Alcohol Use Disorder Among U.S. Veterans

Note: This paper was revised on June 18, 2025, to include reference to three additional publications on measuring the quality of care provided to veterans who have alcohol use disorder: Hepner et al., 2017; Hepner et al., 2019; and Watkins et al., 2011.

Alcohol consumption, even at modest levels, can lead to health risks and negatively affect an individual's overall well-being, particularly among U.S. veterans. In this essay, we provide an overview of alcohol use among veterans, its consequences, and recommendations for preventing and treating alcohol use disorder (AUD) for veterans. Our essay is intended for the people and entities that are seeking to address and mitigate the harms associated with alcohol use, including federal, state, and local policymakers; organizations that serve veterans, including nonprofit and other veteran-serving organizations; health care providers who interact with veterans; researchers; and veterans.

Alcohol use is a major contributing factor to a myriad of health conditions, including liver and cardiovascular disease, mental health problems, and an increased risk of injury (Fuehrlein et al., 2016), as described in Table 1. The likelihood of adverse health outcomes rises according to both the frequency and quantity of alcohol consumption, and, for some individuals, continued use could develop into AUD—a chronic disorder marked by impaired control over drinking, despite the harmful consequences. AUD is often associated with worsening physical and psychological health, strained relationships, and difficulties in maintaining employment. Furthermore, excessive alcohol use is a leading factor in preventable deaths among veterans and associated with increased health care usage and costs (Geiling, Rosen, and Edwards, 2012).

Health Outcome	Magnitude of Problem Among Veterans
Chronic health conditions	In the United States, cirrhosis is one of the top ten leading causes of death, having a rate of 16.4 per 100,000 individuals (Centers for Disease Control and Prevention, 2025). The Veterans Health Administration (VHA) is the largest national provider of care to patients who have cirrhosis, providing care to at least 80,000 veteran patients annually (Backus et al., 2009).a
Cancer	In January 2025, the U.S. Surgeon General issued an advisory on the risk that alcohol poses for seven types of cancers, including colorectal cancer (Office of the Surgeon General, 2025).b The U.S. Department of Veterans Affairs (VA) stated that nearly 50,000 cases of cancer are reported annually in the VA Central Cancer Registry, and colorectal cancer is the third most frequently diagnosed type of cancer (VA, 2021).
Suicide	Approximately 20 percent of veterans who died by suicide in 2022 and had used VHA in the past year had been diagnosed with AUD (Substance Abuse and Mental Health Services Administration [SAMHSA], undated-a).
Overdose	From 2012 to 2018, 2,421 veterans died from an alcohol-involved overdose. Of these, 868 died from alcohol only and had no co-occurring substance, such as an opioid. The overall alcohol overdose mortality rate increased over this period, driven largely by an increase of overdoses from alcohol use plus opioids and other substances (Lin et al., 2022).
Mortality	From 2014 to 2018, there were an estimated 21,861 alcohol-attributable deaths among U.S. veterans, and 71 percent of those deaths resulted from a chronic condition, such as liver disease, and 29 percent resulted from an acute cause, such as an injury and poisoning (Lynch et al., 2022). Evidence from Colorado suggests that this finding is likely a significant underestimate of alcohol-attributable deaths (Spark et al., 2023).

^a Cirrhosis is underdiagnosed nationally, including at VA, so this is a low estimate; as many as one-half of all veterans receiving care at VA present risk factors for liver disease (Beste et al., 2020).
^b The other six types of cancer that have a strong link to alcohol use are breast (in women), esophageal, liver, mouth, pharynx, and larynx.

Prevalence of Alcohol Use Patterns Among Veterans

In 2023, 55 percent of U.S. veterans drank alcohol in the past month. Among veterans who consumed alcohol, 42 percent reported binge drinking, and almost 16 percent reported heavy alcohol use (SAMHSA, 2024). Furthermore, 9 percent of veterans met the criteria for probable AUD in the past year;^[1] probable AUD is used for reporting on survey data that suggest an individual meets criterion for AUD, but there was not a licensed provider to make a diagnosis (see Figure 1). This essay focuses primarily on AUD, although, in certain instances, we include references to other alcohol outcomes, such as binge drinking and heavy drinking. (The definitions of these terms are provided in the "Alcohol Use Patterns" box.)

