Substance abuse is a significant problem among active and retired military personnel in the United States. The stress associated with deployment and combat in war-torn zones puts veterans at a high risk of developing an addiction to a variety of illicit drugs, prescription drugs, and alcohol. Moreover, there are unique challenges that prevent veterans from obtaining effective addiction treatment.

The United States Department of Veterans Affairs has made numerous efforts to reduce problematic substance use among veterans, including providing integrated treatment for mental health disorders and addiction. However, much more needs to be done. Substance use disorders among veterans are associated with severe medical and social problems, including psychiatric disorders like anxiety and depression, problems with obtaining and maintaining employment, breakdown in relationships with family and friends, and increased suicide rates. 1

Statistics on Addiction in Veterans

Veterans deal with numerous complex issues ranging from health problems to financial difficulties. Thousands of veterans face strained relationships with family members due to long-term and/or multiple deployments. Unemployment and homelessness are common among the veteran population. The demands of military life, the psychological stress of deployment in a combat zone, and the challenges of readjusting to civilian life can trigger substance use disorders among veterans. In other words, veterans often use drugs and alcohol as a crutch to deal with the hardships they have faced in life. Here are some statistics that demonstrate the scale of the addiction problem among veterans.

  • The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that an estimated 1.5 million U.S. veterans above the age of 17 have struggled with a substance use disorder in the past year. This translates to 1 in 15 veterans struggling with an addiction. 2
  • Illicit drug use is not common among military personnel due to the zero-tolerance policy. In 2015, less than 1% of personnel across all service branches reported illicit drug abuse. In comparison, illicit drug abuse among civilians in the 18-25 age group was over 22%. 3
  • Heroin and cocaine are the most commonly abused illicit drugs by veterans. Roughly 10% of veteran admissions to substance use disorder treatment programs are for heroin, followed by 6% for cocaine. 4
  • Between 2005 and 2010, the rate of substance use disorders among female veterans increased by more than 80%. 5
  • The rate of drug overdose deaths in veterans is estimated to be around 20 deaths per 100,000 compared to around 11 deaths in the general population (2005 figures). 6
  • Military physicians wrote 3.8 million pain medication prescriptions in 2009, four times more than the number of such prescriptions in 2001. 7
  • Compared to a prescription drug misuse rate of 4.4% in the civilian population, the rate reported by the Department of Defense was 11.7%, which is approximately 2.5 times higher in veterans. 8
  • From 2001 to 2009, the percentage of veterans receiving an opioid prescription increased from 17% to 24%. Opioid overdose rates among veterans also increased from 14% in 2010 to 21% in 2016. 9
  • In 2008, nearly half of all active duty service members admitted to binge drinking, citing easy access to inexpensive alcohol on military bases. A considerable percentage of military personnel on active duty are younger than the legal drinking age. 10
  • Heavy drinking in male military personnel in the 18-25 years age range is approximately 32% compared to 18% in male civilians in the same age group. 11
  • Roughly 12% of soldiers who have never abused alcohol before deployment go on to develop alcohol addiction after assignment to active duty. 12
  • The lifetime prevalence of alcohol use disorder (AUD) among U.S. military veterans is 40%. Also, AUD puts veterans at risk of mood and anxiety disorders, drug abuse, and suicide attempts. 13
  • Excessive alcohol consumption costs the U.S. military more than $1 billion each year. 14
  • 65% of veterans who enter addiction treatment report alcohol as the most frequently abused substance, which is twice that of the general population. 15
  • An estimated 3.5% of veterans report using marijuana. Between 2002 and 2009, cannabis use increased by more than 50% among veterans. 16
  • From 2006 to 2011, behaviors like domestic abuse rose by 33% among military personnel. 17
  • Less than 20% of civilians in the United States use tobacco. However, 30% of active duty service members and 22% of veterans use tobacco. 18
  • American veterans have higher rates of problem gambling compared to their civilian counterparts. 19

Commonly Used Drugs Among Veterans

Nobody is immune to the risk of becoming addicted to drugs or alcohol. It can happen to anyone. Just like the general population, veterans can become addicted to a variety of harmful substances, including alcohol, illicit drugs, and prescription medications. In fact, substance use disorders are especially common among military veterans. The stress of coping with life-threatening situations during war puts veterans at high risk of turning to harmful substances as a coping mechanism. Also, the widespread availability of substances like alcohol has played a role in addiction among veterans.

