Broken Spirits: Confronting Addiction, Stigma, and the Path to Recovery in Ukraine
Substance use disorders are a global emergency, undermining health, society, and security. We call for urgent, integrated action combining medical care, mental health support, and long-term recovery programs.
Substance use disorders (SUDs) are one of the world’s most persistent and overlooked mental health crises, claiming millions of lives, destabilising families and communities, and placing enormous strain on health, social, and economic systems worldwide. More than 300 million people currently live with SUDs, facing direct harms from substance use as well as a complex mix of mental and physical health problems, with ripple effects on social stability and economic wellbeing (WHO, UNODC).
At an individual level, SUDs are deeply entangled with other mental and physical health conditions. People with SUDs frequently suffer from depression, anxiety, or trauma-related disorders. Conversely, people with severe mental illness have higher rates of harmful substance use. This mutually reinforcing cycle worsens both conditions. Physically, addiction damages multiple organs, spreads infectious diseases like HIV and hepatitis, and aggravates chronic illnesses such as diabetes and heart disease.
The societal cost is equally severe. SUDs destabilise families, contributing to domestic violence, child neglect, and intergenerational trauma. They disrupt communities, increasing crime, unemployment, and homelessness. They burden public systems — from healthcare and welfare to criminal justice — and undermine national security by eroding workforce productivity, military readiness, and the bonds that sustain societal cohesion.
Thus, SUDs rarely exist alone — they come with mental, physical, and social complications.
Perhaps the most devastating effect is their intergenerational toll. Children of parents with SUDs face the highest risk — higher than any other group of children with mentally ill parents — of developing mental health disorders themselves. Genetic vulnerability, environmental instability, and learned behavioural patterns combine to lock these risks into the next generation.
Yet, despite their enormous and multi-faceted toll, SUDs remain among the most stigmatised conditions in both mental and physical health policy and care. For centuries, addiction was treated as a moral failing or criminal behaviour rather than a health condition. This legacy still shapes laws, funding priorities, and public attitudes — keeping SUDs in the realm of punishment rather than treatment. Even within mental health stigma, there is a hierarchy: depression and anxiety attract sympathy and advocacy, while addiction is often seen as “self-inflicted” and less deserving of resources. Treatment for addiction remains siloed in many health systems, often placed outside general psychiatry and physical healthcare. This fragmentation makes integrated care harder, keeps SUDs off broader health agendas, and allows law enforcement-led drug policy to dominate over health-based approaches.
In times of war, the burden of SUDs deepens. War fuels substance use through trauma, displacement, and breakdown of services, while simultaneously weakening the health and social systems needed to respond. The result is a dangerous feedback loop: the conditions of war worsen addiction, and widespread addiction in turn undermines recovery, resilience, and security.
In Ukraine, rates of alcohol and drug addiction, mainly opioids, were already high before the war began in 2022. Yet, access to evidence-based treatment such as opioid agonist therapy (methadone and buprenorphine) remained limited. Alcohol use, particularly among men, has long been a major concern, with alcohol being the most commonly used and socially accepted substance. High-risk drinking patterns, including binge drinking, have historically been prevalent, especially in rural and industrial regions.
Prolonged conflict, economic disruption, and psychological strain are driving rising substance use and addiction, with grave implications for both public health and national stability.
Substance use patterns have shifted and diversified in Ukraine. Military personnel and veterans, under extreme stress and trauma, increasingly turn to alcohol and other substances – as self-medication, stress and pain relief. Among civilians, especially displaced or unemployed men, alcohol use has surged. Young people, facing uncertainty and disruption to education and employment, are more vulnerable to risky substance use. People with pre-existing mental health conditions, survivors of violence, and those who inject drugs face compounded risks, as instability, inadequate services, and stigma limit their access to care. Internally displaced persons confront multiple stressors – housing insecurity, fractured support networks, and exposure to trauma – that heighten vulnerability across all forms of addiction.
This creates a multilayered vulnerability. Addiction not only harms individuals and families – it undermines military readiness, weakens civic institutions, drains the national workforce, and impairs Ukraine’s long-term capacity to recover and rebuild. It is not simply a public health issue. It is a security issue. It is a resilience issue.
Ukraine’s mental health response must include the full integration of addiction treatment into broader mental and physical healthcare structures. This means interdisciplinary care teams, shared data systems, and unified treatment plans that follow patients across settings.
Effective integrated addiction treatment does not end at discharge. Continuing care is essential. In fact, the period after inpatient treatment is one of the most critical stages of recovery. Without sustained social support, relapse is common – especially if they return to the same social environments that contributed to their substance use.
Recovery is highly sensitive to social context. It depends on where people live, who they interact with, whether they have stable housing or employment, and whether they feel socially connected. It is also shaped by stigma: if individuals feel ashamed or judged, they are less likely to seek continued care or disclose setbacks.
Continuing care includes case management, peer-led recovery networks, family counselling, and structured reintegration pathways. Recovery is not just a medical process – it is a social one. And without long-term, community-based support, even the best clinical interventions will fall short.
Stigma continues to silence those most in need. Fragmented services leave patients without coherent paths to recovery. And the absence of integrated, long-term care threatens not only individual wellbeing, but national resilience.
If Ukraine is to recover, rebuild, and thrive, its mental health system must integrate the de-stigmatisation, prevention and care of addiction. And if the global community is serious about supporting that recovery, it must treat SUDs as what they are: a public health emergency, a social justice issue, and a security imperative.
A companion piece to this post can be read here.
Robert Schuett is co-founder and managing partner at STK Powerhouse, a global risk advisory firm. A former Defence civil servant, he also serves as Chairman of the Austrian Political Science Association and is a long-standing Honorary Fellow at Durham University.
Viktoriya Teliha is co-founder at STK Powerhouse, a global risk advisory firm. She holds degrees in Politics from the University of Vienna and the Diplomatic Academy of Vienna, and has previously served in the Ukrainian diplomatic service in Paris and Vienna.
Susanne Schuett is a senior executive at a Viennese outpatient mental health clinic. A psychologist by training, she holds the habilitation (venia docendi) in psychiatry from the Medical University of Vienna and serves on the advisory board of STK Powerhouse.
Mykhaylo Pustovoyt is Professor and Head of the Department of Psychiatry, Narcology and Medical Psychology at the Ivano Frankivsk National Medical University. For his major contributions to psychiatric reform he was awarded the Merited Figure of Science and Technology of Ukraine.
Photo by Anna Stepko