SOURCE: Features data from SAMHSA, undated-a.

Among 11.3 million alcohol users, there are 4.7 million binge drinkers (42% of alcohol users) and 1.8 million heavy drinkers (37.3% of binge drinkers and 15.7% of alcohol users).

Theories and Explanatory Models for Alcohol Use Among Veterans

Veterans have an increased risk of adverse alcohol use because of a combination of factors. We describe some of these theories and explanatory models in the following sections.

Military Drinking Culture

Drinking culture in the U.S. military might contribute to the development of problematic alcohol use and AUD among service members (Hoopsick et al., 2020; Straus, Norman, and Pietrzak, 2020). In 2018, a little more than 33 percent of active-duty service members reported binge drinking in the past 30 days, and 9 percent reported heavy drinking (RAND Corporation, 2021). The prevalence of alcohol consumption in military populations might be influenced by societal and cultural factors that normalize excessive drinking as a means of social bonding and coping with stress (Osborne et al., 2022).^[2] The normalization of heavy drinking in military settings not only affects service members during active duty but also poses challenges when they transition to civilian life, in which established drinking habits might persist or escalate into AUD. For example, those who separate from the military are more likely to continue alcohol use behaviors that began in military service, including heavy drinking and binge drinking (Jacobson et al., 2019). Existing or past health conditions related to AUD can be medically disqualifying conditions for appointment, enlistment, or induction into the military according to U.S. Department of Defense (DoD) policy (Code of Federal Regulations, Title 32, Part 66; DoD, 2024). However, it is possible that premilitary factors might increase the risk of developing AUD during military service. DoD and each service branch has policies related to alcohol use, including articles in the Uniform Code of Military Justice related to drunkenness, that could result in a variety of consequences, such as discharge from the military.

Self-Medication

Alcohol use and the development of AUD is often explained by the self-medication theory (Khantzian, 2003), which suggests that individuals consume alcohol to help manage or alleviate distressing psychological symptoms that result from traumatic experiences, anxiety, or low moods. When individuals use alcohol to cope with internal struggles, they might find temporary relief. However, over time, they often need to drink more frequently and in larger amounts to achieve the same effect, increasing the risk of developing AUD (Hawn, Cusack, and Amstadter, 2020; Schumm and Chard, 2012). There is evidence that supports the self-medication theory among veterans; for example, increased alcohol use has been associated with combat exposure (Belding et al., 2022; Davis et al., 2022; Kelley et al., 2013) and sexual trauma while in the military (Goldberg et al., 2019; Rodriguez, King, and Buchholz, 2024; Seelig et al., 2017).

Transition from Military to Civilian Life

Separation from the military can be a particularly difficult time for individuals, including immediately following separation (Pedlar, Thompson, and Castro, 2019; Sokol et al., 2021; Williams et al., 2023) and in the subsequent years after separation (Karre et al., 2024; Livingston et al., 2024). During this period, some veterans face challenges in managing finances, finding housing or consistent employment, enrolling in health care, and managing relationships, and some veterans experience the residual effects of military-related injuries, all of which have been linked to increased prevalence of excessive alcohol use (Blow et al., 2013; Perkins et al., 2016; Sokol et al., 2021; Tsai, Kasprow, and Rosenheck, 2014). Several studies have indicated that military separation and worsening or continued alcohol use are associated with the transition to civilian life (Norman, Schmied, and Larson, 2014; Porter et al., 2020). Other studies have reported separation from the military as a risk factor for relapse to problem drinking, highlighting the transition period as a highly stressful period and a key window for intervention (Williams et al., 2015).

Correlations and Risk Factors of Alcohol Use Disorder Among Veterans

Not all veterans are equally likely to have AUD; some groups of veterans might have elevated rates of AUD relative to their peers.

