Melissa Walsh

Military and Substance Abuse

Salem Press | 2011 | Salem Health: Addictions & Substance Abuse

Essay title: Military and Substance Abuse Category: Social issues

Definition: The use of alcohol and drugs among military personnel, especially those coping with combat-related trauma, is generally understood among mental health professionals as a way for service men and women to self-medicate. Though alcohol and drugs may bring military personnel short-term relief from the emotional, as well as physical, pain resulting from deployment, helping them cope with the intense feelings of loss and graphic memories of battle, the long-term consequences of alcohol and drug use among servicemen poses a grave threat to the quality of life for personnel and their families, as well as to the morale of armed forces units engaging in wartime activities. The prevalence of alcohol and drug use in the military necessitates the development and implementation of best practices and programs for supporting the emotional state of military personnel to prevent them from turning to alcohol and drug use as a stress coping mechanism.

Alcohol and Drug Use in the Military Mental health disorders are strongly linked to substance abuse. Post-Traumatic Stress Disorder (PTSD) is a medically diagnosed anxiety disorder and believed to be common and under-diagnosed among military servicemen, especially those who have experienced combat. A person with PTSD continually relives in his or her mind a highly traumatic memory. This manifests itself in an involuntary flood of thoughts related to the trauma,, nightmares, or an adrenaline rush or spike of anxiety when visual or audible reminders of the experience appear. Many suffering from PTSD, including military personnel, placate symptoms with the immediate effect of alcohol and drug use. Alcohol and drugs like Marijuana and prescription pain killers slow down brain activity and reduce chronic anxiety during the high.

In the book After the War Zone, the authors recommend that military personnel experiencing PTSD and substance abuse disorders be treated for both conditions at the same time. Explaining the common parallel occurence of both, they wrote, "Some say that substance abuse needs to be dealt with before you can deal with PTSD symptoms. Some say that you need to get treatment for PTSD before you can deal with the substance abuse. Since it's really difficult to disentangle these two conditions, we strongly urge that you seek treatment for both at the same time." PTSD and substance abuse disorders are under-diagnosed among military servicemen. PTSD and substance abuse carry a heavy stigma in the military; if either condition is reported on one's record, the individual cannot continue to pursue a career in defense or law enforcement. Therefore, both disorders are believed to be highly under-reported by servicemen and women and their supervisors. Until PTSD and substance abuse disorders are addressed in a way as not to stigmatize and penalize military personnel, service men and women will likely continue to self-medicate.

The danger in self-mediating is that ironically the method used for short-term relief of the emotional pain − alcohol or drug use − inevitably leads to a worsening emotional condition later. The release of dopamine in the brain triggered by alcohol or drugs results in impairment of emotion-regulation in the brain once the high wears off. According to National Institute on Drug Abuse (NIDA) Director Nora D. Volkow, "Demographic factors and the military's unique organizational structures, culture, and experiences contribute to service members' overall high prevalence of smoking and binge drinking and low prevalence of illicit substance abuse, when compared with civilian rates." According to NIDA studies, tobacco use is 50 percent higher among active military personnel than the general civilian population. Among military personnel, smoking is another 50 percent greater among those who have been deployed. Among those having experienced combat, according to the NIDA, one in four veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) presented symptoms of "a mental or cognitive disorder," and one is six showed signs of PTSD.

Military Alcohol and Drug Use Policy In 2001, the U.S. Army revised Army Regulation (AR) 600-85 (effective 15 October 2001). In addition to changing the name from the Alcohol and Drug Abuse Prevention and Control Program (ADAPCP) to the Army Substance Abuse Program (ASAP), the Army changed the requirements and process for the administration separation of soldiers caught engaging in illegal drug and alcohol use. It also prescribed unannounced random drug-testing and deployment restrictions on soldiers undergoing rehabilitation for substance abuse. The new policy, however, conflicted with active enlisted separations regulations, and commanders were directed to use the latter as their policy for confronting drug and alcohol use among their subordinates. So while the new ASAP regulation directed commanders to initiate separation for first-time offense, the legacy enlisted separations policy prescribed more leniency. This coupled with modern military living arrangements designed to allot soldiers more privacy make standardized enforcement more difficult.

