Substance Use Prevalence in the Military
The National Institute on Drug Abuse (NIDA) reports that 47 percent of active military members admit to binge drinking.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines this behavior as consuming enough alcohol in one sitting to raise blood alcohol concentration to 0.08 g/dL. The NIAAA adds that this is typically around five drinks within a two-hour time span for men or four drinks for women.
The NIDA says that 20 percent of active-duty military also report that they have engaged in binge drinking every single week for the prior month. That rate then rises to 27 percent if the soldiers were exposed to high levels of combat.
Tobacco use also tends to be relatively high among service members. According to the NIDA, 30 percent say that they are smokers, which is 1 percent higher than the general population. Soldiers who witnessed combat had the highest levels of all.
Whereas illicit drug use affects approximately 12 percent of the American population, these types of substances impact a relatively small portion of active-duty personnel at 2.3 percent. However, the NIDA says that the number of service members abusing prescription drugs—many of which are opioids—is 11 percent, which is higher than prescription drug misuse by civilians.
Military personnel who no longer serve are not immune to substance abuse issues. In fact, approximately 11 percent of veterans meet the criteria necessary for a substance use disorder diagnosis according to a 2017 study published in the Substance Abuse and Rehabilitation journal.
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What Is A Substance Use Disorder (SUD)?
The Substance Abuse and Mental Health Services Administration (SAMHSA) explains that substance abuse disorder (SUD) is diagnosed when “the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home.”
The SAMHSA explains that SUD is a diagnosis contained within the American Psychiatric Association’s Diagnostic and Statistics Manual of Mental Disorders, Fifth Edition. Also, it may be relatively new terminology, but it essentially combines the concepts of “substance abuse” and “substance dependence.”
The most common types of SUDs in America today include:
- Alcohol use disorder
- Tobacco use disorder
- Cannabis use disorder
- Stimulant use disorder (such as amphetamines and cocaine)
- Hallucinogen use disorder (such as LSD and mushrooms)
- Opioid use disorder (both prescription and illegal)
Which Substances Are The Most Problematic for Military Personnel?
The aforementioned 2017 study reported that alcohol and tobacco are the two drugs most prevalent among our nation’s veterans. Additionally, male vets have SUD twice as often as females (10.5 percent versus 4.8 percent, respectively, for alcohol; 4.8 percent versus 2.4 percent for drugs). This compares to 8.4 percent of the population as a whole with SUD, according to the SAMHSA.
Heavy drinking among military personnel is considered “an accepted custom,” according to Substance Use Disorders in the U.S. Armed Forces, a publication co-created by the Committee on Prevention, Diagnosis, Treatment, and Management of Substance Use Disorders in the U.S. Armed Forces, the Board on the Health of Select Populations, and the Institute of Medicine.
In addition to using alcohol for recreational purposes, service members also often drink as a reward following a work-filled day or to improve cohesion in the unit. And because it’s relatively inexpensive and accessible, alcohol’s appeal increases even more.
Tobacco use is an issue as well. It’s a long-standing one that started when the War Department began issuing tobacco rations around the time of the World Wars, sometimes making cigarettes even more valuable for trade or sale than the food given to the soldiers.
The publication explains that some military personnel also engage in drug use to help ease their pain, increase alertness, decrease boredom, or cope with the feelings of panic commonly experienced when living in a combative environment. During the Vietnam War, heroin and opium were the typical drugs of choice; 43 percent of those serving during that time admitting that they used drugs at least once during that time. Half of those subjects were suspected of being dependent on them.
Today, the number of soldiers misusing opioids is one of the major concerns according to this document, and military personnel can obtain these prescription painkillers from non-physician medics and corpsmen.
Some studies have also found that a soldier’s drug of choice is highly gender-dependent. For instance, one study in the American Journal of Drug and Alcohol Abuse noted that female service members tended to consume less alcohol than male service members. However, their level of tobacco and drug use was relatively the same.
