Substance Abuse in the Army

Key Takeaways

• Substance use in the army is a significant challenge, with service members at a heightened risk after deployment.
• Substance Use Disorder (SUD) affects daily functioning and involves substances like alcohol, nicotine, and illicit drugs.
• Stigma within the military community contributes to low referral rates to treatment services despite high comorbidity with PTSD.
• Alcohol misuse in the army impacts unit cohesion and operational readiness, with a culture that often romanticizes drinking.
• Illicit drugs and prescription medication misuse pose threats to service members’ health and careers.
• Stress, military culture, and environmental stressors are key factors contributing to substance use among army personnel.
• There is a strong correlation between PTSD and substance use, requiring integrated treatment approaches.
• Military policies aim to prevent substance misuse and enhance combat readiness through education and treatment.
• Challenges remain in addressing substance use, including stigma and the need for continuous program evaluation.
• Enhancing prevention and treatment requires comprehensive strategies, including educational campaigns and evidence-based interventions.

What Is Substance Abuse in the Army?

Substance abuse in the army involves the misuse of alcohol, nicotine, and illicit drugs, posing health risks and impacting military readiness. Service members face increased vulnerability post-deployment, exacerbated by stigma around seeking treatment for comorbid conditions like PTSD. Alcohol misuse affects unit cohesion, while stress and military culture contribute to substance use. Military policies aim to prevent misuse through education and treatment, but challenges remain, including stigma and the need for effective program evaluation and intervention strategies.

Substance Abuse in the Army

Substance use within army ranks poses a significant challenge, with service members facing a heightened risk of developing substance use disorders (SUDs), particularly after deployment to combat zones.

Deployment and Substance Use Disorders

• Individuals deployed to conflicts in Iraq and Afghanistan are 1.36 times more likely to develop an alcohol use disorder and 1.14 times more likely to develop a drug use disorder than their non-deployed counterparts.
• 44% of returning service members report difficulties, including problematic substance use.
• Reserve and National Guard personnel also experience post-deployment increases in substance use problems.

Stigma and Referral Rates

• There is a notable gap in referral rates to treatment services, often due to stigma within the military community.
• High comorbidity of SUDs with post-traumatic stress disorder (PTSD) necessitates integrated treatment approaches, as emphasized by the Department of Defense.

Contributing Factors

• Military culture and environmental stressors, such as reintegration challenges, contribute to substance use in the army.
• The 2015 Health Related Behaviors Survey (HRBS) reported that close to 14% of service members were current cigarette smokers, with a significant number starting to smoke after enlisting.

Financial Implications

• Tobacco use costs the Veterans Health Administration an estimated $2.7 billion annually.
• Alcohol remains the most frequently misused substance, with 65% of veterans entering treatment programs reporting it as their substance of choice.

Efforts and Challenges

• Efforts to address substance use include smoking cessation programs and policies like the prohibition of tobacco use in medical facilities.
• Persistent rise in prescription pain medication prescriptions and challenges associated with chronic pain management among veterans highlight the need for continued research and development of targeted prevention and treatment strategies.

Prevalence and Consequences: Examining Alcohol Abuse in the Army

Alcohol misuse within the army is a significant concern, affecting not only individual service members but also unit cohesion and operational readiness.

Prevalence and Impact

• Alcohol misuse persists across the army, with damaging effects on behavior, health, and unit morale.
• Data from the  Defense Centers for Public Health-Aberdeen indicates that up to 50% of suicides, sexual assaults, and incidents of intimate personal violence in the army are alcohol-related.
• The 2018 Department of Defense Health Related Behaviors Survey found that 34% of service members engaged in binge drinking, with 9.8% drinking heavily.

Characteristics and Consequences

• Alcoholism poses a threat to ethical standards and readiness required for the army’s mission.
• Army Regulation 600–85 emphasizes that alcohol use is inconsistent with army values and necessary standards for performance and discipline.
• The culture of alcohol in the military, often romanticized, contributes to problematic drinking behaviors.
• The Northern Hub for Veterans and Military Families Research highlights the role of military characteristics, deployment consequences, mental health implications, and cultural and social factors in alcohol use among service members.

Efforts and Challenges

• Efforts to address alcohol misuse include annual screenings and treatment programs.
• Challenges such as untimely screenings and stigma associated with seeking help persist.
• RAND Corporation discusses the serious threat excessive alcohol use poses to force readiness, emphasizing the need for ongoing attention to this issue.
• A multifaceted approach that includes prevention, early intervention, and treatment, coupled with a shift in cultural attitudes towards drinking, is essential.

Challenges: Substance Abuse in the Army

The issue of drug use within the Army is a significant concern, with both illicit drugs and prescription medication misuse posing threats to the health, career, and well-being of service members.

Drug Use and National Security

• The Department of Homeland Security (DHS) has identified illegal drugs, particularly fentanyl, as one of the top national security threats for 2024, correlating with a spike in overdose deaths surpassing 100,000 in the previous year.
• The Pentagon has reported a doubling in military deaths involving fentanyl from 2017 to 2021, reflecting a national trend as the drug proliferates across the country.

