Substance abuse in active members and veterans of the U.S. Armed Forces remains a significant concern. This article recognizes that substance abuse among veterans is a serious issue, but its focus is on substance abuse in active members of the military.
Substance abuse in the military is problematic for the same types of reasons that substance abuse is problematic over all occupations and individuals. Substance abuse affects one’s health, performance, and ability to learn.
Specifically for active military members, the development of substance abuse can also be associated with:
- Difficulties maintaining order and discipline in military personnel
- Trouble with readiness and in the operations of military protocols
- Placing others at risk
- Serious inefficiencies in job performance
Rates of Substance Abuse in Active Military Members
- One in four veterans who immediately returned from Iraq and/or Afghanistan qualified for diagnosis of a psychiatric/psychological disorder. This indicates that these individuals most likely qualified for the diagnosis while they were still on active duty. Having a diagnosis of a psychological disorder is associated with an increased risk for the development of a substance use disorder. Common psychiatric issues included issues with trauma and stress (e.g., one in six reported symptoms of PTSD), depression, anxiety, and substance abuse.
- The Armed Forces instituted zero-tolerance policies regarding illicit drug use in 1982. The policy remains strictly enforced by random drug testing and a potential dishonorable discharge or even criminal prosecution if an active service member tests positive for illicit drugs. As a result, illicit drug use rates are lower in active military personnel than in the general population. For example, in 2008, 2.3 percent of military personnel reported past-month illicit drug use compared to 12 percent of the civilian population. Of the group most likely to use illicit drugs, those in the 18-25 age group, 3.9 percent of military personnel reported past-month use of illicit drugs as opposed to 17.2 percent of civilian personnel.
- Despite lower levels of illicit drug use, active military personnel demonstrate higher levels of prescription drug use/misuse. Combat-related injuries and issues carrying heavy equipment are believed to account for this. Between 2001 and 2009, prescriptions for pain medication quadrupled by active service members. In 2008, misuse of prescription drugs among active service members was 11 percent, which represented a significant increase over previous years (2 percent in 2002; 4 percent in 2005). The majority of prescription drugs used by service members were opiate pain medications, which are known to have significant potential for abuse and the development of physical dependence.
- Use of alcohol is also higher among active members of the military than civilians. Forty-seven percent of active military personnel reported binge drinking in 2008 and 20 percent of military personnel reported binge drinking weekly within the prior month of taking the survey. Person with combat exposure were more likely to binge drink than military personnel without combat exposure.
- In 2008, 30 percent of active service members currently smoke cigarettes, which is equivalent to the general population (29 percent). However, tobacco use was significantly higher in military personnel with combat experience.
NIDA reports that the stresses of deployment in combat areas and the unique culture of the military most likely contribute to issues with substance abuse in this group.
Some Major Risk Factors
Associated with Military Service and Substance Abuse
Numerous risk factors have been associated with the development of a substance use disorder in all individuals. Organizations such as the American Psychiatric Association (APA) have identified these risk factors along with the diagnostic criteria for the formal assessment and diagnosis of different substance use disorders. Risk factors are not necessarily causal factors in that risk factors cannot be demonstrated to cause someone to develop an issue with substance abuse or to develop a substance use disorder. Instead, the development of any psychiatric/psychological disorder, including substance use disorders, is most likely related to numerous interacting factors that include genetics and environmental experiences.
Based on the information provided by APA, NIDA, and the Institute of Medicine, some risk factors that may be germane to the development of issues with substance abuse in active military members include:
- Military culture: The general approach to dealing with substance use issues in the military does not place a high priority on confidentiality, such that active military members who may apply for treatment associated with substance abuse issues are not often protected. This may result in many individuals who need treatment for issues with substance abuse not accessing resources where they can get treatment. In addition, in some military personnel, the notion of seeking treatment to help one overcome an issue with substance abuse may be perceived as a form of weakness, especially for higher ranking individuals. One approach here would be to use more spiritually focused counseling services for individuals in active military service and to include periodic psychoeducation to active members aimed at informing them about substance abuse.
