The Relationship Between Substance Abuse and Post-Traumatic Stress Disorder in Combatants

Relevance. The full-scale invasion of Ukraine by the Russian Federation has led to widespread psychological traumatization of Ukrainian service members and veterans. Post-traumatic stress disorder (PTSD) is one of the most common psychological consequences of combat, and its comorbidity with substance use disorders (SUD) significantly complicates rehabilitation. This dual diagnosis worsens prognosis, increases the risk of premature termination of therapy, and places an additional burden on the mental health care system. In Ukraine, research on this topic remains limited, which highlights the need to systematize data and develop psychotherapeutic intervention models. Objective. To model the psychological factors underlying the comorbidity of PTSD and SUD in combatants, and to formulate hypotheses regarding optimal approaches to psychotherapy and prevention. Methods. A systematic review of international and Ukrainian studies on PTSD–SUD comorbidity was conducted. Additionally, a phenomenological analysis of 116 cases of service members who underwent inpatient medico-psychological rehabilitation at the Kyiv City Crisis Center “Sociotherapy” during 2022–2023 was performed. Results. A significant proportion of patients with PTSD were found to have substance use problems. Alcohol was the most common substance of choice, followed by cannabinoids, with stimulants, synthetic cathinones, and opioids reported less frequently. Substance use was a leading factor in premature termination of treatment. Phenomenological analysis revealed two patient profiles: (a) individuals with premorbid substance dependence, in whom PTSD symptoms were less intrusive and substance use retained a primarily hedonic function, and (b) individuals who initiated substance use after traumatic exposure, for whom reduction of PTSD symptoms directly decreased craving. The main motives for substance use included anxiety reduction, avoidance of traumatic memories, coping with depression, pain management, and sleep regulation. Conclusions. PTSD–SUD comorbidity presents a major challenge for the mental health care system. An integrated approach combining trauma-focused psychotherapy with addiction treatment techniques and targeted work on substance use motives and alternative coping strategies is optimal. Preventive efforts should focus on stress- and anxiety-management training, structured leisure activities, and reducing social pressure to use substances. The findings and hypotheses provide a basis for further empirical research and the development of comprehensive veteran support programs.