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Substance Abuse in the Army

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Key Takeaways

  • Substance use in the Army reflects military life stress and unique service member experiences, with tobacco, alcohol, and prescription drugs as primary concerns.
  • Alcohol misuse is prevalent among veterans, nearly double the rate of the general population, with prescription drug misuse also significant, especially among those medically discharged or with combat injuries.
  • Deployment and combat are significant risk factors for substance use disorders (SUDs), with a high co-occurrence of PTSD and SUDs in military personnel.
  • The Army has implemented prevention and treatment resources, including smoking cessation programs and campaigns like ‘Too Much to Lose’ and ‘Own Your Limits’.
  • Military culture and stressors contribute to substance use risk factors, with prevention strategies crucial for new active duty personnel.
  • Substance use impacts Army operations by undermining unit cohesion, morale, and readiness, leading to an increased risk of suicide and violence.
  • Barriers to treatment include stigma and career concerns despite available Army prevention and treatment programs.
  • The Army’s comprehensive approach to substance use includes the Substance Abuse Program (ASAP), education campaigns, and treatment services.

Substance Abuse Prevalence in the Army

The prevalence of substance use within the Army is a reflection of not only the stresses and challenges inherent to military life but also the unique culture and experiences faced by service members. Data indicates that tobacco use is significant, with a reported decrease in smoking rates from 2011 to 2015, yet a concerning number of service members begin smoking after enlisting. The Department of Defense has implemented smoking cessation programs and aims for tobacco-free installations, highlighting the need for effective prevention strategies.

Alcohol remains the most frequently misused substance, with a substantial number of veterans entering treatment programs citing it as their primary concern. This is especially notable as the rate of alcohol misuse among veterans is almost double that of the general population. Prescription drug misuse is also present, with a noted decline in recent years, yet it remains an issue, particularly among those transitioning to medical discharge or with combat-related injuries.

Overall, military personnel, including those who have been deployed, exhibit higher rates of substance use disorders (SUDs) compared to civilian populations, with deployment and combat exposure being significant risk factors. The co-occurrence of post-traumatic stress disorder (PTSD) and SUDs is prevalent, necessitating integrated treatment approaches that address both conditions concurrently. The Army has acknowledged these challenges and offers various intervention and treatment resources for service members and their families, aiming to mitigate the impact on individual health and overall military readiness.

Prevalence of Substance Abuse Among Army Personnel

The prevalence of substance use within Army ranks is a multifaceted issue, with various studies highlighting different aspects of the issue. According to the National Institute on Drug Abuse, there has been a notable decrease in certain types of substance use, such as tobacco, among military personnel; however, challenges persist with alcohol and prescription drug misuse. A 2017 study found that veterans were more likely to use alcohol and report heavy alcohol use compared to their civilian counterparts, with a significant number of veterans entering treatment programs citing alcohol as the substance they misuse most frequently.

Prescription drug misuse is also concerning, with a 2015 report indicating that just over 4% of active-duty service members reported misusing prescription drugs in the past year. The transition to medical discharge is particularly critical, as military physicians have historically prescribed large quantities of pain medications to injured personnel. While recent years have seen a decline in the self-reported use of prescription opioids and sedatives, the issue remains significant.

Substance use in the military not only affects individual service members but also has broader implications for unit morale and readiness. For instance, the Army has observed that alcohol misuse contributes to behavioral health issues, misconduct, and suicidal risk behaviors, all of which threaten the overall well-being and operational effectiveness of the force.

With the ongoing opioid crisis and rising overdose deaths involving fentanyl, the Department of Defense is taking steps to compile data on overdoses and provide antidotes like naloxone to troops. This initiative reflects a growing recognition of the need to address substance use proactively within the military community.

Factors Contributing to Substance Abuse Among Army Personnel

Substance use within the Army is a multifaceted issue influenced by various factors, including stress, Post-Traumatic Stress Disorder (PTSD), and military culture. The prevalence of substance use among Army personnel can be attributed to the unique stressors associated with military life, such as the pressures of combat, the challenges of reintegration into civilian life, and the normalization of alcohol use within military culture.