Trauma and Combat

There is some evidence linking greater combat exposure to increased risk of AUD and the development of heavy drinking habits among military populations (Davis et al., 2022; Osborne et al., 2022). This evidence aligns with strong evidence linking lifetime trauma exposures and trauma-induced posttraumatic stress disorder (PTSD) symptoms to AUD, specifically among veterans (Wilson et al., 2024).

Co-Occurring Mental Health Disorders

The majority of veterans who present to VA as having AUD also have co-occurring mental health disorders. Numerous studies have documented these patterns, and most note higher rates of AUD among veterans who screen positive for PTSD, major depression, and generalized anxiety disorder (Norman et al., 2018; Dworkin et al., 2018).

Cohort Differences

Among veterans who served after the September 11, 2001, terrorist attacks (9/11), 8 percent meet the criteria for probable AUD in the past year, compared with 4 percent among pre-9/11 veterans. Those who served post-9/11 also have higher rates of binge drinking (37 percent) than those who served in prior eras (20 percent) (Schuler et al., 2023).

Gender Differences

There are mixed findings when comparing alcohol use for male veterans with that of female veterans. Some research indicates higher risk for past-year alcohol use among male veterans (Fuehrlein et al., 2016). Among female veterans, their baseline consumption following deployment was higher than male veterans, but, over time, their alcohol use declined, whereas male veterans’ consumption remained high over 16 years following their deployment (Winnicki et al., 2024). According to national data, among all veterans, 9 percent of veterans who are men, and 10 percent of veterans who are women, and 9 percent overall meet criteria for AUD (SAMHSA, undated-b; Winnicki et al., 2024).

Age Differences

AUD is more common among younger veterans: Approximately 21 percent of veterans ages 18 to 49 have AUD compared with 9 percent among veterans ages 50 and older (SAMHSA, 2020).

Other Sociodemographic Characteristics

There is evidence that some veterans are more likely to meet criteria for AUD or report greater frequency of alcohol use if they are from a minority race or ethnic group, do not have a partner, have lower educational attainment, or have a lower annual household income (Davis et al., 2021; Fuehrlein et al., 2016; Goldberg et al., 2019; Panza et al., 2022). Moreover, certain early life experiences linked to increased risk of AUD might be more prevalent among veterans. For instance, research indicates that those who served in the military are more likely to have previous adverse childhood experiences than those who did not serve (Blosnich et al., 2014) and that these early experiences are linked to adult difficulties with alcohol use (Brady and Back, 2012; Dube et al., 2003).

Other Military Characteristics

Although surveys on service members indicate that there might be differences in alcohol consumption across military characteristics (e.g., binge drinking across service branches) (RAND Corporation, 2021), few veteran studies have examined whether AUD differs across military characteristics (e.g., military branch, rank, enlisted versus officer status). Those that have examined this question (e.g., Fuehrlein et al., 2016) find little to no evidence of such differences.

Treatments for Alcohol Use Disorder

There is evidence that supports the effectiveness of both behavioral and pharmacological treatments for AUD. We review these treatments and patterns of treatment usage among veterans in the following sections.

Behavioral Treatments for Alcohol Use Disorder

Brief interventions are recommended for individuals who report heavy drinking but do not screen positive for AUD or who have mild AUD symptoms (Pedersen et al., 2017; Perry et al., 2022). The purpose of a brief intervention is to intervene before alcohol use becomes chronic and more difficult to treat. Brief interventions educate individuals about alcohol-related risks, including advice to drink in set limits (see box for further details). Brief interventions are often administered in a single session and can be provided by a primary care (Kaner et al., 2009) or emergency room provider (Schmidt et al., 2016). Interventions might be provided with or without pharmacotherapy specifically for AUD (NIAAA, 2025b).

For those veterans who screen positive for AUD, there are several behavioral interventions that can be provided by a licensed mental health care provider. NIAAA lists six, evidence-based approaches, which are described in Table 2. These can be provided in different settings, including outpatient care, domiciliary care, intensive outpatient care or partial hospitalization, residential care, or intensive inpatient care. Also, there is emerging evidence that these treatments can be provided virtually (i.e., via telehealth; Kruse et al., 2020).