- Trauma and stress: The observation that substance abuse is higher in active military personnel who are exposed to active combat experience is consistent with the notion that the experience of trauma and/or stress is a significant risk factor for the development of a substance abuse issue. Interestingly, trauma and stress in the military may not be isolated to combat experience but may also be associated with other issues in the military. For instance, the Institute of Medicine reports indicate that female service members who develop substance abuse issues are also likely to have issues with sexual discrimination and sexual abuse. Obviously, cracking down on sexual abuse and discrimination in the military could help to ease this strain. Providing psychoeducation to individuals who are entering combat and more resources for them to discuss their experiences could also reduce combat-related stress issues.
- Perceptions of control: Interestingly, the Department of Defense has noted that suicide rates among active military members have risen dramatically. One surprising finding is that suicide rates are high even in members who have not been exposed to combat. Numerous explanations for these findings have been proposed, and one such explanation may be that individuals enrolled in an all volunteer military often struggle with issues regarding their perception of their ability to control the events in their environment. One line of research has suggested that the development of a substance abuse issue often represents an attempt of an individual who is under the perception that they are not in control of important events in their environment attempting to take control by using drugs or alcohol. In other occupations, such as management, labor, etc., one solution is to give employees a stronger voice in corporate decisions. This approach will most likely not be used in the military; however, offering individuals more freedom in their ability to advance and to perform their duties may be one potential solution.
- Having a co-occurring psychiatric/psychological disorder: A very salient risk factor associated with the development of a substance use disorder is having a diagnosis of some other psychological/psychiatric disorder. Obviously, individuals who have been exposed to combat may fit the diagnostic criteria for either an acute stress disorder diagnosis or a post-traumatic stress disorder diagnosis; acute stress disorder is a trauma and stressor-related disorder that often develops into formal PTSD over time and represents the more acute effects of stress and trauma. However, other psychological symptoms are associated with an increased risk to develop issues with substance abuse, including depression and anxiety.
- Peer pressure: Associating with individuals who use substances like alcohol and tobacco or prescription medications often increases the risk that one will use and even abuse the substances as well. Many active service members often feel that it is “their duty and right” to blow off steam by using alcohol. Constantly being exposed to individuals who use tobacco products can influence of the individual to begin using these products themselves. When the use of prescription pain medications is considered to be appropriate for those who suffer from the normal aches and pains associated with their jobs, individuals are more likely to use them. Obviously, one such solution would be to discourage the practice of binge drinking among active service members instead of maintaining the current attitude.
Treatment for Service Members
Treatment for substance use disorders has an overall empirically validated approach that consists of the use of physician-assisted withdrawal management programs when appropriate, the use of substance use disorder therapy (the cornerstone of any substance use disorder treatment program), medical management of issues with substance abuse including any co-occurring issues, and peer and social support for individuals in recovery.
For active service members, this blueprint would also be effective; however, the blueprint is just an overall plan that requires adjustments to meet the specific needs of the individual. In the military, one of the biggest obstacles would be to overcome the issues that are associated with confidentiality, discrimination, and sanctioning those with substance abuse issues. The use of strong social support groups, such as 12-Step groups, in the military might be one way to address this issue and get individuals at all ranks and levels of service involved in a manner that makes them comfortable.
Despite the military culture barriers to treatment for substance abuse, all branches of the military service have active substance abuse treatment programs. Active members of the military can enter a substance abuse treatment program by:
- Seeking out help for a substance abuse issue
- Being referred by a commanding officer
- Being referred for treatment as a result of a positive drug screen
- Being referred by a doctor or other health professional
- Having disciplinary or legal issues associated with substance abuse
The most productive way for an active member of the military to seek a referral is to discuss the issue with a military physician, mental health worker, or chaplain. This can help to maintain an individual’s confidentiality and also direct them to the appropriate resource given their situation.
Several additional resources that may be of use are the treatment locator provider by the Substance Abuse and Mental Health Services Administration (SAMHSA), information provided by SAMHSA for veterans and military families, and resources provided by the Department of Veterans Affairs:
- SAMHSA’s Treatment Locator can help individuals to find local treatment resources. Phone support is available at 1-800-662-HELP.
- The U.S. Department of Veterans Affairs: Treatment Programs for Substance Use Problems can provide useful information.
- The U.S. Department of Veterans Affairs: National Center for PTSD can assist with trauma and stress-related issues.
- The Substance Abuse and Mental Health Services Administration: Veterans and Military Families can also provide assistance.