Service Members at Risk

• Service members with combat deployment experience exhibit higher rates of SUD diagnoses compared to civilian populations.
• Despite this, referral rates to SUD treatment services remain low, often due to stigma associated with substance use within military culture.

Educational Campaigns and Policies

• The Department of Defense (DOD) has implemented educational campaigns like ‘Too Much To Lose’ and ‘YouCanQuit2’ to inform service members about the risks associated with drug misuse and promote responsible drinking.
• New policies require the Pentagon to compile data on overdoses and provide access to opioid overdose antidotes like naloxone to troops.
• The Army has introduced an improved drug testing collection system to enhance its drug testing program.

These efforts signify a concerted effort to combat substance use and enhance the readiness and resilience of the armed forces.

Contributing Factors: Substance Abuse Among Army Personnel

Substance use within army ranks is a multifaceted issue influenced by various factors.

PTSD

• PTSD is a prevalent mental health condition among army veterans and active-duty soldiers, triggered by experiencing or witnessing traumatic events.
• The high-stress environment of military service, combined with exposure to combat, increases the risk of PTSD.
• Substance use often becomes a coping mechanism for individuals with PTSD, leading to a vicious cycle where substance use exacerbates PTSD symptoms.
• The self-medication hypothesis suggests that army personnel may use alcohol or drugs to alleviate distressing symptoms of PTSD such as anxiety, insomnia, and flashbacks.
• Studies indicate a strong correlation between PTSD and increased rates of substance use among army members.
  • Example: A National Institutes of Health study found military personnel with PTSD significantly more likely to experience alcohol and drug use issues.
• Effective treatment requires an integrated approach that tackles both PTSD and substance use concurrently.
• Understanding the interplay between PTSD and substance use is essential for developing targeted interventions and support systems within the army.

Military Culture

• Military culture emphasizes values such as discipline, loyalty, and self-sufficiency, impacting attitudes and behaviors toward substance use and seeking help for addiction.
• Historical norms in the military often associate drinking with camaraderie and stress coping, leading to higher alcohol use prevalence.
• These cultural aspects can contribute to the stigmatization of substance use and mental health issues, making it challenging for individuals to seek treatment.
• Initiatives to reduce stigma and encourage help-seeking behaviors include:
  • Real Warriors Campaign
  • Combat Operational Stress Control programs
• Despite these efforts, significant challenges remain:
  • Many service members and veterans still perceive seeking help as a sign of weakness, worsened by values of self-reliance.
• Transitioning from active duty to civilian life increases the risk of SUDs.
  • Co-occurring mental health disorders like PTSD, depression, and anxiety are prevalent among veterans with SUDs.
• The Department of Defense advocates for evidence-based practices and trauma-informed care interventions addressing both PTSD and SUD symptoms concurrently.
• Changing the military culture to promote mental well-being and normalize seeking help for substance use requires:
  • Ongoing education and leadership training
  • Developing trust in the therapeutic relationship
  • Maintaining the core values that define military service.

Substance use within army ranks is a multifaceted issue influenced by various factors. 

Consequences: Substance Abuse on Army Personnel and Military Operations

The impact of substance use within the Army is profound and multifaceted, affecting personnel health, unit cohesion, and the overall readiness of military operations.

Physical Health Consequences

• Alcohol Misuse:
  • Short-term effects include increased stress on the body and internal organs, leading to fatal injuries, drownings, and assaults.
  • Long-term use causes chronic damage to vital organs and increases the risk of death from various causes.
  • Linked to physical health comorbidities, requiring integrated treatment approaches.
• Other Substances:
  • Tobacco, heroin, and methamphetamine are associated with cardiovascular problems.
  • Injection drug use carries risks such as overdose and infectious diseases.
  • Respiratory issues range from infections to respiratory depression and death.
  • Increased risks for diseases such as cancer, heart disease, and HIV.

Mental Health Consequences

• Exacerbation of Mental Health Conditions:
  • Substance use can worsen existing conditions like depression and anxiety.
  • The self-medication hypothesis suggests substances are used to cope with stress, trauma, and combat exposure.
• PTSD and Substance Use:
  • Strong correlation between PTSD and increased substance use.
  • Requires integrated treatment addressing both PTSD and substance use concurrently.
• Veterans’ Challenges:
  • Transition to civilian life can lead to persistent substance use.
  • Substance use impairs mental health and social functioning.

Career Consequences

• Disciplinary Actions:
  • Range from mandatory treatment programs to administrative separation from military service.
  • Alcohol misuse linked to misconduct, crimes, and suicidal behaviors.
• Impact on Career Progression:
  • Substance use can hinder promotions and fitness for duty.
  • Extended leave for treatment and rehabilitation can interrupt careers.
• Administrative Separation:
  • Severe cases of SUDs may result in separation from the military, ending careers.