Treatment	Key Elements of Treatment
Cognitive behavioral therapya	Identify and challenge negative thought patterns. Develop coping strategies to handle triggers and cravings. Set realistic goals for reducing or stopping alcohol use. Practice problem-solving skills.
Motivational enhancement therapya	Build intrinsic motivation to change drinking behavior. Conduct brief, structured counseling sessions. Use motivational interviewing techniques. Set specific, achievable goals for change.
Acceptance- and mindfulness-based interventions	Build skills to notice cravings and feelings in the moment. Develop techniques to respond to a trigger in an adaptable way rather than reacting in an automatic way that could increase drinking.
Contingency managementa	Match concrete rewards with objective treatment goals.
12-step facilitation	Encourage participation in 12-step groups (e.g., Alcoholics Anonymous). Teach the principles of the 12-step program. Provide support for maintaining sobriety. Foster a sense of community and accountability.
Behavioral couples therapy	Engage partners in the treatment process. Improve communication and relationship skills. Set joint goals for reducing or stopping alcohol use. Provide mutual support and reinforcement.

SOURCE: Features information from NIAAA, 2025b.
^a This treatment is offered by VA.

The VA/DoD Clinical Practice Guidelines for the Management of Substance Use Disorders, updated in 2021, aligns with evidence-based practices and recommends (1) brief interventions for those who screen positive but do not meet criteria for AUD and (2) behavioral treatment with or without pharmacotherapy for those who meet criteria for AUD (Perry et al., 2022). Not all veterans who have AUD are eligible to receive care at VA, and some might prefer to receive care elsewhere. There are some organizations that provide treatment for AUD specifically for veterans (e.g., Forge Veterans and First Responders, Avalon Action Alliance). NIAAA operates the NIAAA Alcohol Treatment Navigator, which also provides additional options for veterans and nonveterans (NIAAA Alcohol Treatment Navigator, undated).

Pharmacotherapy Treatments for Alcohol Use Disorder

Evidence supports the use of approved medications for AUD (Anton et al., 2006; Batki et al., 2014). There are three medications that have U.S. Food and Drug Administration (FDA) approval to treat AUD: acamprosate, naltrexone, and disulfiram. The VA/DoD guidelines recommend naltrexone and topiramate for veterans who have moderate to severe AUD, particularly when those medications are paired with behavioral treatments (Perry et al., 2022). Naltrexone, an opioid receptor antagonist, diminishes the rewarding effects of alcohol, leading to reduced cravings and a lower likelihood of drinking episodes (Jonas et al., 2014). Although topiramate is not approved by FDA for treating AUD and is mainly used to treat seizures, that medication has also been used in other ways to help calm brain activity by reducing stress signals and increasing relaxation signals. This effect has been linked to lower alcohol consumption and an improved ability to abstain from alcohol consumption. Emerging research has identified potential new pharmacological agents for treating AUD, including semaglutide, which is commonly used for Type 2 diabetes and weight management (Hendershot et al., 2025).

Despite evidence indicating that pharmacotherapy can reduce alcohol consumption among those who have AUD, these medications are underprescribed in clinical settings (Gregory et al., 2022). The barriers to prescribing medications in various VA settings include limited access to providers who are willing to prescribe and are knowledgeable of medications to treat AUD, disinterest from leadership, beliefs that veterans might not be interested in or in need of medications, and a general attitude toward discouraging medication prescribing (Finlay et al., 2017; Williams et al., 2018). Estimates by VA indicate that the number of veterans who are receiving medications for AUD treatment increased from 2017 to 2022 (VA, 2022). Still, efforts to expand medication treatment for AUD are needed. Further efforts to address barriers to pharmacotherapy AUD treatments are essential to deliver a quality of care that aligns with VA/DoD guidelines and ensure that veterans receive comprehensive care.

Patterns of Treatment Usage Among Veterans Who Have Alcohol Use Disorder

Despite the availability of treatment services, many individuals—both veterans and nonveterans—experience gaps in treatment access and usage.

