VA Substance Use Disorder Treatment Programs

Substance use disorder (SUD) is a diagnosed mental health condition in which a person has difficulty controlling their use of alcohol or drugs such as opioids. Over time, unhealthy use of substances causes changes in the brain that lead to an overwhelming desire to continue or increase use — even when it causes harm.

The VA treats SUD as a medical condition, not a character flaw. Evidence-based treatments are proven to be effective for most people. People with substance use challenges can and do recover.

SUD commonly occurs alongside other conditions in Veterans — including PTSD, depression, homelessness, and unemployment. Veterans with SUD have more than twice the risk of suicide compared to those without, and women Veterans with SUD face five times the risk.

About 9% of Americans over age 18 have a non-tobacco substance use disorder, and approximately 1 in 4 will develop one over their lifetime. Among Veterans, SUD frequently occurs alongside other challenges:

• Over 4 out of 10 adults (45%) with PTSD also have problems with drug or alcohol use
• Veterans with lifetime PTSD are 2 times more likely to develop alcohol use disorder
• Veterans with lifetime PTSD are 3 times more likely to develop drug use disorder
• Among Iraq and Afghanistan Veterans with PTSD: 34% of men and 20% of women also had alcohol use disorder

VA offers a full range of substance use disorder treatment services, from outpatient counseling to residential programs:

• Medically managed detoxification to stop substance use safely
• Short-term outpatient counseling
• Intensive outpatient treatment (IOP)
• Residential (live-in) care for more severe cases
• Medications — including drug substitution therapies (methadone, buprenorphine) for opioid addiction, and medications for alcohol and tobacco use
• Marriage and family counseling
• Self-help groups
• Continuing care and relapse prevention
• Specialized programs for women Veterans, combat Veterans, and homeless Veterans

Medication-assisted treatment (MAT) combines FDA-approved medications with counseling and behavioral therapies. For many substance use disorders, medication significantly improves outcomes.

For Opioid Use Disorder

• Methadone — reduces cravings and withdrawal symptoms (administered through specialized clinics)
• Buprenorphine — reduces cravings and withdrawal; can be prescribed in regular clinic settings
• Suboxone — combination of buprenorphine and naloxone
• Injectable extended-release naltrexone — blocks opioid effects (monthly injection)

VA has significantly expanded access to these medications. The SCOUTT (Stepped Care for Opioid Use Disorder Train the Trainer) initiative increased the number of Veterans with OUD receiving buprenorphine by 164% and the number of prescribing providers by 169%.

For Alcohol Use Disorder

• Acamprosate — helps maintain abstinence after detox
• Disulfiram — causes unpleasant effects when alcohol is consumed, discouraging drinking
• Naltrexone — reduces cravings and the rewarding effects of alcohol
• Topiramate — may help reduce heavy drinking

For Tobacco Use Disorder

• Nicotine replacement therapy — patches, gum, lozenges
• Bupropion — reduces cravings and withdrawal symptoms
• Varenicline — reduces cravings and blocks nicotine's rewarding effects

For Veterans who need more support than outpatient care provides, VA offers residential (live-in) treatment programs.

Mental Health Residential Rehabilitation Treatment Programs (MH RRTP)

• Approximately 250 programs across roughly 120 sites nationwide (including Alaska and Hawaii)
• Over 6,500 beds available
• Typical stay around 6 weeks (range: a few weeks to a few months)
• 24/7 care in supportive residential environments
• Includes dedicated substance use disorder treatment tracks
• Uses a whole-health, recovery-oriented approach

Substance Abuse Treatment Program (SATP)

• Voluntary 28-day inpatient program
• Available to health care-eligible Veterans with substance use disorder
• Therapies include CBT, Motivational Interviewing, and Motivational Enhancement Therapy
• Sobriety is a requirement of the program
• Participation is voluntary — Veterans can leave if they choose
• Upon completion, staff help determine appropriate outpatient follow-up treatment

Eligibility: Most Veterans must be enrolled in VA health care. Contact your local VA medical center or use the VA facility locator to find residential treatment programs near you.