Alcohol: One of the most common addictions seen among veterans is alcohol. Heavy alcohol consumption is a cultural norm in military social circles. Surveys have found that the prevalence of heavy drinking is up to 20% among veterans. Mirroring the trend in the general population, men in the military are 3.5 times more likely to report heavy drinking compared to women. 20Studies have found that a family history of drinking problems, drug problems, depression, and suicide attempts are risk factors for alcohol dependence among veterans. 21Also, large-scale surveys have found that the total number of deployments and cumulative time spent in deployment are linked to a higher likelihood of service members becoming problem drinkers. Interestingly, many service members who seek treatment for alcohol use disorders also have PTSD (post-traumatic stress disorder). Both conditions need to be treated simultaneously for positive outcomes. 22

Prescription pain medications: The misuse of opioid pain pills is a public health crisis in the United States. Unfortunately, veterans are especially vulnerable to the misuse and abuse of prescription narcotic analgesics. Prescription opioids are effective pain relievers and are widely prescribed in the military to help with pain related to injuries sustained during war. It is not uncommon for veterans to divert or misuse these medications and develop an opioid addiction. The challenges of adjusting to civilian life, unemployment, homelessness, and PTSD are additional risk factors that put veterans at risk of prescription pain pill abuse. 23 Studies have shown that prescription opioid addiction and addiction to illicit drugs like heroin and crack is not common before deployment. However, service members develop drug use disorders involving prescription opioids while in the military or soon after discharge. What’s more, roughly 8 out of 10 heroin users report using opioid pain pills before transitioning to heroin abuse. 24As of 2009, more veterans had died from suicide and fatal drug overdoses than from combat itself, and prescription pain pills are a major contributor to this tragic statistic. 25

Reasons for Substance Abuse in Veterans

Tobacco, alcohol, and prescription drug abuse are common among veterans. Fortunately, abuse of illicit drugs is less prevalent among veterans compared to the general civilian population. 26 Here are some of the most common reasons why veterans are at an increased risk of addiction.

Combat Stress: One of the main reasons that veterans often suffer from addictions is the stress of deployment in combat zones overseas. Serving in a war-ravaged region involves being away from home for prolonged periods in challenging environments. Also, loneliness and fatigue as a result of deployment put veterans at risk of substance abuse as a coping mechanism.

Military Culture: The strict discipline and zero-tolerance policies in the military as well as a lack of confidentiality and mandatory drug tests have created a substantial stigma around substance abuse in military culture. As a result, many active duty service members and veterans are hesitant to seek addiction treatment. For example, surveys have shown that half of all military personnel believe that seeking treatment for mental health disorders will negatively impact their career. 27

Injuries and Chronic Pain: Prescription opioid pain pills are widely prescribed to veterans to help them deal with chronic pain related to injuries sustained during wartime. Also, the strain of carrying heavy equipment during deployment can lead to chronic pain and the need for pain management. Many veterans who start using opioid pain pills as prescribed by a physician end up self-medicating, i.e., misusing these drugs and then going on to develop an opioid addiction.

Easy Availability: When it comes to alcohol, binge drinking is highly prevalent among military personnel, especially those with multiple deployments and those in active combat zones. One of the reasons is that alcohol is sold at discounted prices on U.S. military bases. Alcohol-infused parties are a common way for service members to decompress from the stress of combat. However, once they return home, veterans often find that as a result of all that heavy drinking they are now battling alcoholism.

Self-Medication: Veterans have to deal with a variety of complex issues, such as health problems and readjustment to civilian life. Unfortunately, some veterans deal with this stress in an unhealthy manner by turning to illicit drugs or alcohol as an escape mechanism. Veterans may also use harmful substances to dull the pain associated with post-traumatic stress disorder (PTSD).

