The association between PTSD and alcohol misuse is well-established, but there is still a paucity of data to support a link between PTSD and drug misuse. The causal relationship between combat related PTSD and substance misuse is thought to be a combination of shared risk factors and self-medication of symptoms. The author uses her experience of 14 years service in the Army to explore whether the military environment is protective and facilitative for substance misuse.

Compulsory drugs testing in the UK Armed Forces creates a protective environment for drug misuse, with lower rates than the civilian population. However, service personnel discharged for illicit drug use could be at greater risk of dependence due to the sudden loss of earnings, accommodation and support networks.

Screening for substance misuse post-deployment is not currently undertaken in the UK, but a trial is currently underway by KCMHR. The US have found limitations in screening for substance misuse in the decompression period as individuals have not had access to alcohol or drugs for the duration of the deployment. There may also be limitations to a screening programme in service personnel reluctant to admit problems to a uniform-clad military medical practitioner.