Seven years clean, Oleksandr believed he had left addiction behind. Then, a year into fighting Russia, the Ukrainian soldier was prescribed painkillers for a shoulder injury. Under the strain of war, he relapsed and quickly began using stronger illicit opioids.
“From that moment, I was fighting two wars – one inside myself and one with Russia,” he said, speaking at a rehabilitation facility in Kyiv.
Oleksandr continued to serve for another two years, rising to the rank of officer even as his addiction deepened. “I was hiding my use from the others. It’s the kind of thing you’re ashamed of,” he said.
Last winter, he reached a breaking point. Unable to perform his duties, he came clean to his superiors. “Luckily, they were understanding and I was sent to rehabilitation.”
Combat Trauma, Addiction and a Military Under Strain
Drug and alcohol abuse have shadowed every modern conflict. In Ukraine’s war, now in its fifth year, the psychological toll on soldiers has been immense – and for some, addiction has followed. For a country whose political leadership has anchored its future in a pro‑European path and closer alignment with Western standards of military professionalism, the quiet spread of substance use within the ranks raises uncomfortable questions for commanders and policymakers as well as clinicians.
From a public health perspective, this represents a critical challenge in dual diagnosis, where substance use disorders (SUD) coexist with post-traumatic stress disorder (PTSD), complicating both treatment and recovery. It also intersects with defence policy: how an army at war manages, rehabilitates or quietly cycles out addicted personnel is increasingly a matter of governance rather than only medical ethics.
“Drug use among troops is a grey area,” said Oleh Olishevskiy, who runs a specialised rehabilitation clinic at Kyiv City Clinical hospital No 10, treating addiction alongside psychological trauma since the start of Russia’s full-scale invasion. “Everyone knows it exists, but few want to talk about it.”
The relationship between combat stress and addiction is often cyclical. Stimulants are sometimes used to stay awake during long stretches of duty. However, the most acute risks often emerge during periods of respite. Most patients say their addiction worsened away from the front, when they returned to base after weeks of fighting and struggled to unwind, turning to drugs or alcohol to blunt intrusive memories, manage anxiety or simply get through the night.
“I never used it on a mission – you’d get killed quickly. You’re already running on adrenaline anyway,” said Dmytro, a Ukrainian soldier, speaking in the rehab’s cafeteria over a bowl of soup. “When you’re back, you just want to switch off. Forget everything you’ve seen – all the death and other shit.”
Epidemiological Patterns in a Closed Military System
The scale of the problem is difficult to quantify because Ukraine’s military does not disclose how many soldiers are dealing with mental health problems, let alone addiction. The country’s broader health statistics were already patchy before the full‑scale invasion, and wartime secrecy has added another layer of opacity. “I don’t think we’ll ever know the real numbers. No one is keeping track,” Olishevskiy said.
However, targeted data provides a snapshot of the substances most prevalent among those serving. A 2024 study of 1,000 soldiers highlighted a significant reliance on both illicit stimulants and prescription medications to manage the rigors of war. While not representative of the entire armed forces, the survey offers a rare glimpse into patterns that frontline medics and commanders are forced to manage informally and largely out of public view.
| Substance Category | Reported Prevalence | Common Usage Context |
|---|---|---|
| Amphetamines | Over 33% (at least monthly) | Alertness and endurance during duty |
| Prescription Drugs (e.g., pregabalin) | Approximately 20% | Anxiety management and sleep |
| Synthetic Cathinones (“Salt”) & Opioids | Approximately 15% | Severe escapism and pain management |
The availability of these substances is exacerbated by modern logistics. Dmytro, who was undergoing rehabilitation for an addiction to synthetic stimulants, noted that drugs were relatively easy to obtain – ordered through the Ukrainian post service or collected from hidden stashes shared through messaging apps. In practice, this means that even units deployed far from major cities are still exposed to the same online drug markets that were expanding in Ukraine well before the invasion.