Key Risk Factors for Drug Addiction in Veterans

Post-Traumatic Stress Disorder

One of the most important risk factors for drug and alcohol addiction in veterans is PTSD (post-traumatic stress disorder). It is a psychological condition that occurs as a result of exposure to dangerous and life-threatening events during deployment in combat zones. Veterans with PTSD suffer from numerous symptoms such as reliving the trauma through flashbacks, having uncontrolled negative thoughts, feeling jittery or unable to sleep, feeling hopeless or despondent, and feeling anxious all the time. As a result of these symptoms, veterans often find it difficult to hold down a job and may also experience relationship problems. This combination of symptoms puts veterans with PTSD at risk of addiction.

Many veterans turn to drugs or alcohol as a temporary escape from the symptoms of PTSD. Studies have shown that veterans with PTSD are up to four times more likely to develop a substance use disorder compared to those without PTSD. Roughly 6 out of 10 veterans diagnosed with a substance use disorder also have PTSD. Also, veterans with PTSD and addiction are more likely to have additional mental health problems. 28

Difficulties Reintegrating with Civilian Life

Deployment in a war zone puts U.S. service members at an extremely high risk of injury and death. When veterans return home after active duty, family and friends rejoice at the homecoming. However, it is not always easy for veterans to reintegrate into civilian society and lead a normal life after experiencing combat. Oftentimes, the transition to civilian life involves looking for employment and affordable housing. Also, many veterans think of their unit as their family and miss the camaraderie and the benefits of military life.

Veterans who have difficulty transitioning to civilian life face an increased risk of homelessness and other long-term problems. 29The stress of reintegrating into civilian society can sometimes lead veterans to turn to drugs or alcohol. Some of the challenges that put veterans at risk of addiction include:

  • Physical injuries and psychological after-effects of war
  • Changes in personal and family circumstances
  • Difficulty reconnecting with family and friends
  • Difficulty finding employment and/or affordable housing
  • Lack of support from the military and/or unit members
  • Missing the adrenaline of combat or feeling alienated with mundane life

These risk factors emphasize the need to ensure veterans receive treatment for PTSD and all the support they can get to help them readjust to civilian life. These two factors can go a long way in reducing the incidence of alcoholism and drug addiction in veterans.

Short- and Long-Term Effects of Drug Abuse in Veterans

Like everyone else, drug and alcohol addiction in veterans can have devastating consequences. Some of the short- and long-term effects of substance abuse in veterans include:

Homelessness: In 2016, the Department of Veterans Affairs reported there are 40,000 homeless veterans in the United States. Roughly 11% of the homeless population in the US are veterans. The vast majority of homeless veterans are male and single, live in urban areas, and suffer from mental illness and/or substance abuse and/or alcohol abuse. The high prevalence of homeless is veterans is due to a shortage of affordable housing, inadequate income, and lack of access to health care. Lack of social support networks, PTSD, and substance abuse also put veterans at risk of homelessness. 30

Unemployment: The presence of disabling conditions like PTSD and substance abuse put veterans at risk of being unable to find employment or losing their job. According to the U.S. Department of Labor, there were 284,000 unemployed veterans in 2019. Also, 4 out of 10 unemployed veterans were age 55 and above. 31

Poverty: Veterans who become addicted to drugs or alcohol may spend large sums of money on obtaining these harmful substances, putting them at risk of poverty. The National Veterans Foundation reports that 1.5 million veterans are living in poverty in the US, with the highest prevalence among veterans in the 18- to 34-year age group (veterans of Iraq and Afghanistan deployments). 32

Criminal Behavior: Homelessness, PTSD, poverty, and lack of employment all predispose veterans to criminal behavior. The Bureau of Justice estimates that close to 200,000 veterans are incarcerated in US prisons. 33The Department of Veterans Affairs has found that more than half of all veterans involved with the criminal justice system have substance abuse disorders and/or mental health problems like depression, anxiety, PTSD, and are at risk of suicide. 34

Suicide: The trauma of combat puts veterans at risk of addiction and PTSD. Studies have found that PTSD is associated with an elevated risk of suicide. People with PTSD are six times more likely to attempt suicide compared to a demographically-matched population. 35

