How does substance abuse affect military personnel?

Alcohol and Drugs

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 underdiagnosed among military personnel, especially those who have been in combat. A person with PTSD continually relives in his or her mind a highly traumatic event. This manifests itself in an involuntary flood of thoughts related to the trauma. It includes nightmares, an adrenaline rush, and spikes of anxiety when visual or audible reminders of the experience appear.

Many who have PTSD placate symptoms with alcohol and drugs such as marijuana and prescription pain killers. These drugs slow brain activity and reduce chronic anxiety during the substance high.

The authors of the book After the War Zone (2008) recommend that military personnel experiencing PTSD and substance abuse disorders be treated for both conditions at the same time. Explaining the common parallel occurrence of both, the authors write that
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 underdiagnosed among military service members. PTSD and substance abuse carry a heavy stigma in the military; the inclusion of such conditions as part of one’s official record often means that the service member may not be able to pursue a career in, for example, defense or law enforcement after military service. Therefore, both disorders are believed to be highly underreported by service members and their supervisors. Until PTSD and substance abuse disorders are addressed in a way that does not lead to stigmatization, service members will likely continue to self-medicate.

The danger in self-medicating is that the method (drinking alcohol or taking drugs) used for short-term relief of the emotional pain inevitably worsens emotional conditions 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. A Department of Defense study found that less than 3 percent of military personnel had used illicit drugs in the past month, but nearly half reported binge drinking. Abuse of prescription drugs is also an According to NIDA, one in four veterans of Operation Enduring Freedom and Operation Iraqi Freedom, and who were in combat, presented symptoms of a mental or cognitive disorder and one is six veterans of these two missions showed signs of PTSD.

Alcohol and Drug Use Policy

In 2001, the US Army revised Army Regulation 600-85, which changed the name of the Alcohol and Drug Abuse Prevention and Control Program to the Army Substance Abuse Program (ASAP). The regulation also changed the requirements and process for the administrative separation of soldiers using drugs or alcohol illegally. The regulation also prescribed random drug-testing and deployment restrictions on soldiers undergoing rehabilitation for substance abuse. The new policy, however, conflicted with existing separations regulations for active enlisted personnel, so commanders were directed to use the latter as their policy for confronting drug and alcohol use among their subordinates.

While the new ASAP regulation directed commanders to initiate separation for first-time offense, the legacy policy on enlisted separations allowed for more leniency. Coupled with modern military living-arrangements designed to allot soldiers more privacy, this conflict and confusion in regulations makes 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 Army vice chief of staff, General Peter Chiarelli, found that among all soldiers who tested 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, LSD, methamphetamine, heroin, and illicitly used prescription drugs. Brigadier General Colleen McGuire found that among 1,000 soldiers who tested positive for drug use, 372 were repeat offenders and none had been sent to treatment.

Major General Anthony Cucolo, who reviews substance abuse cases for the Army, 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.

Treatment

According to a 2010 article in the journal Addiction Professional, increasingly, more veterans are seeking treatment at the community level rather than through the US Department of Veterans Affairs (VA). There remains a degree of distrust in relying on the government to treat drug and alcohol abuse. Any diagnosis or treatment given through the VA will show up on the service member’s record.

Knowing that military personnel are more inclined to seek help outside the military structure, the VA is seeking to partner with community resources. Treatment strategies include twelve-step therapies, “stop, think, act” impulse-control programs, and “soldiers helping soldiers” programs, in which 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.

Intervention and Rehabilitation Outlook

Mental health and military experts agree that more investigation is needed into how to better support military personnel emotionally during and after deployment. Though recognition of depression, anxiety disorders, and substance abuse is pervasive, more needs to be understood about wartime stress on military personnel and their families, so that techniques for early intervention and treatment can be developed.

In July of 2010, the US National Institutes of Health announced the approval of $6 million in federal funding to support research by institutions in eleven states specializing in substance abuse among military personnel, veterans, and their families. NIDA partnered with the VA 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.

In 2010, the Army transferred its outpatient substance-abuse treatment services from medical to non-medical leadership, which some have argued has led to substandard care from underqualified and overextended personnel. Between 2010 and 2015, according to USA Today, ninety soldiers committed suicide within three months of receiving substance-abuse treatment through the military. In one case, the soldier had been stated to be in good mental health by an unlicensed counselor hours before his death. Many soldiers who seek treatment are also turned away—in 2014, 7,000 soldiers were denied help by the military substance-abuse program.

Bibliography

“Army Substance Abuse Program.” Army Lawyer (Sept., 2002): 51–53. Print.

Bray, Robert M., et al. Understanding Military Workforce Productivity: Effects of Substance Abuse, Health, and Mental Health. New York: Springer, 2014. Print.

Cavallaro, Gina. “Army Cracks Down as Drug, Alcohol Cases Rise.” Army Times, 8 Jun. 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 8.4 (2010): 16. Print.

Hoggatt, Katherine J., et al. "Alcohol and Drug Misuse, Abuse, and Dependence in Women Veterans." Epidemiologic Reviews 37.1 (2015): 23–37. Print.

Kelsall, Helen Louise, et al. "Alcohol Use and Substance Use Disorders in Gulf War, Afghanistan, and Iraq War Veterans Compared with Nondeployed Military Personnel." Epidemiologic Reviews 37.1 (2015): 38–54. Print.

Slone, Laurie B., and Matthew J. Friedman. After the War Zone: A Practical Guide for Returning Troops and Their Families. Cambridge: DaCapo, 2008.

“Studies on Combat-Related Substance Use and Abuse to Be Funded by NIH and VA.” Defense and Aerospace Week 15 Sept. 2010: 142. Print.

Volkow, Nora D. “Substance Abuse among Troops, Veterans, and Their Families.” NIDA Notes 22.5 (2009). PDF file.

Zoroya, Gregg. "Investigation: Army Substance Abuse Program in Disarray." USA Today. Gannett, 12 Mar. 2015. Web. 30 Oct. 2015.