The Cost of Freedom: Military and Veteran Substance Use Disorders (2 HR) Syllabus 

I. Understanding the Scope of the Problem

• Review the prevalence of substance use disorders (SUDs) among active-duty personnel and veterans
• Examine the connection between binge drinking and military culture
• Identify rising trends in substance misuse despite prevention efforts
• Explore the impact of substance use on readiness, performance, and overall health

II. Contributing Psychological and Environmental Factors

• Examine links between PTSD, depression, anxiety, and increased substance use
• Identify the effects of stress, neuroticism, and low emotionality on drinking behavior
• Understand environmental stressors such as deployment, combat exposure, and reintegration challenges
• Consider the influence of early interpersonal trauma and adverse childhood experiences

III. Specific Substances and Patterns of Use

• Discuss alcohol use as the most prevalent SUD in military populations
• Review rising rates of prescription opioid use and overprescribing patterns
• Identify risks related to polypharmacy and overlapping prescriptions
• Highlight trends in marijuana, illicit drug use, and smoking among veterans

IV. PTSD and the Substance Use Connection

• Recognize hypervigilance, nightmares, emotional numbing, and irritability as PTSD symptoms
• Understand how substance use is often used to self-medicate PTSD symptoms
• Explore the role of avoidance, isolation, and emotional dysregulation in substance use
• Link trauma reactivity to increased relapse risk

V. Diagnostic Criteria and Prevalence Considerations

• Define SUD using DSM-5 criteria based on symptom count and severity
• Understand how changes from DSM-IV and ICD-9 affect prevalence reporting
• Note challenges in VA diagnostic data and underreporting in non-VA veterans

VI. Evidence-Based Treatment Approaches

• Implement SBIRT (Screening, Brief Intervention, and Referral to Treatment) as a preventative tool
• Use CBT and contingency management for behavioral change and relapse prevention
• Apply motivational interviewing to enhance treatment engagement
• Utilize digital and web-based interventions for younger veterans

VII. Pharmacological Interventions

• Use FDA-approved medications for alcohol use disorder such as naltrexone, acamprosate, and disulfiram
• Treat opioid use disorder with methadone, buprenorphine, and extended-release naltrexone
• Explore medications under study for co-occurring PTSD and SUD such as prazosin and topiramate

VIII. Current Treatment Challenges

• Address stigma related to mental health and addiction in military culture
• Integrate SUD care into general mental health and primary care to reduce stigma
• Recognize access issues for rural veterans and the benefits and limitations of telehealth
• Tailor treatment approaches to match the needs and realities of veteran populations

IX. Gender-Specific Considerations

• Acknowledge the increasing rates of substance use among female veterans
• Recognize the impact of military sexual trauma and domestic violence
• Understand the need for women-only or gender-responsive programming
• Address logistical barriers such as childcare and comfort in mixed-gender settings

X. Dual Diagnosis and Integrated Treatment

• Understand that most veterans with SUD also have co-occurring psychiatric diagnoses
• Explore the integration of PTSD and SUD treatment to reduce relapse and improve outcomes
• Recognize common medical comorbidities and psychosocial impacts among dually diagnosed veterans
• Support integrated, trauma-informed approaches that address both conditions simultaneously