Operational Consequences

• Unit Cohesion and Readiness:
  • Substance use undermines unit morale and readiness.
  • Incidents related to alcohol, such as suicides and assaults, erode trust and reliability.
• Combat Exposure and Deployment:
  • Increased risk of SUDs among those deployed to combat zones.
  • Reintegration challenges post-deployment exacerbate substance use risk.

Efforts to Mitigate Substance Use

• Prevention and Treatment Programs:
  • Army Substance Abuse Program (ASAP) provides guidance and support.
  • Initiatives like smoking cessation programs and prohibition of tobacco in medical facilities.
• Educational Campaigns:
  • ‘Too Much To Lose’ and ‘YouCanQuit2’ campaigns educate on drug misuse and responsible drinking.
• Improved Drug Testing and Policies:
  • Enhanced drug testing collection system.
  • Policies to compile overdose data and provide access to opioid overdose antidotes like naloxone.

These comprehensive efforts signify the Army’s commitment to addressing substance use and maintaining the readiness and resilience of its personnel.

Policies and Programs: Substance Abuse in the Army

The US Army has implemented a comprehensive framework to address substance use within its ranks, focusing on prevention, education, and treatment.

Army Substance Abuse Program (ASAP)

• Overview:
  • The Directorate of Prevention, Resilience, and Readiness has established DOD Instruction 6400.09 to integrate policies aimed at mitigating self-harm and prohibited abusive acts, emphasizing a career-cycle perspective for force readiness.
  • Army Substance Abuse Program (ASAP) enhances Soldiers’ combat readiness by providing leadership on non-clinical alcohol and other drug policy issues and administering prevention and education efforts. 
• Mission:
  • Prevent misuse of legal substances and the use of illicit drugs, which negatively impact performance, discipline, and readiness.
  • Prevent misuse of expired legally prescribed medications.
  • Increase individual fitness and unit readiness and provide responsive services to the Army’s workforce.
• Objectives:
  • Army Substance Abuse Program’s objectives are to increase individual fitness and unit readiness.
  • Provide responsive services to the Army’s workforce.
• Education Campaigns:
  • The Department of Defense (DOD) has been operating substance use programs for many years, focusing on prevention, treatment, and research.
  • Too Much To Lose: Informs service members about the risks of prescription drug misuse and illicit drug use.
  • YouCanQuit2: Provides resources for quitting tobacco.

Assessing the Effectiveness of Substance Abuse Policies in the Army

The effectiveness of these initiatives is critical to the Army’s mission, and several key aspects of these programs have been highlighted in recent research and policy documents.

• Substance Use Disorder Clinical Care (SUDCC):
  • Integrated into the Army Behavioral Health System of Care to provide comprehensive substance use treatment.
  • Ongoing policy reviews aim to improve access to treatment services due to recognized barriers to care.
• ASAP‘s Focus:
  • Prevention of substance misuse and the use of illicit drugs.
  • The ASAP’s non-clinical alcohol and other drug policy guidance and leadership initiatives are designed to foster a culture of readiness and wellness.
• Leadership Initiatives:
  • Non-clinical alcohol and other drug policy guidance.
  • Fostering a culture of readiness and wellness.
• Department of Defense (DOD) Policies:
  • Strategies for prescription monitoring.
  • Urine screening for high-risk patients.
  • Education for both military members and healthcare professionals.

Despite these efforts, challenges still need to be addressed:

• Stigma of Seeking Help:
  • Continues to be a significant barrier to effective treatment and support.
• Continuous Evaluation:
  • Ongoing assessment of program effectiveness is crucial.

The Army’s comprehensive strategy includes prevention, treatment, and ongoing support, aiming to reduce the impact of substance use on individual service members and unit cohesion.

Strategies: Enhancing Substance Abuse Prevention and Treatment in the Military

Enhancing substance use prevention and treatment within the military requires a multifaceted approach that addresses the unique challenges faced by service members. Based on current practices and research, several recommendations can be made to improve these programs.

• Comprehensive Educational Campaigns:
  • Implement educational campaigns that inform service members about the risks associated with substance use, including prescription drug misuse and illicit drug use, as seen in the “Too Much to Lose” campaign.
• Strengthen the Army Substance Abuse Program (ASAP):
  • Provide effective alcohol and drug use prevention education at all command levels.
  • Encourage commanders to proactively support these efforts.
• Evidence-Based Interventions:
  • Utilize evidence-based interventions such as contingency management for patients receiving medication for opioid use disorder, as suggested by research published in JAMA Psychiatry.
• Address Stigma:
  • Address the stigma associated with substance use disorders through educational initiatives.
  • Advocate for programs that assist patients, as emphasized by experts in the field.
• Family Involvement:
  • Incorporate family involvement in treatment plans, such as the Youth Opioid Recovery Support (YORS) intervention, to ensure consistent medication administration and support for those with opioid use disorder.
• Post-Incarceration Programs:
  • Develop post-incarceration programs that provide comprehensive support for substance use disorders to reduce the risk of relapse and improve long-term outcomes.

By adopting these strategies, the military can build on existing programs and create a more supportive environment for service members struggling with substance use issues.

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