills. We’ll also monitor any changes in PTSD symptomology or substance use patterns among users.
Ultimately, even if the effect on each user is relatively small, this digital platform has the potential to positively impact a large number of veterans who need support in coping with PTSD and substance use. If it proves to be an effective treatment model, I hope to integrate it into the VA’s current treatment plans as a resource that healthcare professionals can recommend to patients. My hope is to be able to provide as many people as I can with the resources and skills they need to better self-regulate and generate positive change in their lives.
USC: Could you expand upon the definition of “mindfulness,” and why it has the potential to help veterans struggling with substance use and PTSD?
JD: A lot of people hear the word “mindfulness” and think it means relaxing, feeling calm, or not engaging in any thoughts. On the contrary, mindfulness is very much about the act of noticing distraction: it is about being aware of everything around you, but bringing all of those distractions back to a central focus—whether that be your breathing, sensory perception or a single thought.
The prefrontal cortex of the brain is your command center—it’s responsible for decision-making, emotions and self-regulation. Your prefrontal cortex allows you to create distance between a negative stimulus—a bad memory, a perceived threat or a negative feeling—and your response to that stimulus. It allows you to process logic and respond appropriately. However, in someone with PTSD, the prefrontal cortex doesn’t create much of a space between those negative stimuli and responses. As such, they may feel overwhelmed and seek relief from that discomfort through the use of alcohol or other drugs.
A mindfulness approach like MBRP includes the use of meditation as a cognitive behavioral strategy to help a person develop self-regulating skills. Gradually, the person will become more aware of their triggers, understand their cravings and impulsivity more comprehensively, and be better equipped to manage negative stimuli. It works to create that healthy space between stimulus and response.