There is limited research directly comparing alcohol treatment usage between veterans and nonveterans. One study documented greater screening for alcohol use problems and receipt of guidance on the harmful effects of alcohol among veterans compared with nonveterans, which could contribute to higher treatment engagement (Bachrach, Blosnich, and Williams, 2018). Although one study reported that veterans were more likely to receive treatment for substance use (which was defined broadly but included AUD) than nonveterans were (Boden and Hoggatt, 2018), another study found no significant difference in treatment usage between the two groups (Golub and Bennett, 2014).

Several studies using veteran or nonveteran samples have investigated predictors of alcohol treatment usage. Being older and having a lower income have been found to be associated with increased alcohol treatment usage among both veterans (Halvorson, Ghaus, and Cucciare, 2014) and nonveterans (Mowbray, 2014). For veterans, combat exposure is also associated with alcohol treatment usage (Miller, Pedersen, and Marshall, 2017). Research by Ranney et al. (2023) indicated that although veterans reported slightly higher alcohol consumption than nonveterans, veterans were not significantly more likely to need intensive alcohol treatment, and past-year treatment usage was similar for both groups. However, veterans were three times more likely than nonveterans to have received alcohol treatment at any time during their lives. Additionally, among those needing treatment, only 15 percent of veterans and 13 percent of nonveterans had received past-year treatment, indicating a substantial unmet need for both populations.

Pressing Issues

Despite advances in the treatment of AUD, several issues remain critical to preventing and reducing AUD among veterans.

Prevention Efforts Are Needed Both During Military Service and During the Transition to Civilian Life

Early prevention efforts are key to reducing downstream issues with alcohol use, including binge drinking, heavy drinking, and AUD. In the military, each service offers its own approach to prevention and treatment. However, researchers have argued that all service branches need to continue to address the culture of excessive alcohol use in the military (Meadows et al., 2023). Motivational interviewing and brief motivational interventions are effective at reducing alcohol use among active-duty service members (Watterson et al., 2021) and among similar age groups in the general population (Vasilaki, Hosier, and Cox, 2006).

The period of transition out of the military is another point at which prevention efforts might be important. Currently, the VA operates two programs, called Solid Start and Make the Connection, for all service members reintegrating into civilian life, but whether and how these programs address drinking behaviors has not been clear (VA, 2024b). Military OneSource is also available to service members for 12 months after leaving the military, but stigma or cultural beliefs might hinder veterans who have recently separated from reaching out for help or accurately disclosing their drinking behaviors (Military OneSource, undated).

Veterans Who Have Co-Occurring Disorders Need Both Treated

Many veterans presenting with AUD have co-occurring mental health disorders, most prominently PTSD. Although psychotherapy is critical for treating both disorders, most patients who have PTSD and AUD receive treatment for only one disorder (Taylor, Petrakis, and Ralevski, 2017). There is a common belief in a sequential model of treatment in which the focus is first on stabilizing the most acute disorder and then addressing the other problems (Cook et al., 2006). Over the past decade, integrated treatment models that simultaneously address both AUD and PTSD in therapy have been developed. Multiple randomized controlled trials of integrated interventions have demonstrated improvements in both PTSD and substance use outcomes (Roberts et al., 2015; Torchalla et al., 2012). In particular, combining pharmacotherapy for AUD with behavioral treatments for PTSD can effectively lead to improvements for both outcomes (Taylor, Petrakis, and Ralevski, 2017).

VA has taken steps to integrate treatment by funding PTSD and substance use disorder specialist positions and supporting research to identify effective evidence-based treatments (Hawkins et al., 2010). Unfortunately, one major issue facing clinicians treating individuals who need integrated care for PTSD and AUD is low retention rates. Retention rates for treatment of PTSD and AUD remain a challenge, and trauma-focused studies have reported participant retention at approximately 51 percent, whereas non–trauma-focused studies had a retention rate of around 50 percent (Flanagan et al., 2018). Studies that were specifically focused on substance use disorders have had even lower retention, averaging about 44 percent. Given the high dropout rates among individuals who have co-occurring PTSD and AUD, there is a pressing need to develop and evaluate integrated treatment approaches that enhance long-term participation and outcomes.