Stress, PTSD, and Substance Abuse in Army Personnel

The correlation between stress, post-traumatic stress disorder (PTSD), and substance use in military settings, particularly within the Army, is a critical area of concern. Studies have shown that Army personnel experiencing the high-stress environment of combat or struggling with PTSD are at an increased risk of developing substance use issues. The Springer Nature publication on the management of PTSD in veterans and military service members highlights the importance of staying current with treatment interventions, which may also impact substance use tendencies.

According to a report by the Army, there is a notable link between depression, often a byproduct of stress and PTSD, and higher rates of substance use. The National Institute of Drug Abuse acknowledges that military personnel who have experienced trauma are more susceptible to mental health and substance use problems. Furthermore, the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that depression is more prevalent in the military than in the civilian population, potentially contributing to substance misuse.

Research from the National Center for Biotechnology Information (NCBI) reveals that PTSD and alcohol use disorder (AUD) commonly co-occur in military and veteran populations. This comorbidity is challenging to treat and often results in a more chronic course of illness. The self-medication hypothesis suggests that individuals with unresolved PTSD may use substances as a coping mechanism, leading to a higher likelihood of relapse after treatment for substance misuse.

It is clear that the military’s unique stressors, including combat exposure, moral injury, and military sexual trauma, contribute to elevated risks of PTSD and subsequent substance use. Addressing these issues holistically is essential for the well-being of Army personnel and the effectiveness of the Army’s operations.

Influence of Military Culture on Substance Abuse Incidence

The military culture, with its unique stressors and lifestyle, significantly influences substance use among service members. A systematic narrative review by Osborne et al. (2022) highlights the historic social and cultural norms within the military, including the ‘romanticizing’ of alcohol use, as factors contributing to substance use. The UK’s Ministry of Defence has recognized this issue and is promoting initiatives to encourage sensible alcohol use.

Research indicates that the prevalence of hazardous alcohol use behaviors is notably higher in the military compared to civilian populations (SAMHSA, 2019). This is worsened by a culture that often normalizes alcohol consumption as part of camaraderie and bonding experiences. Consequently, substance use and particularly alcohol misuse continue to pose challenges to the well-being and readiness of Army personnel, contributing to behavioral health issues and high-risk behaviors (Milliken, 2022).

Efforts to address substance use in the military must consider the impact of military culture. This includes developing prevention and intervention strategies that are sensitive to the unique aspects of military life, such as the normalization of alcohol use and the potential stigma associated with seeking help for substance use issues.

Impact of Substance Abuse on Army Personnel and Military Operations

Substance use within the Army significantly affects individual soldiers and broader military operations. Research has indicated that service members, particularly those who have experienced combat, face a heightened risk of developing substance use disorders (SUDs). This is exacerbated by the prevalence of co-occurring conditions such as post-traumatic stress disorder (PTSD), with studies showing that a substantial percentage of individuals seeking treatment for alcohol use disorder also meet the criteria for PTSD. The interplay between PTSD and SUDs can lead to severe mental health consequences, affecting soldiers’ well-being and their capacity to perform their duties effectively.

Health and Career Consequences of Substance Abuse for Army Personnel

Substance use can affect Army personnel’s health, careers, and personal lives. The use of substances, particularly tobacco, alcohol, and prescription drugs, can lead to a range of health issues. Smoking, for instance, has been linked to a significant financial burden on healthcare services, with the Veterans Health Administration spending billions on smoking-related care. Alcohol misuse is prevalent, with a high percentage of veterans reporting alcohol as their most frequently misused substance, nearly double that of the general population. Prescription drug misuse, especially pain medication, is also a concern, with military physicians prescribing large quantities, although recent data indicates a decrease in self-reported use.

Substance use can lead to mental health disorders such as PTSD, depression, and anxiety, which are commonly co-occurring in veterans with substance use disorders (SUDs). These mental health challenges can arise or be worsened by military service stressors, including deployment and combat exposure. Moreover, substance misuse affects military readiness and performance, leading to potential disciplinary actions, career limitations, or discharge. The Army has implemented various prevention and treatment programs to combat substance use, emphasizing the importance of early identification, responsible behavior, and the provision of counseling and education services. However, barriers to seeking treatment, such as perceived stigma and career concerns, remain significant obstacles for soldiers in need of help.

Impact of Substance Abuse on Army Operations and Readiness

The impact of substance use on Army operations and readiness is multifaceted and significant. Substance use within the Army can lead to various negative consequences that affect individual soldiers and the broader operational effectiveness of military units. According to the National Center for Biotechnology Information, substance use, including alcohol misuse and illicit drug use, can undermine military readiness by impairing performance, discipline, and the maintenance of high standards.