Clinical Infrastructure and Wartime Trade-offs
At the Kyiv clinic, Olishevskiy and his team treat about 25 patients at a time, with stays of up to four months. The facility employs a structured regimen of group therapy, individual sessions, and physical activities such as yoga and table tennis. Some staff, including a counsellor named Petro, are former addicts and servicemen themselves, grounding the treatment in shared experience and a soldier’s sense of credibility.
The clinical philosophy is built on the premise that addiction and war trauma are inseparable. “If trauma isn’t processed and someone copes through drugs or alcohol, within months you can have severe PTSD that becomes much harder to treat,” said Olishevskiy.
However, the healthcare system is under immense pressure. Ukraine’s acute manpower shortages create difficult trade-offs. Pressure to fill gaps has led to some patients being sent back to service before fully recovering. In theory, military medical protocols are supposed to balance fitness to serve against the duty of care to wounded or ill personnel, but in practice those decisions are being made in the context of daily shelling and rotating frontlines.
While complete recovery is the “ideal scenario,” Olishevskiy admitted that in practice, even reducing drug use to a level where they can function may be considered good enough. For commanders stretched thin, that often means quietly accepting partial sobriety as the price of keeping experienced soldiers in uniform.
Institutional Stigma, Screening Failures and Policy Blind Spots
Substance abuse remains a taboo subject, particularly for men in military roles. In the Russian army, drug use has been widely reported, often met with punitive measures such as deployment to high-risk assault units. In contrast, Ukraine is attempting to shift toward a medicalized approach, though progress is inconsistent and frequently dependent on the attitude of local commanders rather than uniform policy.
“There is more understanding now, but much still depends on your superiors,” said Petro. “It’s getting better.”
A significant regulatory failure occurs at the point of entry. Mobilisation officers and medical examiners often overlook existing addictions during the enlistment process, effectively importing pre-existing public health crises into the military structure. In principle, medical commissions are supposed to apply Ukraine’s official schedule of fitness categories under the Law of Ukraine on Military Duty and Military Service, which sets the framework for who can be called up and in what capacity. In practice, several soldiers and clinicians describe a system under such pressure to fill ranks that obvious red flags are brushed aside.
Anton, who had been using synthetic drugs for six months before joining the army, noted, “It was obvious to everyone, including the doctors, that I was addicted during my enlistment medical.”
This lack of stringent screening can lead to catastrophic health outcomes. Anton later developed a severe addiction and was sent to hospital after suffering a heart attack. Despite this, he expressed a desire to return to the frontlines, stating, “This clinic gave me another chance at life. I want to give something back.” His story illustrates how, for many soldiers, the pull of duty and the social pressure to keep serving can outrun both medical advice and any fragile early recovery.
Long-term Public Health Risks and the Policy Horizon
The current crisis suggests a looming mental health emergency that will persist long after active hostilities cease. The prevalence of synthetic cathinones and other potent stimulants introduces risks of long-term neurological damage and chronic psychosis. Dmytro described the severity of this shift, recalling how he strapped grenades to his bedroom door in Kramatorsk, convinced he was being ambushed. “I started to lose track of what was real,” he recalled.
Medical professionals warn that punishing soldiers for substance use ignores the biological and psychological drivers of addiction. “Punishing a soldier at the front by docking his pay will not help treat the underlying issue behind drug use,” Olishevskiy said. For policymakers in Kyiv, the choice is increasingly stark: either build a coherent system of prevention, early intervention and rehabilitation, or absorb the long-term social and economic costs of a large cohort of traumatised veterans cycling through underfunded civilian services.
As Ukraine continues to navigate its manpower crisis, the tension between immediate military necessity and the long-term health of its veteran population remains a critical policy challenge. The need for addiction-related care far exceeds current capacity, suggesting that the psychological wounds of the conflict will require a systemic, decades-long healthcare response. How the state chooses to integrate frontline experience into postwar mental health, employment and veterans’ policy will shape not only individual recoveries, but the country’s broader attempt to rebuild after years of total war.