Ensure That All Veterans Have Access to Alcohol Use Disorder Treatments

Enhanced efforts by federal, state, and local policymakers and health care systems are needed to reach certain veterans who have AUD. For example, where veterans reside affects whether they have access to treatment for AUD: Those living in rural areas are less likely to receive evidence-based treatments for AUD (Edmonds et al., 2021). VA providers treating AUD in rural clinics report facing challenges to connecting veterans to specialty care and inadequate support from the broader health care system, whereas VA providers in urban clinics report fewer barriers (Young et al., 2018). Furthermore, veterans in rural areas who are diagnosed with AUD are significantly less likely to fill one or more AUD medication prescriptions than veterans in urban areas (Edmonds et al., 2021). Clinics that provide AUD treatment in rural areas might consider providing telehealth options and include stakeholders who are connected with rural communities in the medical system (Davis and O’Neill, 2022). Further efforts are needed to reduce barriers to specialty care and pharmacotherapy to treat veterans who have AUD and live in rural areas (Edmonds et al., 2021).

Racial minorities, particularly Black veterans, are more frequently diagnosed with AUD (Williams et al., 2016) than white veterans (Vickers-Smith et al., 2023). These differences might be because of several factors, including differing presentations of AUD symptoms, differing socioeconomic statuses, and provider bias (Vickers-Smith et al., 2023). Black veterans are less likely than white veterans to receive effective treatments for AUD (Williams et al., 2017). These differences are even more pronounced among women, and Black and Asian or Pacific Islander women veterans are less likely to receive brief interventions for unhealthy alcohol use than white and Asian or Pacific Islander men (Chen et al., 2020).

Address Barriers to Prescribing Medication for Alcohol Use Disorder

Providers are the gatekeepers to accessing effective AUD pharmacological treatments. In 2023, only 2 percent of individuals in the general public who had AUD in the past year received medication-assisted treatment (NIAAA, 2025a). A study found that medications for AUD remain underused, and most clinicians prescribe them infrequently (Kennedy-Hendricks et al., 2025). Similar results have been noted in studies assessing use of medications for alcohol use among veterans seeking care at VHA (Harris et al., 2010). Policy barriers (e.g., formulary restrictions), inadequate physician knowledge, and beliefs about treatment efficacy (or lack thereof) all contribute to lower levels of prescribing among providers (Gregory et al., 2022). Efforts to increase prescriptions must target both providers who do not have experience using medications for AUD and those who prescribe it occasionally, particularly in primary care, in which AUD is common but specialty treatment is often inaccessible. Addressing barriers in primary care through policy and system-level changes could help expand the usage of medication for AUD and improve treatment access.

The perception that medications for AUD are ineffective remains widespread among clinicians, creating a significant barrier to prescribing (Donroe and Edelman, 2022). This skepticism might stem from the fact that patients respond differently to AUD medications and that treatments often require a personalized treatment approach. When clinicians prescribe medications for AUD to patients who do not experience the expected benefits, clinicians might conclude that these treatments lack efficacy, further reinforcing a reluctance to prescribe.

Policies for Addressing Alcohol Use Disorder

Policy efforts to address AUD among veterans continue both at the congressional and federal levels and have an increasing focus on comprehensive approaches that enhance access to treatment and support services. Such efforts include funding for specialized programs in VA that provide counseling, rehabilitation, and recovery support tailored to veterans’ unique needs. The 2025 VA budget request includes establishing seven additional locations of care for domiciliary substance use disorder through 2026 (VA, 2024a).

Congress continues to discuss and propose measures that would expand and improve treatment and services for AUD by integrating mental health care with substance use treatment. Both committees of jurisdiction have held hearings to discuss these issues. As a result of these hearings and other ones, Congress has introduced bills to address this issue, including the Veteran Care Improvement Act of 2023 (H.R. 3520, 2023b), Protecting Veteran Community Care Act (H.R. 3554, 2023a), and Veterans Mental Health and Addiction Therapy Quality of Care Act (S.3546, 2023). In January 2025, the House and Senate committees of jurisdiction introduced companion bills known as the Veterans’ Assuring Critical Care Expansions to Support Servicemembers (ACCESS) Act (H.R. 740, 2025; S. 275, 2025) to address residential rehabilitation treatment and priority admission to certain programs if a veteran is at high risk.

