Substance Abuse in the Army

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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.

Prevalence of Substance Abuse Among Army Personnel

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. Studies reveal that individuals deployed to recent 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. The transition back to civilian life often exacerbates substance use behaviors, with 44% of returning service members reporting difficulties, including problematic substance use. Notably, Reserve and National Guard personnel also experience post-deployment increases in substance use problems.

Despite the prevalence of SUDs, there is a notable gap in referral rates to treatment services, often due to stigma within the military community. This is particularly concerning given the high comorbidity of SUDs with post-traumatic stress disorder (PTSD), which necessitates integrated treatment approaches. The Department of Defense advocates for evidence-based practices for SUD treatment, emphasizing the importance of trauma-informed care interventions that address both PTSD and SUD symptoms concurrently.

Other factors contributing to substance use in the army include military culture and environmental stressors, such as the challenges of reintegration into civilian life. For instance, 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. The financial implications are substantial, with tobacco use costing 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 to address substance use in the army include smoking cessation programs and policies such as the prohibition of tobacco use in medical facilities. However, the persistent rise in prescription pain medication prescriptions and the challenges associated with chronic pain management among veterans highlight the need for continued research and development of targeted prevention and treatment strategies.

Examining Alcohol Abuse in the Army: Prevalence and Consequences

Alcohol misuse within the army is a significant concern, affecting not only individual service members but also unit cohesion and operational readiness. Studies reveal that 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. Additionally, the 2018 Department of Defense Health Related Behaviors Survey found that 34% of service members engaged in binge drinking, with 9.8% drinking heavily.

Alcoholism, characterized by increased tolerance, withdrawal symptoms, and difficulty in reducing consumption, poses a threat to the ethical standards and readiness required for the army’s mission. Army Regulation 600–85 emphasizes that alcohol use is inconsistent with army values and the necessary standards for performance and discipline. The culture of alcohol in the military, often romanticized, has been identified as a contributing factor 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 to address alcohol misuse include annual screenings and treatment programs, yet challenges such as untimely screenings and stigma associated with seeking help persist. The RAND Corporation discusses the serious threat excessive alcohol use poses to force readiness, emphasizing the need for ongoing attention to this issue. To reduce alcohol misuse in the army, a multifaceted approach that includes prevention, early intervention, and treatment, coupled with a shift in cultural attitudes towards drinking, is essential.

Substance Abuse Challenges 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. 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 are at an increased risk of developing substance use disorders (SUDs), especially those with combat deployment experience. Research indicates that military personnel returning from deployment exhibit higher rates of SUD diagnoses compared to civilian populations, with a notable prevalence of alcohol and drug use disorders. Despite this, referral rates to SUD treatment services remain low, often due to stigma associated with substance use within military culture.

To address these challenges, 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. Additionally, new policies require the Pentagon to compile data on overdoses and provide access to opioid overdose antidotes like naloxone to troops. The Army has also 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 to Substance Abuse Among Army Personnel

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

PTSD and Substance Abuse in the Army

The relationship between Post-Traumatic Stress Disorder (PTSD) and substance use in military personnel is a complex and significant issue. PTSD is a mental health condition triggered by experiencing or witnessing a traumatic event, and it is prevalent among army veterans and active-duty soldiers. The high-stress environment of military service, combined with exposure to combat and traumatic events, contributes to a higher risk of PTSD within this population.

Substance use often becomes a coping mechanism for individuals living with PTSD. The self-medication hypothesis suggests that army personnel may use alcohol or drugs to alleviate the distressing symptoms of PTSD, such as anxiety, insomnia, and flashbacks. However, this form of self-medication can lead to a vicious cycle where substance use exacerbates PTSD symptoms, increasing dependency and the risk of developing a substance use disorder (SUD).

Studies have indicated a strong correlation between PTSD and increased rates of substance use among army members. For instance, a study published by the National Institutes of Health found that military personnel with PTSD were significantly more likely to experience issues related to alcohol and drug use. Addressing this dual diagnosis is critical for effective treatment, as it 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. This understanding can lead to improved screening, prevention strategies, and specialized treatment programs that address the unique needs of those affected by both conditions.

Military Culture and Its Influence on Substance Abuse

Military culture is known for its unique set of values, including discipline, loyalty, and self-sufficiency, which can significantly impact the attitudes and behaviors of service members toward substance use and seeking help for addiction. The historical norms within the military have often associated drinking with camaraderie and coping with stress, leading to a higher prevalence of alcohol use. However, this cultural aspect can also contribute to the stigmatization of substance use and mental health issues, making it challenging for individuals to seek treatment.

Efforts to reduce stigma and encourage help-seeking behaviors have been implemented, such as the Real Warriors Campaign and Combat Operational Stress Control programs. These initiatives aim to foster a supportive culture and integrate mental health and substance use treatment within the military structure. Despite these efforts, significant challenges remain. Many service members and veterans still perceive seeking help as a sign of weakness, which can be worsened by military values of self-reliance.