Mental Health Disorders: Veterans have a higher prevalence of major depression, PTSD, and traumatic brain injury compared to the general population. One large survey found 14% of veterans had major depression, 14% were positive for PTSD, 10% had both PTSD and depression, and 19% had traumatic brain injuries.Roughly 1 out of every 5 veterans have a mental health diagnosis. 36 37

Gender-Based Differences in Veteran Addiction

Men and women in the military are equally exposed to a range of stressors; however, some gender-based differences play a role in the development of addiction in veterans. For example, women in the military may experience additional stressors related to working in a predominantly male environment. Research has shown that women consistently report higher stress. Also, depressive symptoms are two times higher in women than men. Women also perceive more family stress than men. One-third of women in the military experience a large amount of stress on account of being a woman in the military. 38Women are also subjected to additional stress on account of sexual harassment or fear or sexual trauma. Stress and depression are well-known risk factors for substance use disorders.

Preventing Drug Addiction in Veterans

Over 2 million American soldiers have been deployed to Iraq and Afghanistan in recent times. Approximately one-third of these service men and women return home with complex behavioral problems and mental health disorders like PTSD. Veterans who are diagnosed with PTSD are four times more likely to report suicidal ideation. Also, mental health conditions are risk factors for addiction in veterans. However, only half of all veterans who require treatment for mental health problems receive the necessary care. 39

Treating mental health conditions in veterans is, therefore, an important way of preventing addiction in this population. Nonetheless, some unique challenges prevent veterans from getting the treatment they need. Many veterans are reluctant to seek treatment for mental disorders because: 40

  • There is a stigma associated with mental health and substance use disorders.
  • There is a lack of awareness about drug and alcohol abuse and its link to mental health.
  • Health care is not affordable or accessible to veterans. There are nearly 3.5 million veterans who live in rural areas where access to mental health services is problematic.
  • Veterans worry about privacy and confidentiality or the quality of care at the VA.
  • Veterans are not aware of the resources available to them. Addiction treatment services are underutilized and only 1 out of 10 veterans with a substance use disorder receive any type of treatment for this condition.
  • Prolonged wait times for treatment at the VA prevent veterans from getting timely help.

Addiction Treatment for Veterans

Substance abuse is a serious problem among U.S. war veterans and active-duty military personnel. The intense experiences during combat put these individuals at high risk of mental health conditions and addiction. A range of effective pharmacological treatments and behavioral therapies are available to veterans battling substance abuse. However, several barriers prevent veterans from getting timely and adequate treatment for substance use disorders.

Despite attempts by government agencies to address the problem of substance abuse among veterans, the incidence of addiction in veterans continues to rise. Substance abuse in veterans is associated with a range of negative consequences, including psychiatric problems like anxiety and depression, difficulty in obtaining or maintaining employment, challenges with interpersonal relationships, as well as increased rates of suicide attempts. Studies have shown that 30% of suicides in veterans are preceded by drug or alcohol use and 20% of high-risk deaths are on account of overdoses.41

Addiction treatment services are available to veterans through VA Medical Centers across the country. However, access to these services continues to be challenging for many veterans, particularly those who live in rural areas. Also, young veterans are less likely to seek care at traditional VA medical centers. In response to these needs, the VA has implemented various programs. The SBIRT program (screening, brief intervention, and referral to treatment) helps to identify veterans with unhealthy or risky drinking habits. The goal is to provide them with treatment before they progress to an alcohol use disorder. More such initiatives can go a long way in reducing the incidence of substance use disorders in veterans.

