Abstract
The problem of mental and behavioral disorders caused by psychoactive substance (PAS) use in the context of war represents a complex biopsychosocial phenomenon shaped by chronic traumatic stress, impaired psychological adaptation, social disintegration, changes in substance availability, and limited rehabilitation pathways. Under conditions of full-scale war in Ukraine, the risk of maladaptive stress-coping strategies, including psychoactive substance use, has significantly increased. This issue is especially relevant regarding cannabinoids (F12), stimulants (F15), and multiple substance use (F19), as the contemporary illicit drug market is characterized by a growing prevalence of synthetic substances, combined use patterns, and unpredictable psychopathological consequences. The study of clinical, psychopathological, and psychosocial features of these disorders under wartime conditions is essential for improving diagnosis, treatment, and rehabilitation.
Objective
To analyze current international and Ukrainian scientific approaches to understanding mental and behavioral disorders due to psychoactive substance use during wartime and to identify the key clinical, psychopathological, psychosocial, and rehabilitation-related aspects of this problem.
Methods
Bibliographic-semantic, analytical, comparative, and systemic research methods were used. A theoretical analysis of contemporary international and Ukrainian scientific publications, clinical guidelines, epidemiological reports, and regulatory documents on substance use disorders, comorbid post-traumatic stress disorder (PTSD), anxiety-depressive disorders, and rehabilitation approaches was conducted.
Results
The literature analysis demonstrated that wartime conditions increase the risk of developing mental and behavioral disorders associated with psychoactive substance use as a maladaptive mechanism for emotional regulation and stress reduction. Cannabinoid- and stimulant-related disorders were found to have specific clinical and psychopathological mechanisms distinct from traditional alcohol dependence models. Cannabinoid-related disorders are characterized by a high level of comorbidity with anxiety, depressive, and post-traumatic disorders. Stimulant-related disorders are associated with affective instability, exhaustion, anxiety, impaired impulse control, and psychotic symptoms. Multiple substance use is linked to a more severe course of psychological maladaptation, greater social dysfunction, and a poorer rehabilitation prognosis. Contemporary integrated therapeutic approaches have demonstrated greater effectiveness compared to sequential treatment models.
Discussion
The findings support the concept of reciprocal reinforcement between traumatic experience and substance use disorders. War-related stress acts not only as a trigger for substance initiation but also as a factor contributing to dependence progression, relapse, and treatment resistance. The growing prevalence of synthetic psychoactive substances in Ukraine during wartime adds additional clinical complexity. This requires reconsideration of diagnostic approaches with a stronger focus on early identification of comorbid psychopathological conditions, functional impairment, resilience, social support, and motivation for change. The implementation of comprehensive rehabilitation models integrating mental health care, addiction treatment, trauma-focused interventions, and social reintegration is of particular importance.
Conclusions
War is a powerful predictor of the increasing prevalence of mental and behavioral disorders due to psychoactive substance use. Cannabinoid-, stimulant-, and multiple substance-related disorders currently represent the most clinically significant forms in wartime settings. Their course is characterized by high comorbidity with anxiety, depressive, and post-traumatic disorders, severe psychological maladaptation, and impaired social functioning. The development of integrated medical and psychological rehabilitation programs adapted to wartime conditions is a promising direction for improving treatment outcomes.