Moreover, the transition from active duty to civilian life brings its own set of challenges, which can increase the risk of substance use disorders (SUDs). The prevalence of co-occurring mental health disorders such as PTSD, depression, and anxiety among veterans with SUDs highlights the need for integrated treatment approaches. The Department of Defense advocates for evidence-based practices and trauma-informed care interventions that address both PTSD and SUD symptoms concurrently.

Ultimately, changing the military culture to one that promotes mental well-being and normalizes seeking help for substance use is a complex but crucial endeavor. It requires ongoing education, leadership training, and the development of trust in the therapeutic relationship, all while maintaining the core values that define military service.

Consequences of 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. The prevalence of substance use, particularly alcohol, is significant, with a 2016 Army Substance Abuse Program (ASAP) study revealing that the majority of Army personnel claim to be ‘social drinkers,’ and 98% of Soldiers enrolled in ASAP fall into that category. Furthermore, 27% of Army soldiers were found to meet the criteria for referral to treatment after returning from service in Iraq, underscoring the urgency of addressing this issue.

Substance use in the Army contributes to a range of detrimental outcomes, including behavioral health issues, misconduct, crimes, and suicidal risk behaviors. For instance, up to 50% of suicides, sexual assaults, and intimate personal violence incidents in the Army are related to alcohol use. These incidents not only affect the individuals involved but also erode unit morale and undermine the trust and reliability essential for effective team functioning. Additionally, the co-occurrence of post-traumatic stress disorder (PTSD) and substance use disorders (SUDs) is prevalent among military personnel, with research indicating that 58% of individuals seeking treatment for alcohol use disorder (AUD) also meet the criteria for PTSD. This comorbidity can have severe repercussions for mental health and operational effectiveness.

Combat exposure and deployments are identified as risk factors for increased substance use, with recent conflicts in Iraq and Afghanistan showing significantly higher rates of SUD diagnoses compared to civilian populations. The challenges of reintegration into civilian life post-deployment further exacerbate the risk of developing SUDs. The Army has recognized the need for comprehensive prevention, intervention, and treatment strategies, including evidence-based practices and trauma-informed care, to mitigate the impact of substance use on its personnel and operations.

Substance Abuse Policies and Programs in the Army

The US Army has implemented a comprehensive framework to address substance use within its ranks, focusing on prevention, education, and treatment. The Directorate of Prevention, Resilience, and Readiness has established the DOD Instruction 6400.09, which integrates policies to mitigate self-harm and prohibited abusive acts, emphasizing a career-cycle perspective for force readiness. The Army Substance Abuse Program (ASAP) is a cornerstone initiative that enhances Soldiers’ combat readiness by providing leadership on non-clinical alcohol and other drug policy issues and administering prevention and education efforts.

ASAP’s mission is to prevent misuse of legal substances and the use of illicit drugs, which are inconsistent with Army values and can negatively impact performance, discipline, and readiness. This program also aims to prevent misuse of expired legally prescribed medications. The Army Substance Abuse Program’s objectives include increasing individual fitness and unit readiness and providing responsive services to the Army’s workforce. The Department of Defense (DOD) has been operating substance use programs for many years, focusing on prevention, treatment, and research.

Education campaigns such as Too Much To Lose and YouCanQuit2 inform service members about the risks of prescription drug misuse and illicit drug use and provide resources for quitting tobacco. The Army’s approach is multi-faceted, aiming to sustain a ready and resilient force through a combination of policy guidance, educational outreach, and treatment programs.

Assessing the Effectiveness of Substance Abuse Policies in the Army

The US Army has implemented various policies and programs to address substance use within its ranks, aiming to enhance combat readiness and maintain the overall health of its personnel. 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.

The Substance Use Disorder Clinical Care (SUDCC) program, for instance, has been integrated into the Army Behavioral Health System of Care to provide comprehensive substance use treatment. However, the Army has recognized barriers to care, prompting ongoing policy reviews to improve access to treatment services. The Army Substance Abuse Program (ASAP) focuses on the prevention of substance misuse and the use of illicit drugs, emphasizing the incompatibility of substance use with Army values and the standards needed for performance and readiness.

Furthermore, the ASAP’s non-clinical alcohol and other drug policy guidance and leadership initiatives are designed to foster a culture of readiness and wellness. The Department of Defense’s policy guidance on substance misuse includes strategies for prescription monitoring, urine screening for high-risk patients, and education for both military members and healthcare professionals.

Despite these efforts, challenges still need to be addressed, including the stigma of seeking help and the need to continuously evaluate program effectiveness. The Army’s approach underscores the importance of a comprehensive strategy that includes prevention, treatment, and ongoing support, with the ultimate goal of reducing the impact of substance use on individual service members and unit cohesion.

Strategies for 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.

  • Implement comprehensive 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) by providing effective alcohol and drug use prevention education at all command levels and encouraging commanders to proactively support these efforts.
  • 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 the stigma associated with substance use disorders through educational initiatives and by advocating for programs that assist patients, as emphasized by experts in the field.
  • 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.
  • 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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