Last updated: October 25, 2020

References

  1. Teeters JB, Lancaster CL, Brown DG, Back SE. Substance use disorders in military veterans: prevalence and treatment challenges. Subst Abuse Rehabil. 2017;8:69-77. Published 2017 Aug 30. doi:10.2147/SAR.S116720. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587184/
  2. Substance Abuse and Mental Health Services Administration. 1 in 15 veterans had a substance use disorder in the past year. https://www.samhsa.gov/data/sites/default/files/report_1969/Spotlight-1969.html
  3. National Institute on Drug Abuse. Substance Use and Military Life Drug Facts. https://www.drugabuse.gov/publications/drugfacts/substance-use-military-life
  4. National Institute on Drug Abuse. Substance Use and Military Life Drug Facts. https://www.drugabuse.gov/publications/drugfacts/substance-use-military-life
  5. Teeters JB, Lancaster CL, Brown DG, Back SE. Substance use disorders in military veterans: prevalence and treatment challenges. Subst Abuse Rehabil. 2017;8:69-77. Published 2017 Aug 30. doi:10.2147/SAR.S116720. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587184/
  6. Clement C, Stock C. Who Overdoses at a VA Emergency Department?. Fed Pract. 2016;33(11):14-20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6373703/
  7. Institute of Medicine. Substance Use Disorders in the U.S. Armed Forces. https://www.nap.edu/resource/13441/SUD_rb.pdf
  8. Indiana University. Military and Behavioral Health Problems: Substance Abuse and Problem Gambling. https://iprc.iu.edu/drug-info/featured-articles/200-military-and-behavioral-health-problems-substance-abuse-and-problem-gambling
  9. National Institute on Drug Abuse. Substance Use and Military Life Drug Facts. https://www.drugabuse.gov/publications/drugfacts/substance-use-military-life
  10. Institute of Medicine. Substance Use Disorders in the U.S. Armed Forces. https://www.nap.edu/resource/13441/SUD_rb.pdf
  11. National Institute on Alcohol Abuse and Alcoholism. Alcohol and Stress in the Military. Available online. Accessed on October 19, 2020. https://pubs.niaaa.nih.gov/publications/arcr344/401-407.htm#
  12. Indiana University. Military and Behavioral Health Problems: Substance Abuse and Problem Gambling. https://iprc.iu.edu/drug-info/featured-articles/200-military-and-behavioral-health-problems-substance-abuse-and-problem-gambling
  13. Fuehrlein BS, Mota N, Arias AJ, Trevisan LA, Kachadourian LK, Krystal JH, Southwick SM, Pietrzak RH. The burden of alcohol use disorders in US military veterans: results from the National Health and Resilience in Veterans Study. Addiction. 2016 Oct;111(10):1786-94. doi: 10.1111/add.13423. Epub 2016 May 26. PMID: 27061707. https://pubmed.ncbi.nlm.nih.gov/27061707/
  14. National Institute on Alcohol Abuse and Alcoholism. Alcohol and Stress in the Military. Available online. Accessed on October 19, 2020. https://pubs.niaaa.nih.gov/publications/arcr344/401-407.htm#
  15. National Institute on Drug Abuse. Substance Use and Military Life Drug Facts. https://www.drugabuse.gov/publications/drugfacts/substance-use-military-life
  16. National Institute on Drug Abuse. Substance Use and Military Life Drug Facts. https://www.drugabuse.gov/publications/drugfacts/substance-use-military-life
  17. Indiana University. Military and Behavioral Health Problems: Substance Abuse and Problem Gambling. https://iprc.iu.edu/drug-info/featured-articles/200-military-and-behavioral-health-problems-substance-abuse-and-problem-gambling
  18. National Institute on Drug Abuse. Substance Use and Military Life Drug Facts. https://www.drugabuse.gov/publications/drugfacts/substance-use-military-life
  19. Indiana University. Military and Behavioral Health Problems: Substance Abuse and Problem Gambling. https://iprc.iu.edu/drug-info/featured-articles/200-military-and-behavioral-health-problems-substance-abuse-and-problem-gambling
  20. National Institute on Alcohol Abuse and Alcoholism. Alcohol and Stress in the Military. Available online. Accessed on October 19, 2020. https://pubs.niaaa.nih.gov/publications/arcr344/401-407.htm#
  21. Jacob T, Blonigen DM, Koenig LB, Wachsmuth W, Price RK. Course of alcohol dependence among Vietnam combat veterans and nonveteran controls. J Stud Alcohol Drugs. 2010;71(5):629-639. doi:10.15288/jsad.2010.71.629. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930495/