Substance Abuse Risk Factors for Service Members
There are certain factors that the NIDA says can increase a military service member’s risk of developing a SUD, such as the stress of deployment, combat exposure, and sustaining a combat-related injury.
Stress of Deployment
The Psychological Health Center of Excellence (PHCE) reports that deployment-related stressors can be broken down based on those that occur pre-deployment, during deployment, and post-deployment.
Some of the most common pre-deployment stressors include:
- Marital disagreement or detachment
- Dealing with children who have fears, sadness, or anger over the deployment
- Prepping for an extended absence (paying bills, arranging for childcare, etc.)
- Coming to terms with the potential of being injured or killed
Stressors some service members face while actively deployed are:
- Being injured during combat
- Injuring or killing someone else, or witnessing someone else’s death
- Exposure to extreme temperatures and different terrains
- Exposure to chemical warfare or radiation
- Reduced communication from those back home
Although it would seem like post-deployment is a time marked by happiness as the family reunites, the PHCE says that stress often remains an issue for soldiers when returning home.
Some of the most common issues during this time include:
- Experiencing a loss of independence
- Feeling uncertainty about where the service member fits in with the family unit following an extended absence
- Trouble letting go of the military role and returning to civilian life
These stressors can cause emotional issues such as depression, frustration, guilt, and anger, according to the PHCE. Cognitive responses may be experienced, too, in the form of memory troubles, concentration issues, and reduced levels of motivation.
These stressors can also affect veterans physically and result in higher levels of fatigue, being startled more easily, having sleep or sex and intimacy issues, suffering from digestive problems, or developing heart issues. Some vets also report an increase in headaches, dizziness, and changes in appetite.
As a way to cope with these unpleasant mental and physical effects, military personnel sometimes turn to alcohol or other drugs. This can instigate the development of an SUD that then compounds these stressors even more.
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Additionally, some studies have found that home and work-related stressors lead to substance abuse more often in male military personnel than female. However, these same pieces of research found that female service members tend to have higher rates of drug and tobacco usage if they experience “stress associated with being a woman in the military.”
A study published in the journal Armed Forces & Society elaborated on this subject further, stating that being a woman in the military often brings about stress related to “the challenges of competing in a predominantly male organization” and “problems of unwanted sexual advances or harassment by their male counterparts.”
A second factor that can raise a military service member’s risk of developing a substance use disorder is exposure to combat.
One study published in the Journal of Traumatic Stress reported that “exposure to heavy combat more than doubled a typical Vietnam veteran’s risk of reporting a post-discharge substance abuse problem, as compared to what would have been expected had he served, but seen no combat, in Vietnam.” This study also found that the younger the soldier was when he or she engaged in combat, the higher the risk of developing a substance abuse issue.
Studies conducted on today’s soldiers are finding similar results. A January 2018 study reported that heavy drinking and the use of prescription drugs for non-medical purposes are both lowering the quality of life among soldiers exposed to combat.
The third risk factor that increases the likelihood of substance abuse among soldiers is being injured in combat, according to the NIDA.
In 2013, the Journal of Trauma and Acute Care Surgery published a study that looked at military personnel in the cavalry scout who were injured between 2003 and 2011. In all, 3,189 injuries were noted, with explosions as the leading cause of injury at 70 percent. Another 18 percent suffered gunshot wounds.
In some cases, soldiers use drugs to self-medicate after sustaining these types of injuries. That’s what a 2013 study published in the Journal of Social Work Practice in the Addictions found, noting that psychological issues co-occurring with the physical injuries can make these types of addiction more difficult to treat.
One of the top psychological concerns with military personnel is PTSD.
The Evolution of PTSD and Substance Abuse
Roughly 2 percent of the American population suffers from some level of PTSD (post-traumatic stress disorder).
According to the Anxiety and Depression Association of America, this disorder leads to symptoms such as irritability, engaging in self-destructive behavior, trouble concentrating, persistent negative beliefs, sleep issues, and startling easily.
However, the National Institute of Health (NIH) reports that these rates can go as high as 31 percent for veterans of war.
