The Dual War: Ukraine's Soldiers Battling Addiction Amid Combat
Oleh Olishevskiy leads the rehabilitation programme at a specialised clinic within Kyiv City Clinical Hospital No. 10. Photograph: Julia Kochetova/The Guardian. Troops frequently turn to substances to manage untreated PTSD and anxiety, creating a destructive cycle. By Pjotr Sauer in Kyiv. Photographs by Julia Kochetova.
After seven years of sobriety, Oleksandr thought he had conquered his addiction. However, one year into fighting against Russia, the Ukrainian soldier was prescribed painkillers for a shoulder injury sustained in combat. Under the immense pressure of warfare, he relapsed and rapidly progressed to using stronger illicit opioids.
"From that moment, I was fighting two wars – one inside myself and one with Russia," he revealed, speaking from a rehabilitation facility in Kyiv. Oleksandr continued serving for an additional two years, even advancing to officer rank while his addiction intensified. "I was hiding my use from the others. It's the kind of thing you're ashamed of," he admitted.
Last winter, he reached a critical breaking point. Unable to fulfil his duties, he confessed to his superiors. "Luckily, they were understanding and I was sent to rehabilitation." Oleksandr's relapse into addiction followed treatment for a combat injury. Drug and alcohol abuse have been persistent shadows in every modern conflict. In Ukraine's war, now entering its fifth year, the psychological burden on soldiers has been overwhelming – and for many, addiction has become a devastating consequence.
The Unspoken Crisis in Military Ranks
"Drug use among troops is a grey area," explained Oleh Olishevskiy, who operates the specialised rehabilitation clinic treating addiction alongside psychological trauma since Russia's full-scale invasion began. "Everyone knows it exists, but few want to talk about it."
The true scale of this problem remains difficult to quantify. Ukraine's military does not disclose statistics regarding soldiers dealing with mental health issues, let alone substance abuse disorders. "I don't think we'll ever know the real numbers. No one is keeping track," Olishevskiy stated.
He referenced a 2024 study conducted by the Ukrainian charity 100% Life, which surveyed 1,000 soldiers. The research found that more than one-third had used amphetamines at least once monthly, while one in five reported using prescription medications like pregabalin. Approximately 15% admitted to using inexpensive synthetic cathinones, commonly known as "salt," and various opioids.
At the Kyiv clinic, a modest three-storey building situated in a verdant area of the capital, Olishevskiy and his team treat around 25 patients simultaneously, with treatment programmes lasting up to four months. The ultimate objective is to rehabilitate soldiers sufficiently to enable their return to military service.
Treatment Challenges and Stigma
However, mental health professionals emphasise that the demand for addiction-related care among Ukraine's military personnel significantly exceeds available treatment resources, a situation that will likely persist long after combat concludes. As in numerous other nations, substance abuse remains challenging to discuss openly – particularly among men, and even more so among soldiers.
"The war's scale is unmatched in modern history. And it is not even over; the worst still lies ahead when soldiers return," Olishevskiy warned.
While widespread drug use within the Russian army has been extensively documented in media reports – both at the frontlines and in rear areas, where soldiers face punishments like deployment to high-risk assault units or confinement in pits and cellars – Ukraine is attempting a different approach. Although stigma surrounding drugs persists, medical professionals report that attitudes among commanders are gradually shifting, with increasing numbers of soldiers being referred for treatment.
"There is more understanding now, but much still depends on your superiors," said Petro, a counsellor at the clinic who requested his surname be withheld. "It's getting better," he added. Several rehabilitation staff members, including Petro, are former addicts and servicemen themselves.
The Inseparable Link Between Trauma and Addiction
The clinic's foundational philosophy maintains that addiction and war trauma are fundamentally interconnected. Counsellors assert that drug use can only be properly understood alongside the untreated PTSD and psychological wounds that typically precede substance abuse.
Stimulants are occasionally used by soldiers to maintain alertness during extended duty periods. Yet most patients report that their addiction intensified away from frontline combat, when they returned to base after weeks of fighting and struggled to decompress, turning to drugs or alcohol to numb intrusive memories, manage anxiety, or simply endure sleepless nights.
"I never used it on a mission – you'd get killed quickly. You're already running on adrenaline anyway," explained Dmytro, a Ukrainian soldier speaking in the rehabilitation centre'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."
Dmytro, undergoing rehabilitation for addiction to synthetic stimulants, asked for his name to be altered, fearing Russian forces might exploit his addiction if he were captured. Like others, Dmytro noted that drugs were relatively accessible – ordered through Ukraine's postal service or retrieved from hidden stashes shared via messaging applications.
The substances induced paranoia. He described attaching grenades to his bedroom door in Kramatorsk, an eastern Ukrainian city near the frontline where troops recuperate, convinced Russian forces were preparing an ambush. "I started to lose track of what was real," Dmytro recalled.
Rehabilitation and Recovery Efforts
Within the facility, daily routines for Dmytro and other patients are highly structured, resembling typical rehabilitation centres. Mornings commence with group therapy sessions, followed by individual counselling and physical activities – yoga, light exercise, table tennis. Nevertheless, the war remains ever-present: patient artwork displayed on walls depicts firearms and other combat scenes.
Olishevskiy maintains close communication with specialists in Western countries, incorporating their latest medical research. This summer, he has organised a therapeutic retreat for patients at a horse farm in Kharkiv. His enthusiasm becomes evident when discussing promising trial results using ketamine to treat PTSD.
"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," Olishevskiy emphasised.
"Punishing a soldier at the front by docking his pay will not help treat the underlying issue behind drug use," he added. However, Ukraine's severe manpower shortages create complex dilemmas for Olishevskiy and his staff. Pressure to fill frontline gaps has resulted in some patients returning to service before achieving full recovery.
Complete recovery represents the "ideal scenario," according to Olishevskiy. In practical terms, however, even reducing drug use to levels where soldiers can function effectively may be considered acceptable progress.
Patients and medical personnel also reported that mobilisation officers frequently permit prospective soldiers with existing substance use issues to enlist. "It was obvious to everyone, including the doctors, that I was addicted during my enlistment medical," revealed Anton, who had been using synthetic drugs for six months before joining the army.
He subsequently developed a severe addiction and was hospitalised after suffering a heart attack. Despite this, Anton expressed his desire to recover and return to frontline duties. "This clinic gave me another chance at life. I want to give something back."
