Could Number of Deployments Worsen Symptoms?

Eugene Lucas spent about a decade working inside the Department of Veterans Affairs, treating veterans with post-traumatic stress disorder from conflicts spanning Vietnam through Iraq and Afghanistan. In a recent interview with Military.com otherwise focused on emerging GLP-1 research and alcohol use disorder, Lucas, a psychiatric nurse practitioner who is now associate professor and coordinator of the Psychiatric/Mental Health Nurse Practitioner Program at Wilkes University, made a clinical observation that stood apart from the rest of the conversation:

In his experience, the number of times a veteran deployed to a combat zone tracked closely with how much trauma they carried and how likely they were to turn to alcohol or drugs to manage it.

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What He Saw, Era After Era

Lucas described the pattern as consistent across every generation of veteran he treated, not specific to any single war.

“There are still a lot of people coming to the VA from conflicts going back decades,” Lucas said. “Our most recent conflict lasted a long time, and a lot of service members were exposed to multiple deployments, sometimes over a year each. In my experience going back to Vietnam, the people who deployed more than once consistently experienced more trauma and had a greater tendency to self-treat with drugs or alcohol.”

The post-9/11 wars, in particular, produced a specific version of this pattern that earlier conflicts didn’t generate in the same way. Deployment tempo during the height of operations in Iraq and Afghanistan meant a meaningful share of service members deployed multiple times, often with relatively short intervals between tours, a structural feature of those wars distinct from, say, the single-tour norm that shaped much of the Vietnam-era force.

Why That Matters for How Research Gets Targeted

Lucas’s clinical read has a direct implication for where addiction and PTSD research, including the current wave of studies examining GLP-1 medications for alcohol use disorder, should be focused next.

“I think anyone who’s been deployed more than once to a combat zone is a good place to start research,” Lucas said. “Generally speaking, they’ve experienced more trauma than anyone else in that system.”

That’s a meaningfully different framing from how a lot of veteran mental health research gets structured, which more often groups veterans broadly by combat exposure or era of service rather than isolating deployment count itself as a variable. If Lucas’s clinical experience holds up under more formal study, it would suggest that a veteran’s number of deployments is a more precise predictor of both trauma burden and substance use risk than combat exposure treated as a single yes-or-no category.

Related: VA Is Running Multiple Psychedelic Drug Trials for Veterans — With One Shared Goal

What Treatment Already Looks Like for This Group

Lucas described a model from his VA years for veterans in this higher-risk category who are in acute crisis: inpatient stabilization first, in a dedicated substance abuse rehabilitation unit, followed by structured outpatient care.

“We always had a SARB unit, an inpatient alcohol and drug use section, in the VA hospital for people with acute addiction who needed immediate assistance,” Lucas said. “Starting there, observing someone for maybe a week or so while they’re getting support through therapy and medication, that would be a great place to start, and then follow up as an outpatient.”

He was clear that he didn’t view medication alone, including any future role for GLP-1 drugs in this space, as a substitute for trauma-focused therapy for veterans in this category. The model he described from his own clinical practice paired medication with intensive therapy addressing the underlying combat trauma directly, tapering in intensity over time rather than stopping abruptly.

An Open Question Worth Asking

Lucas’s observation comes from clinical experience rather than a formal published study, and he was careful throughout the interview to distinguish between what he’s observed in practice and what’s been rigorously established in research.

Still, it may raise a question for VA researchers and the broader addiction research community: Does a veteran’s number of deployments, independent of combat exposure more broadly, meaningfully predict PTSD severity and substance use risk in a way current screening and treatment protocols don’t fully account for? For a veteran population for whom repeat deployments were common throughout the post-9/11 wars, that’s not an academic question.