US Army Substance Abuse: Impact, Risk Factors & Treatment

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.

What Is the Prevalence of Substance Abuse in the Army?

The prevalence of substance use within the Army reflects both the inherent stresses of military life and the unique experiences of service members. Data indicates significant issues with tobacco, alcohol, and prescription drugs, necessitating targeted prevention and treatment strategies.

• Tobacco Use: While smoking rates decreased from 2011 to 2015, many service members start smoking after enlisting. The Department of Defense implements smoking cessation programs and aims for tobacco-free installations.
• Alcohol Misuse: Alcohol remains the most frequently misused substance, with a high number of veterans entering treatment citing it as their primary concern. Rates of alcohol misuse among veterans are nearly double those of the general population.
• Prescription Drug Misuse: Although there has been a decline, prescription drug misuse remains problematic, especially among those transitioning to medical discharge or with combat-related injuries.
• Substance Use Disorders (SUDs): Military personnel, including deployed members, have higher rates of SUDs compared to civilians. PTSD and SUDs often co-occur, necessitating integrated treatment approaches.
• Intervention and Treatment: The Army provides various resources for service members and families to address substance abuse, aiming to mitigate its impact on health and military readiness.

Prevalence of Substance Abuse Among Army Personnel

The issue of substance use among Army personnel is multifaceted:

• Recent Trends: There has been a decrease in tobacco use but challenges remain with alcohol and prescription drugs.
• Alcohol Use: Veterans exhibit higher rates of alcohol use and heavy drinking compared to civilians, impacting overall health and readiness.
• Prescription Drugs: Misuse rates have shown some decline, yet misuse remains a concern, particularly post-discharge.
• Impact on Readiness: Substance use affects unit morale, behavioral health, and operational effectiveness.
• Opioid Crisis: The military is responding to the opioid crisis by tracking overdoses and providing naloxone to troops, acknowledging the need for proactive measures.

Contributing Factors: Substance Abuse in the Army

Substance use within the Army is influenced by various complex factors, including stress, PTSD, and military culture. 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.

Stress, PTSD, and Substance Abuse in Army Personnel

• Stress and Combat: Military life involves unique stressors such as combat and reintegration challenges, contributing significantly to substance use issues.
• PTSD and Substance Use: According to a report by the Army, there is a strong correlation between PTSD and substance use among Army personnel. Those experiencing combat stress or PTSD are at higher risk for substance abuse. 
• Depression and Substance Misuse: Research from the National Center for Biotechnology Information (NCBI) reveals depression, often linked to stress and PTSD, is prevalent among military personnel and contributes to substance misuse.
• Comorbidity with AUD: PTSD and alcohol use disorder commonly co-occur in military populations, complicating treatment and recovery.
• Self-Medication Hypothesis: Individuals with unresolved PTSD may use substances as coping mechanisms, increasing the likelihood of substance misuse relapse.

Military Culture: Its Influence on Substance Abuse Incidence

• Cultural Norms: 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. 
• Prevalence of Alcohol Misuse: Research indicates that the prevalence of hazardous alcohol use behaviors is notably higher in the military compared to civilian populations (SAMHSA, 2019).
• Challenges Posed: Alcohol misuse within the military contributes to behavioral health issues and high-risk behaviors, impacting overall readiness (Milliken, 2022).

Addressing Substance Abuse in the Military

Efforts to combat substance abuse must consider the impact of military culture and the challenges posed by stress and PTSD:

• Holistic Approaches: Addressing combat exposure, moral injury, and military sexual trauma is crucial for mitigating PTSD and substance use risks.
• Intervention Strategies: Develop tailored prevention and intervention strategies that acknowledge the normalization of alcohol use and reduce stigma associated with seeking help.

Impact of Substance Abuse: Army Personnel & Military Operations

Substance use within the Army significantly affects both individual soldiers and broader military operations.

Health and Career Consequences 

• Substance Use Disorders (SUDs): Service members, particularly combat-exposed individuals, are at increased risk of developing SUDs, often alongside conditions like PTSD.
• Health Issues: Substance use, including tobacco, alcohol, and prescription drugs, contributes to various health problems, impacting healthcare costs and service delivery.
• Mental Health: Substance misuse exacerbates mental health disorders such as PTSD, depression, and anxiety, affecting soldiers’ well-being and operational effectiveness.
• Career Impact: Substance abuse can lead to disciplinary actions, career limitations, or discharge, affecting military readiness and unit cohesion.
• Treatment Programs: The Army implements prevention and treatment programs, yet stigma and career concerns hinder soldiers from seeking help.

Army Operations and Readiness

• Operational Effectiveness: Substance use undermines military readiness by impairing performance, discipline, and standards maintenance, according to the National Center for Biotechnology Information. Furthermore, the Army’s Substance Abuse Program (ASAP) acknowledges that substance use detracts from the overall fitness and effectiveness of the Army’s workforce. 
• Substance Use Trends: The US Army has reported alcohol misuse is prevalent despite prevention efforts, impacting absenteeism, attrition rates, and unit morale, 
• Opioid Overuse: 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.
• Unit Cohesion: Substance use-related issues create staffing gaps and reduce unit cohesion, posing challenges to mission effectiveness. 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.

Efforts to Address Substance Abuse

• Prevention and Intervention: Ongoing efforts focus on early identification, responsible behavior promotion, and counseling services provision.
• Policy and Support: The Army continues to combat substance misuse through policy initiatives and support services like the Army Substance Abuse Program (ASAP).

Prevention & Treatment Strategies: Substance Abuse in the Army

The US Army employs a comprehensive approach to address substance use among its personnel, focusing on prevention, treatment, and ongoing research initiatives.

Prevention Initiatives

• Program Overview: The Department of Defense (DOD) operates programs targeting prevention, treatment, and research related to alcohol, illicit drugs, and prescription drug misuse.
• Army Substance Abuse Program (ASAP): Coordinates non-clinical alcohol and drug policy issues, offering prevention, education, treatment, and testing programs. Collaborates with Suicide Prevention Task Force and Community Health Promotion Council (CHPC) to mitigate high-risk behaviors.

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.
• Educational Campaigns: Initiatives like ‘Too Much To Lose’ educate on prescription and illicit drug risks, while ‘YouCanQuit2’ supports tobacco cessation, contributing to a ready and resilient force.

Treatment and Rehabilitation Options: Army Personnel with Substance Abuse Issues

Treatment and Rehabilitation Options

• Comprehensive Support: The Army offers treatment and rehabilitation to enhance fitness, effectiveness, and readiness.
• Army Behavioral Health Care System: Tracks treatment outcomes, focusing on improving PTSD, depression, and anxiety symptoms.
• Administrative Actions: Service members requiring treatment may take extended leave or face administrative separation depending on circumstances.
• Army Recovery Care Program (ARCP): Supports wounded, ill, and injured soldiers, including those with substance use issues.
• Specialized Research: The Department of Defense conducts research on traumatic brain injury and psychological health through programs like the Congressionally Directed Medical Research Programs (CDMRP), aiming for innovative interventions and improved healthcare.

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