About 1.6 million men and women have served in Iraq and Afghanistan since the start of military operations in 2001. One-third of deployed soldiers have served at least two tours of duty; 70,000 have been deployed three times; and 20,000 have been deployed at least five times. The more times soldiers are deployed, the greater the likelihood of mental disorders. Multiple deployments are associated with a 50 percent greater prevalence of psychiatric disturbance. A recent RAND Corporation study estimated that as many as 300,000 returning veterans are suffering from post- traumatic stress disorder (PTSD) and/or depression, often complicated by the presence of traumatic brain injuries, as a result of exposure to improvised explosive devices (IEDs). (RAND, 2008, http:// veterans.rand.org). Approximately 1,000 returning veterans commit suicide each year, which is twice the likelihood of their civilian counterparts. ***

Among male Vietnam veterans who met the diagnostic criteria for PTSD, 73 percent also qualified for a lifetime diagnosis of alcohol abuse or dependence; and 25 to 56 percent have a lifetime drug abuse/dependence. Such lifestyle behaviors exacerbate chronic PTSD. Among female Vietnam veterans, a PTSD diagnosis predicts greater than five-fold increase in alcohol abuse and dependence. ***

In the case of gender, women are more likely than men to develop SUDs subsequent to trauma exposure and PTSD, with approximately 65 to 84 percent of women meeting criteria for PTSD before they develop SUDs. This pattern suggests that women self-medicate or cope with trauma-related symptoms by using substances. ***

More than 160,000 women (1 in 10 soldiers) have been deployed to Iraq and Afghanistan. They experience more lethal attacks than American women in any other war.

In addition to the stress of combat exposure, female soldiers are more likely to also experience sexual harassment (66 percent) and sexual assault (23 percent) (a “double whammy” of combat exposure and sexual abuse). Only 10 to 30 percent of female soldiers who are sexually assaulted, report it to military officials. Female veterans who reported being sexually assaulted in the military were found to be twice as likely to screen positive for symptoms of alcohol abuse than those who were not assaulted. Moreover, women with PTSD and alcohol abuse are more likely to report a history of childhood sexual abuse and they report having experienced a greater number of childhood traumas. Female sexual assault survivors are five times more likely to overuse prescription drugs; three times more likely to use marijuana; six times more likely to use cocaine; and 10 times more likely to use other hard drugs than women who have never been assaulted. They are 13 times more likely to have serious problems with alcohol. ***

Meichenbaum, D. (2009). Trauma and substance abuse: Guidelines for treating returning veterans. Counselor Magazine.10: 10-15.