The level of risk is different depending on the conflict witnessed by the service member, the NIH says, and the numbers related to specific conflicts are:
- 31 percent for Vietnam vets
- 10 percent for Gulf War vets
- 11 percent for those serving in Afghanistan
- 20 percent for veterans in the Iraq war
The U.S. Department of Veterans Affairs (VA) says that PTSD-like symptoms have been witnessed in our nation’s military as far back as 1761. However, they were referred to simply as “nostalgia” because soldiers said how they felt sad, had difficulty sleeping, experienced anxiety, and were missing home. In cases where a physical cause was thought to be the blame, individuals were said to have “soldier’s heart.”
Around 1919, the existence of these symptoms was renamed “shell shock,” mainly because soldiers experienced them after being around exploding artillery shells. Around World War II, they were called “battle fatigue.”
Beginning in 1952, however, the American Psychiatric Association started producing its diagnostic manuals. Over time, symptoms now associated with PTSD went from being clinically referred to as “gross stress reaction,” “adjustment reaction to adult life,” and ultimately post-traumatic stress disorder.
Unfortunately, PTSD and substance abuse often go hand in hand. An article published in Current Psychiatry Reports says that approximately one-half of individuals who seek help for their substance abuse issue also meet the criteria necessary for a PTSD diagnosis.
Those with substance abuse and PTSD also tend to experience stronger drug and alcohol cravings, according to the same article. And if they relapse, they often do so more quickly than substance abusers without PTSD.
SUD Obstacles for Military Personnel
On its own, SUD can be difficult to diagnose and treat. Success is highly dependent on the person’s willingness to admit there is an issue and his or her desire to undergo treatment. However, the NIDA says even more obstacles exist for military personnel.
Zero Tolerance Policy
An Army memorandum dated January 24, 2014 says that it is “simple and clear” that zero tolerance means just that: zero tolerance.
The memo explains that neither the use, possession, promotion, manufacture, or distribution of drugs and drug paraphernalia will be tolerated by this branch of the Armed Forces.
Furthermore, any service member who violates this policy—it includes the wrongful use of cough and cold medication—will be disciplined “as appropriate.”
There is also a stigma associated with substance use that may deter military personnel from wanting to talk about it, according to the NIDA. Some pieces of research have also found that “substance use disorders are more highly stigmatized than other health conditions.”
The NIDA states that this stigma is further complicated by SUD’s link to diseases that are highly stigmatized as well. This includes HIV (human immunodeficiency virus), AIDS (acquired immune deficiency syndrome), hepatitis C, and many forms of mental illness.
SUD is also often connected to unsafe and criminal behaviors like drinking and driving, which increases the stigma even more.
Lack of Confidentiality
In 2017, the Journal of Consulting and Clinical Psychology published a study conducted by the University of Washington that involved 242 Army personnel with alcohol use disorder who had not engaged in any type of treatment.
Some participants received a one-hour telephone intervention utilizing “motivational interviewing” to help them make positive changes in regard to their drinking behaviors. Others were provided educational information about alcohol and drug use over the phone, serving as a control.
Follow up interviews revealed that, over time, all participants “significantly reduced” their level of drinking. However, those receiving the one-time intervention showed a greater reduction than the control, dropping from drinking 32 drinks per week on average to just 14 drinks per week during a six-month time-frame.
In a news release issued by the university, researchers revealed that they felt that the success of the study was at least partially due to the confidentiality it offered, calling it a “private and a low-burden intervention.”
For military personnel, some substance abuse treatment options are guided by the government.
In 2017, for instance, the VA and Department of Defense issued an updated “Clinical Practice Guideline for Opioid Therapy for Chronic Pain.” In this guideline, the departments suggest that in cases where patients have been taking opioids over longer periods of time, it is recommended that their prescriptions be tapered down when possible.
However, traditional therapies still exist for treating some of the most common substances abused in the military today. These include counseling, group therapy, and medication.