  22. Allen JP, Crawford EF, Kudler H. Nature and Treatment of Comorbid Alcohol Problems and Post Traumatic Stress Disorder Among American Military Personnel and Veterans. Alcohol Res. 2016;38(1):133-140. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872608/
  23. Bennett AS, Elliott L, Golub A. Opioid and other substance misuse, overdose risk, and the potential for prevention among a sample of OEF/OIF veterans in New York City. Subst Use Misuse. 2013;48(10):894-907. doi:10.3109/10826084.2013.796991. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789237/
  24. Azadfard M, Huecker MR, Leaming JM. Opioid Addiction. [Updated 2020 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448203/
  25. Golub A, Bennett AS. Prescription opioid initiation, correlates, and consequences among a sample of OEF/OIF military personnel. Subst Use Misuse. 2013;48(10):811-820. doi:10.3109/10826084.2013.796988. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789239/
  26. Institute of Medicine. Substance Use Disorders in the U.S. Armed Forces. https://www.nap.edu/resource/13441/SUD_rb.pdf
  27. National Institute on Drug Abuse. Substance Use and Military Life Drug Facts. https://www.drugabuse.gov/publications/drugfacts/substance-use-military-life
  28. National Institute on Drug Abuse. Substance Use and Military Life Drug Facts. https://www.drugabuse.gov/publications/drugfacts/substance-use-military-life
  29. Ahern J, Worthen M, Masters J, Lippman SA, Ozer EJ, Moos R. The Challenges of Afghanistan and Iraq Veterans’ Transition from Military to Civilian Life and Approaches to Reconnection. PLoS One. 2015;10(7):e0128599. Published 2015 Jul 1. doi:10.1371/journal.pone.0128599. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4489090/
  30. National Coalition for Homeless Veterans. Background and Statistics. http://nchv.org/index.php/news/media/background_and_statistics/
  31. Bureau of Labor Statistics, U.S. Department of Labor. Employment Situation of Veterans 2019. https://www.bls.gov/news.release/pdf/vet.pdf
  32. Bureau of Labor Statistics, U.S. Department of Labor. Employment Situation of Veterans 2019. https://www.bls.gov/news.release/pdf/vet.pdf
  33. Bureau of Justice Statistics. Veterans in Prison and Jail 2011-2012. https://www.bjs.gov/index.cfm?ty=pbdetail&iid=5479
  34. Bureau of Justice Statistics. Veterans in Prison and Jail 2011-2012. https://www.bjs.gov/index.cfm?ty=pbdetail&iid=5479
  35. Wilcox HC, Storr CL, Breslau N. Posttraumatic stress disorder and suicide attempts in a community sample of urban american young adults. Arch Gen Psychiatry. 2009;66(3):305-311. doi:10.1001/archgenpsychiatry.2008.557
  36. Vazan P, Golub A, Bennett AS. Substance use and other mental health disorders among veterans returning to the inner city: prevalence, correlates, and rates of unmet treatment need. Subst Use Misuse. 2013;48(10):880-893. doi:10.3109/10826084.2013.796989. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3794703/
  37. Clement C, Stock C. Who Overdoses at a VA Emergency Department?. Fed Pract. 2016;33(11):14-20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6373703/
  38. Bray RM, Camlin CS, Fairbank JA, Dunteman GH, Wheeless SC. The Effects of Stress on Job Functioning of Military Men and Women. Armed Forces Soc. 2001;27(3):397-417. doi:10.1177/0095327X0102700304. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2883251/
  39. Bray RM, Camlin CS, Fairbank JA, Dunteman GH, Wheeless SC. The Effects of Stress on Job Functioning of Military Men and Women. Armed Forces Soc. 2001;27(3):397-417. doi:10.1177/0095327X0102700304. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2883251/
  40. Teeters JB, Lancaster CL, Brown DG, Back SE. Substance use disorders in military veterans: prevalence and treatment challenges. Subst Abuse Rehabil. 2017;8:69-77. Published 2017 Aug 30. doi:10.2147/SAR.S116720. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587184/
  41. Teeters JB, Lancaster CL, Brown DG, Back SE. Substance use disorders in military veterans: prevalence and treatment challenges. Subst Abuse Rehabil. 2017;8:69-77. Published 2017 Aug 30. doi:10.2147/SAR.S116720. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587184/