Furthermore, the Army’s Substance Abuse Program (ASAP) acknowledges that substance use detracts from the overall fitness and effectiveness of the Army’s workforce. The US Army has reported that the majority of soldiers enrolled in ASAP are categorized as ‘social drinkers,’ yet alcohol is the most commonly misused substance, which can lead to a range of issues from absenteeism to attrition, thereby creating staffing gaps and reducing unit cohesion and morale.

Additionally, the US Army has been combating opioid overuse, particularly due to pain management for injuries, which can lead to dependency and impact soldier health and readiness. The Congressional Research Service notes that unplanned attrition due to substance use can disrupt unit operations and perpetuate mental health stigma, further affecting the well-being of service members.

Overall, the prevalence of substance use in the Army poses a challenge to maintaining operational readiness and effectiveness, necessitating ongoing prevention, intervention, and treatment efforts to support the health of the force and its mission.

Strategies for Substance Abuse Prevention and Treatment in the Army

The US Army has implemented a comprehensive approach to tackle substance use among its personnel, encompassing prevention, treatment, and ongoing research. The Department of Defense (DOD) operates programs that focus on the prevention, treatment, and research of substance use, including alcohol, illicit drug use, and non-medical use of prescription drugs. 

Army Substance Abuse Prevention Initiatives

The US Army has implemented various prevention programs and initiatives aimed at combating substance use among its personnel. These programs are designed to enhance soldiers’ combat readiness by providing comprehensive support and resources to address alcohol and drug-related issues. One such initiative is the Army Substance Abuse Program (ASAP), which focuses on non-clinical alcohol and other drug policy issues, including prevention, education, treatment, and testing programs. ASAP coordinates with agencies such as the Suicide Prevention Task Force and Community Health Promotion Council (CHPC) to reduce high-risk behaviors and suicidal tendencies among soldiers.

Key components of the Army’s substance use prevention efforts include:

  • Alcohol and Drug Abuse Prevention Training (ADAPT): A 12-hour course designed to educate and raise awareness among soldiers and civilians, aiming to intervene in high-risk substance use behaviors.
  • Applied Suicide Intervention Skills Training (ASIST): A 16-hour course that equips participants with the skills to prevent the immediate risk of suicide, which can be related to substance use.
  • Employee Assistance Program (EAP): Offers assessments, referrals, short-term counseling, crisis intervention, and coordination with treatment facilities to assist civilian employees and family members.
  • Drug-Free Workplace Program: In compliance with Public Law, the program includes managing a Testing Designated Position (TDP) database, coordinating drug testing, and providing training for supervisors and employees.

Additionally, the Army has launched educational campaigns such as ‘Too Much To Lose’ to inform service members about the risks of prescription drug misuse and illicit drug use and ‘YouCanQuit2’ to support tobacco cessation. These campaigns are part of the Department of Defense’s broader efforts to maintain a ready and resilient force.

Treatment and Rehabilitation Options for Army Personnel with Substance Abuse Issues

The US Army provides comprehensive treatment and rehabilitation programs to support personnel struggling with substance use, aiming to enhance overall fitness, effectiveness, and readiness. The Army Behavioral Health Care system tracks treatment outcomes for soldiers, focusing on improvements in PTSD, depression, and anxiety symptoms. As noted in the CRS Reports, this system is part of the broader Military Health System (MHS), which received substantial funding in the DOD budget to deliver health services.

Service members requiring substance use treatment may take extended leave from duty and, in some cases, may face administrative separation. The Army Substance Abuse Program (ASAP) is another key initiative designed to increase individual fitness and enhance unit readiness by providing proactive and responsive services. Additionally, the Army Recovery Care Program (ARCP) assists wounded, ill, and injured soldiers, including those affected by substance use issues.

For more complex cases involving traumatic brain injury and psychological health, the Department of Defense offers specialized research programs, as indicated by the CDMRP. These programs focus on innovative and impactful research to transform health care and provide targeted interventions. The comprehensive nature of these programs underscores the Army’s commitment to addressing substance use and ensuring the well-being and readiness of its personnel.

Addiction Treatment and Mental Health Care for Veterans

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