The NIDA says that engaging in counseling or one-on-one therapy helps individuals with SUD in many ways. For instance, these types of approaches encourage abstinence, help change substance-related attitudes and behaviors, and improve individuals’ coping skills when facing something that may trigger traditional substance use.
A few of the most common types of therapies include cognitive-behavioral therapy, motivational enhancement therapy, and 12-step facilitation therapy.
When looking for the right counselor for you, it helps to know what you can expect in a successful therapy program.
Wake Forest University explains that it is the role of the addiction recovery counselor to:
- Develop trust with the patient
- Encourage the recovery process by motivating the patient to take positive actions
- Work with the patient to create a plan for preventing a relapse
- Provide guidance to the patient’s family members and overall support system
- Refer the patient to outside support to receive additional help between therapy sessions
Therefore, patients engaged in SUD counseling should look for a therapist who they can trust, is motivating, and has a focus on relapse prevention. This professional should also be willing to connect you to outside resources while guiding your family and friends through the recovery process so they can better help you.
Just as individual therapy is beneficial when dealing with SUD, group therapy is too.
According to the SAMHSA’s publication Substance Abuse Treatment: Group Therapy (which is part of its Treatment Improvement Protocol Series), individuals who attend group therapy often have a higher success rate when it comes to staying sober because of its therapeutic and rewarding effects.
Overall, this type of therapy is intended to:
- Help support participants “in times of pain and trouble”
- Provide an environment where participants are able to grow in healthy ways
- Give recovering addicts the ability to learn beneficial social skills
- Persuade participants to take positive action with the help of peer reinforcement
Together, these benefits of group therapy help stabilize the recovering addict as he or she works to overcome the substance being abused.
In some cases, medications are used to help enhance the therapeutic process. The exact substance prescribed varies largely on the type of addiction.
For instance, with an opioid addiction, the NIDA says that methadone, buprenorphine, and naltrexone can all potentially help. However, if alcohol is being misused or abused, a few commonly prescribed medications include naltrexone, acamprosate, disulfiram (Antabuse), and topiramate.
Some of these medications help ease the withdrawal symptoms whereas others (like Antabuse) create a direct, negative reaction if the drug is ingested. This helps squelch the desire to use because of the side effects created when the two drugs interact.
Dual Diagnosis Treatment
If other issues, such as mental health disorders, exist beyond the SUD, treating both at the same time is generally preferable. This enables the service member to create a healthier life overall.
For instance, if PTSD is also present, the VA says that medications and talk therapy can often help. Thus, incorporating these elements into the SUD treatment can help the service member overcome both issues safely and effectively.
The VA offers a number of programs and services designed to help service members overcome alcohol, tobacco, and other drugs, as well as any other mental health issues sustained after serving in the Armed Forces.
To find out which ones are available in your area, you can access the VA’s online SUD program search and click on your state. From there you are taken to a page with a list of all of the available SUD programs and their contact information.
And if you need a little encouragement to either start your journey to recovery or to keep going, the VA provides a number of inspiring and encouraging videos that share the stories of other veterans who have overcome these same issues.
Additional Resources for Veterans
There are many different agencies available to assist both active and inactive military personnel and their families when there are issues related to substance abuse and/or mental health, or if help is needed in other areas of their lives.
These agencies and organizations include:
- National Suicide Prevention Lifeline – (800) 273-TALK (8255)
- Disaster Distress Helpline – (800) 985-5990 or text “TalkWithUs” to 66746
- Veterans Crisis Line – (800) 273-8255, text to 828255, or online chat
- Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline – (800) 662-HELP (4357)
- National Call Center for Homeless Veterans – (877) 4AID-VET (424-3838)
- Women Veterans Call Center – (855) VA-WOMEN (829-6636)
- inTransition – (800) 424-7877 (provides coaching and mental health assistance)
- Vets4Warriors – (855) 838-8255, text to (732) 333-3634, email, or online chat (24/7 peer support network)
- Caregiver Support Line – (855) 260-3274