Future Research Priorities

Research will help policymakers and health care providers understand how to better prevent AUD among veterans and improve the effectiveness of interventions for those who have AUD. We highlight five areas for future research in the following sections.

Measuring Alcohol Use Disorder Quality of Care for Veterans

Systematic reviews consistently indicate that clinical quality and patient safety in VA care are at least as good as that for non-VA care (Apaydin et al., 2023; O’Hanlon et al., 2017; Price et al., 2018; Trivedi et al., 2011). These studies are focused on primarily general medical care, inpatient and outpatient effectiveness, and patient safety, and studies often evaluate broad populations rather than specific subgroups that have unique health care needs. There are existing quality measures for assessing the quality of AUD care (Hepner et al., 2017). When such quality measures were applied to one VA system, few patients received all recommended care, with variability in what patients were offered (for example, most were screened for co-occurring depression, but few were offered pharmacotherapy; Hepner et al., 2019). Studies comparing this performance to care provided in the community are scant (for an exception, see Watkins et al., 2011). More studies are needed to assess the quality of AUD care in VA, including whether and how VA differs from other health care systems with respect to AUD screening, treatment access, medication usage, and treatment outcomes. Research is also needed on AUD screening and treatment in VA Community Care, which accounts for an increasing share of VA care (Rasmussen and Farmer, 2023). Understanding these gaps could help improve care delivery and identify areas in which integrated, veteran-focused interventions are most needed.

Evaluating Integrated Treatments for Veterans Who Have Co-Occurring Alcohol Use Disorder and Posttraumatic Stress Disorder

Although there is promising evidence for integrated treatments for PTSD and AUD, most research on these models is limited in scope and methodological rigor. More robust research on integrated medication and psychological treatments for co-occurring AUD and PTSD is needed. Testing approaches for improving retention in these treatments is especially important because fewer than one-half of veterans receiving care for AUD and PTSD complete their prescribed treatment plans (Flanagan et al., 2018). Research should also compare outcomes for veterans receiving integrated PTSD–AUD treatment in VA with outcomes for those receiving fragmented care in separate settings.

Improving Access to and Retention in Alcohol Use Disorder Treatments

Most veterans who have AUD or report heavy alcohol use do not receive treatment. Telehealth could be one way to improve retention and promote medication management, and thus, research is specifically needed to examine the effectiveness of care that is delivered virtually to optimize digital health solutions for veterans (Kelemen et al., 2022; Uscher-Pines, Lin, and Busch, 2024). Extending the reach of interventions beyond veterans and equipping their partners with the tools to motivate their loved ones to seek care might also increase access to care but needs further research (Osilla et al., 2023).

Testing Alcohol Use Disorder Treatment Among Veteran Subpopulations Who Have Unique Needs

Research on AUD treatment among military populations often includes primarily or solely men, leaving uncertainty about whether the observed benefits would extend to women. Women in the military might adopt drinking behaviors similar to men because of prevailing social norms, which have been linked to the narrowing gender gap in alcohol consumption among nonmilitary populations (Bratberg et al., 2016; Livingston et al., 2018). However, the extent to which gender-specific interventions might be necessary to address alcohol use in military settings remains unclear. Furthermore, because stigma is one of the most significant barriers to alcohol use treatment (Frost et al., 2022; Pietrzak et al., 2009) and many veterans hold beliefs around being self-reliant and maintaining control that could make it difficult for them to seek help (Hitch, Toner, and Armour, 2023), efforts are needed to reduce these barriers to service members seeking treatment. Moreover, qualitative studies exploring veteran-reported barriers to treatment usage and retention, particularly among veterans in rural or underserved areas, could guide policy improvements.

