The drug numbs that part. And then it becomes a problem.
Soldiers use drugs to manage pain, suppress fear, and endure combat conditions, with an estimated 50% of frontline troops experiencing some drug use. Lack of mental health support, inadequate rotation systems, and untreated PTSD drive soldiers toward self-medication with methadone and amphetamines.
- Estimated 50% of frontline troops have experienced some form of drug use
- Five years of continuous combat with minimal rotation or mental health support
- Families of soldiers killed in combat lose state compensation if drugs are found in autopsies
- Substance dependence support only recently added to Ukrainian veteran strategy as pilot program
Ukrainian and Russian soldiers increasingly rely on stimulants and opioids to cope with combat trauma, with substance dependence becoming a widespread but neglected crisis as the war enters its fifth year.
Five years into the war, Ukrainian and Russian soldiers are turning to drugs not as a luxury or escape, but as a tool for survival. They use stimulants to stay awake through endless shifts at the front. They use opioids to dull pain from wounds that won't heal properly. They use whatever they can find to suppress the fear that comes with knowing the next moment might kill them. The drugs work, in a way. And then they don't.
Dmytro is a Ukrainian officer who has lived through this cycle. He was hit in the arm during combat and given painkillers in the hospital. When he was discharged, the absence of those drugs felt like falling. He returned to his unit and the feeling didn't improve. So he found Prinagolin, another painkiller. Then methadone, which circulated quietly among the troops under his command. He knew what it was. He knew the risks. He took two pills, then three, then lost count of how many. "I reached a point where I couldn't control myself anymore," he says now, in recovery.
Stanislav served in the Ukrainian counteroffensive in Zaporizhzhia from 2023 to 2024. He started with alcohol during training, moved to amphetamines, and eventually to methadone. The drugs created a distance between him and what he had seen—the severed limbs, the smell, the constant noise of dying. Two years ago he deserted his unit. He has been hiding ever since, trying to rebuild a life without the substances that kept him functional but destroyed everything else. "When you're on methadone, you can forget a little," he explains. "It's not that you gain strength. It's that you can distance yourself from the horrors and the constant anxiety."
This is not new. Nazi Germany distributed millions of methamphetamine tablets to troops during World War II. The United States military supplied stimulants to soldiers for decades—through World War II, Afghanistan, Iraq. During Vietnam, as many as 15 percent of American soldiers used heroin, not to enhance performance but to survive the psychological weight of what they were doing. What is different now is the scale, the duration, and the near-total absence of a plan to manage it.
Ukraine has been rotating soldiers minimally. Many have been at the front since the full-scale invasion began in 2022. There is no systematic rest, no mandatory rotation home, no structured mental health support waiting for them. The result is that soldiers—many of them relatively young—are reaching for both stimulants and opioids in roughly equal measure. Ihor Alferow is a psychotherapist with more than two decades of experience treating substance dependence. He also serves as a military chaplain, working directly with troops struggling with drug use. "In recent history, no army has fought for four years without rotation," he says. "These people come back with altered brain chemistry. And they don't care about anything anymore—not family, not home, not work, not career. The drug numbs that part. And then it becomes a problem."
The immediate cause is trauma layered upon trauma. Soldiers with multiple combat injuries develop severe pain syndromes that standard medications cannot touch. They also develop post-traumatic stress disorder, anxiety, and depression—conditions that require a combination of medical care, medication, and psychotherapy. None of that is reliably available. According to Health Solutions, an organization researching drug use in military and civilian populations, an estimated 50 percent of frontline troops have had some experience with drug use, often mixing alcohol with other substances. The organization's executive director, Victoriia Tymoshevska, notes that even soldiers who are severely wounded, hospitalized, and treated continue to experience poorly controlled pain alongside PTSD and other psychological conditions that demand integrated care they are not receiving.
The military's informal approach is to tolerate drug use as long as it does not interfere with a soldier's ability to fight. If you show up, complete your missions, and function in combat, the use is overlooked. But this creates a trap. The drugs that allow soldiers to continue fighting are the same drugs that will follow them home, embedded in their altered neurobiology. There are almost no rehabilitation services waiting for them in civilian life. There are no spaces where veterans can gather, no psychologists offering reintegration support, no museums or parks or community structures designed to help them rebuild. Only recently has the Ukrainian government begun to include substance dependence support in its veteran strategy, and only as a pilot program.
Meanwhile, drug use remains officially forbidden in the armed forces. Soldiers caught using face severe punishment. If drugs are found in the body of a soldier killed in combat, his family loses state compensation. Dmytro, now in recovery, points to the gap that will define the post-war years: "There are no places where veterans can go, no time to spend together, no psychologists working to offer rehabilitation services." The war created the need. The war is ending the ability to meet it.
Citas Notables
When you're on methadone, you can forget a little. It's not that you gain strength. It's that you can distance yourself from the horrors and the constant anxiety.— Stanislav, Ukrainian soldier who deserted after developing opioid dependence
In recent history, no army has fought for four years without rotation. These people come back with altered brain chemistry. And they don't care about anything anymore—not family, not home, not work, not career.— Ihor Alferow, military chaplain and psychotherapist
La Conversación del Hearth Otra perspectiva de la historia
Why do soldiers turn to drugs specifically, rather than just enduring the pain and fear?
Because endurance has a limit, and the human body reaches it. Pain that doesn't respond to normal medicine becomes unbearable. Fear that never stops becomes a kind of drowning. Drugs interrupt that. They don't solve it—they just create enough distance that a person can function for another day.
But surely the military knows this is happening. Why not just provide better mental health care from the start?
They do know. But mental health care requires time, trained personnel, and a willingness to rotate soldiers out of combat. Ukraine doesn't have the luxury of that. They're fighting for survival. A soldier on methadone who can still shoot is more valuable to them right now than a soldier in therapy who can't.
So the military is essentially choosing addiction over defeat?
Not consciously. But yes, functionally. The informal rule is: as long as you can fight, we don't ask questions. It's a bargain that works for the war but destroys the person.
What happens when the war ends?
That's the question no one has answered. These soldiers will come home with altered brain chemistry, no support system, and a dependence that kept them alive but will keep them isolated. The war will be over, but the damage will be just beginning.
Is there any precedent for this?
Vietnam. Fifteen percent of American soldiers used heroin there. Many came home addicted. The country wasn't prepared then either. Ukraine is watching that history repeat, and still not preparing.