In 2009, an Army Times article brought to light the consequences of commander discretion trumping ASAP regulation. An investigation led by Vice Chief of Staff Gen. Peter Chiarelli found that among all soldiers found to test positive for illegal drug use, only 70 percent were referred to ASAP for treatment. The most common illegal drug found through urine tests was marijuana, followed by cocaine, then other drugs like LSD, methamphetamines, heroin, and illicitly used prescription drugs. Brig. Gen; Colleen McGuire found that among 1,000 soldiers testing positive for drug use, 372 were repeat offenders, none of which had been sent to treatment. Maj. Gen. Anthony Cucolo, who reviews substance abuse cases, said that alcohol use is the most prevalent substance-abuse concern. Commander rejection of a standard separation policy, given the urgent need for retaining soldiers during wartime, compounds the substance-abuse issue and generates a need for case-by-case analysis of each offender's need for treatment and level of readiness to serve.

Substance Abuse Treatment Military Personnel According to Gary A. Enos in a 2010 article in Addiction Professional, increasingly more veterans are seeking treatment at the community level, rather than receiving services through the Department of Veterans Affairs (VA). There is a degree of distrust in relying on the government to treat their condition. Any diagnosis or treatment given via the VA will show up on the serviceman's record. Knowing the military personnel are more inclined to seek help outside the military structure, the VA is seeking to partner with community resources. Treatment strategies include 12-step therapies, "stop, think, "act" impulse control programs, and "soldiers helping soldiers" programs, where soldiers are trained to help their peers in dealing with combat-related stress. According to a June 2010 poll by Addiction Professional, more than 90 percent of respondents felt that there is a shortage of community-based assistance for returning veterans, many citing the lack of PTSD treatment.

Outlook on Intervention and Rehabilitation Specialists in the mental health and military professions agree that there ought to be more investigation into how better to support military personnel emotionally during deployment and once they return home. Though a recognition of the emotional realities, including depression, anxiety disorders, and substance abuse is pervasive, more needs to be understood about wartime stress on military personnel and their families to develop techniques for early intervention and treatment. In July of 2010, U.S. National Institutes of Health (NIH) announced the approval of $6 million in federal funding to support research by institutions in 11 states specializing in substance abuse among military personnel, veterans, and their families. The National Institute on Drug Abuse (NIDA) partnered with the Department of Veterans Affairs to award the grants earmarked for investigating the links between deployment and combat-related trauma to the prevalence of substance abuse, mainly among veterans returning from the wars in Iraq and Afghanistan.

Melissa Walsh

Further Reading

"Army Substance Abuse Program." Army Lawyer (2002): 51.

Cavallaro, Gina. "Army Cracks Down as Drug, Alcohol Cases Rise." Army Times (June 8, 2009).

Enos, Gary A. "Doing Whatever It Takes: Treatment Programs Try to Employ a Full Arsenal to Meet the Complex Needs of Veterans." Addiction Professional (2010): 16.

"Studies on Combat-Related Substance Use and Abuse to be Funded by NIH and VA." Defense and Aerospace Week (Sept. 2010): 142.

Slone, Laurie B. and Matthew J. Friedman. After the War Zone. DeCapo Press, 2008, 175-82. Experts from the VA National Center for PTSD offer guidance to service members and their families for dealing with deployment- and combat-related stress issues.

Volkow, Nora D. "Substance Abuse Among Troops, Veterans, and Their Families." NIDA Notes (Dec. 2009): 2.

Web Sites of Interest American Council for Drug Education

National Institute on Drug Abuse

Not Alone

Substance Abuse and Mental Health Services Administration (SAMHSA)