Experimental Research to Treat Alcohol Use Disorder

There are existing treatments for AUD, but there could be more treatment options to better fit the needs of veterans. NIAAA lists six drugs, including topiramate and gabapentin, as not currently approved by FDA for treating AUD but that are promising. Psychedelic agents, such as psilocybin, lysergic acid diethylamide (LSD), and 3,4-Methylenedioxy methamphetamine (MDMA), also are promising (Sicignano et al., 2024; van der Meer et al., 2023). GLP-1 agonists used to treat diabetes and obesity could also help with some symptoms of AUD (Lähteenvuo et al., 2025). Further research to test the effectiveness of these medications among veterans of various identities and co-occurring mental health disorders is warranted to provide additional options for treatment.

Notes

• [1] In contrast, the general U.S. adult population exhibited a past-year prevalence of AUD of 10 percent, although this percentage is not adjusted for age, sex, or other demographic differences between the groups.
• [2] This drinking culture persists, even though there are serious negative consequences to excessive drinking, including an inability to deploy, loss of security clearance, and even receiving a less than honorable discharge.

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• NIAAA—See National Institute on Alcohol Abuse and Alcoholism.
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• SAMHSA—See Substance Abuse and Mental Health Services Administration.
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• VA—See U.S. Department of Veterans Affairs.
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• Williams, Emily C., Melissa A. Frasco, Isabel G. Jacobson, Charles Maynard, Alyson J. Littman, Amber D. Seelig, Nancy F. Crum-Cianflone, Anna Nagel, and Edward J. Boyko, “Risk Factors for Relapse to Problem Drinking Among Current and Former US Military Personnel: A Prospective Study of the Millennium Cohort,” Drug and Alcohol Dependence, Vol. 148, March 2015.
• Williams, Emily C., Shalini Gupta, Anna D. Rubinsky, Joseph E. Glass, Rhonda Jones-Webb, Kara M. Bensley, and Alex H. S. Harris, “Variation in Receipt of Pharmacotherapy for Alcohol Use Disorders Across Racial/Ethnic Groups: A National Study in the U.S. Veterans Health Administration,” Drug and Alcohol Dependence, Vol. 178, September 2017.
• Williams, Emily C., Shalini Gupta, Anna D. Rubinsky, Rhonda Jones‐Webb, Kara M. Bensley, Jessica P. Young, Hildi Hagedorn, Elizabeth Gifford, and Alex H. S. Harris, “Racial/Ethnic Differences in the Prevalence of Clinically Recognized Alcohol Use Disorders Among Patients from the U.S. Veterans Health Administration,” Alcoholism: Clinical and Experimental Research, Vol. 40, No. 2, February 2016.
• Williams, Kayla M., Heather M. Salazar, Carrie M. Farmer, and Rajeev Ramchand, “If Everyone Is Responsible, Then No One Is”: Proceedings from a Roundtable on Factors That Affect Veterans’ Transitions from Military to Civilian Life, RAND Corporation, CF-A1363-3, 2023. As of May 2, 2025:
  https://www.rand.org/pubs/conf_proceedings/CFA1363-3.html
• Wilson, Sayre E., Karla Garcia, Nicole M. Fava, and Robert F. Leeman, “Examining the Relationships Among Adverse Experiences, Impulsivity, and Alcohol Use: A Scoping Review of Recent Literature,” Current Addiction Reports, Vol. 11, March 2024.
• Winnicki, Brittany M. Mathes, Daniel J. Lee, Sage E. Hawn, Nicholas A. Livingston, Brian P. Marx, and Terence M. Keane, “Alcohol Consumption and Dependence Risk Among Male and Female Veterans: Trajectories and Predictors,” Drug and Alcohol Dependence, Vol. 257, April 2024.
• Young, Jessica P., Carol E. Achtmeyer, Kara M. Bensley, Eric J. Hawkins, and Emily C. Williams, “Differences in Perceptions of and Practices Regarding Treatment of Alcohol Use Disorders Among VA Primary Care Providers in Urban and Rural Clinics,” Journal of Rural Health, Vol. 34, No. 4, September 2018.

About the Authors

Veterans' Issues in Focus

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  RAND Epstein Family Veterans Policy Research Institute

  Sep 30, 2025

Topics

• Alcohol
• Health Interventions
• Military Veterans
• Substance Use Disorder Treatment