VA offers harm reduction measures to keep Veterans safe, even if they are not yet ready to stop using substances. These services save lives and reduce the spread of disease:

• Naloxone (Narcan) — a medication that reverses opioid overdoses. VA can provide naloxone kits to Veterans and their family members
• Sterile needles — for infection prevention (reduces risk of HIV, hepatitis C, and other bloodborne infections)
• Fentanyl and xylazine detection test strips — to check substances for dangerous contaminants before use

Ask your VA provider about harm reduction services. These are available alongside — not instead of — treatment options.

PTSD and substance use disorder frequently go together. Research shows 44.6% of people with lifetime PTSD also meet the criteria for an alcohol or substance use disorder. PTSD typically develops first, and people may turn to substances to cope with the symptoms.

VA's key principle: Having one condition should not be a barrier to receiving treatment for the other. The 2023 VA/DoD Clinical Practice Guideline recommends evidence-based treatments be available for both disorders at the same time.

Integrated Treatment Approaches

• Trauma-focused therapies work for dual diagnosis: Research shows Veterans with both PTSD and SUD can safely engage in and benefit from CPT, Prolonged Exposure, and EMDR
• COPE (Concurrent Treatment of PTSD and SUD Using Prolonged Exposure): Integrates Prolonged Exposure therapy for PTSD with relapse prevention for SUD. Research shows COPE outperforms treatment-as-usual for reducing PTSD symptoms
• Integrated, trauma-focused interventions that address both disorders together have the greatest benefit compared to treating each condition separately

Important Notes

• Every VA medical center has a PTSD-SUD specialist trained to treat Veterans with both conditions
• Veterans with both diagnoses face poorer outcomes when conditions are treated separately — integrated treatment is the goal
• There is no evidence that benzodiazepines help core PTSD symptoms, and there is growing evidence of harm, particularly for people who also have SUD

For more on PTSD treatment specifically, see our PTSD Treatment Programs guide.

The VA has taken significant steps to address the opioid crisis among Veterans:

• VA's Opioid Safety Initiative decreased opioid dispensing by approximately 172,000 Veterans per quarter (about 25%) by mid-2016
• Veterans receiving the highest opioid doses were more than twice as likely to die by suicide compared to those on the lowest doses
• Nearly half of Veterans who died from drug overdose (2004-2009) while on opioids were also receiving benzodiazepines — the combination is especially dangerous

If you are currently taking opioids for pain and are concerned about dependence, talk to your VA provider. Safer pain management alternatives exist, and tapering plans can help you reduce use safely.

If you are not sure whether you or someone you care about has a substance use problem, the VA offers free, confidential online tools:

• Confidential online screening questionnaire — a self-assessment to help you understand your substance use
• Free online "Alcohol and Drug Education" course — learn about the effects of substance use and what treatment involves
• Information on signs, symptoms, and treatment options — available at mentalhealth.va.gov/substance-use

If You're Enrolled in VA Health Care

• Talk to your VA primary care provider about substance use concerns
• Request a referral to a Substance Use Disorder (SUD) program
• Use the VA Substance Use Disorder Program Locator through the VA facility locator

If You're Not Enrolled

• Apply for VA health care: See our VA Healthcare guide to get started
• Vet Centers: Combat Veterans can access free counseling and substance use assessment at over 300 community Vet Centers — no VA enrollment required
• Homeless or at-risk Veterans: Call the National Call Center for Homeless Veterans at 877-424-3838 (24/7 support)

Anyone Can Call

• SAMHSA National Helpline: 1-800-662-4357 — free, confidential, 24/7, available to anyone (not VA-specific)
• Veterans Crisis Line: 988 (press 1), text 838255, or chat at veteranscrisisline.net

• VA Substance Use Problems Page — Overview of VA SUD treatment and services
• VA Mental Health: Substance Use — Education, self-assessment, harm reduction, and treatment information
• VA SUD Treatment Details — Specific therapies and medications offered
• VA Facility Locator — Find SUD programs and mental health services near you
• PTSD and Substance Misuse — Understanding the connection between PTSD and SUD