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Substance Abuse in the Army

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Last Updated - 06/21/2024

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Key Takeaways

  • Substance use in the military, particularly involving alcohol and prescription drugs, remains a significant concern affecting service members and operations.
  • Service members face higher risks of substance use disorders (SUDs) than civilians, with deployment and combat exposure as key risk factors.
  • Efforts to decrease substance use include prevention and treatment programs, such as the Army Substance Abuse Program (ASAP).
  • Alcohol misuse is prevalent in the Army, contributing to behavioral health concerns and incidents that affect unit morale and readiness.
  • Younger, less educated, unmarried male personnel are at a higher risk for substance use, with military life stressors significantly elevating SUD risks.
  • Peer pressure and military culture, which often romanticizes alcohol use, contribute to substance use among army personnel.
  • Substance use has detrimental effects on military personnel and operations, including increased risk for mental health issues and compromised mission effectiveness.
  • The Army has developed strategies for substance use prevention and treatment, focusing on education, deterrence, and health services.

Substance Abuse Among Army Personnel

The prevalence of substance use in the Army is a critical concern, impacting both individual well-being and operational readiness. The National Survey on Drug Use and Health (NSDUH)  by the Substance Abuse and Mental Health Services Administration (SAMHSA) provides valuable insights. However, it does not isolate Army personnel from the general population. Nevertheless, it indicates significant substance use issues within the civilian population that could reflect similar trends in military contexts.

Alcohol Misuse and Behavioral Impacts

According to the US Army’s data, alcohol misuse remains a prevalent issue, contributing to a range of behavioral health concerns and incidents that affect unit morale and readiness. Additionally, research from the National Center for Biotechnology Information (NCBI) suggests that the military’s stringent policies against drug use have led to lower prevalence rates compared to civilian populations. Yet, challenges persist, particularly with prescription drug and alcohol misuse.

Higher Risks in Deployed Personnel

Moreover, studies indicate that service members, particularly those deployed in combat, exhibit higher rates of substance use disorders (SUDs) than civilians. The complexities of military life, including stressors such as combat exposure and reintegration into civilian life, contribute to these elevated risks.

Action Needed: Monitoring and Programs

In light of these findings, it is imperative to continue monitoring substance use trends within the Army and to bolster prevention and treatment programs that address the unique challenges faced by military personnel.

Prevalent Substance Abuse Types in the Army

The types of substances commonly misused by army personnel include alcohol, prescription drugs, illicit drugs, and tobacco products. 

Alcohol Misuse

Alcohol misuse remains a significant issue within the army, contributing to various behavioral health challenges, misconduct, and increased suicidal risk behaviors. Binge drinking and heavy drinking are particularly concerning patterns of alcohol consumption identified among service members.

Prescription Drug Misuse

Prescription drug misuse is also notable, with a history of high prescription rates for pain medications among injured and sick military personnel. While recent data suggest some decrease in prescription opioid and sedative misuse, the non-medical use of prescription drugs remains a concern.

Illicit Drug Use

Illicit drug use is less common due to stringent military policies and deterrents like urinalysis testing. However, the use of substances like marijuana and cocaine, while lower compared to civilian rates, still occurs among service members.

Tobacco Use

Tobacco use, including cigarette smoking and smokeless tobacco, is prevalent in the military. Deployment and combat exposure are risk factors for smoking initiation, despite efforts to reduce tobacco use within the ranks.

Impact and Response

Substance use in the army not only affects individual health and well-being but also impacts unit morale and the overall effectiveness of military operations. Preventive strategies and treatment programs, such as the Navy’s Substance Abuse Rehabilitation Program (SARP) and the Air Force’s ADAPT Program, aim to address these issues by promoting readiness, health, and wellness through education, treatment, and comprehensive support.

Factors Influencing Substance Abuse in Army Personnel

A complex interplay of factors influences substance use within the Army. Demographically, younger, less educated, unmarried male personnel, particularly those of lower military ranks (E1-E3), are at a higher risk for substance use.

Military Stressors

The stressors associated with military life, such as deployment, combat exposure, and the challenges of reintegration into civilian life post-deployment, significantly elevate the risk of substance use disorders (SUDs) among military personnel and veterans. Moreover, those who have experienced trauma or hospitalization during combat are more prone to increased drinking or drug use.

Environmental Factors

Environmental stressors specific to military life also contribute to the risk of SUDs. For instance, nearly 40% of military smokers begin smoking after enlisting, highlighting the need for targeted prevention strategies for new active-duty personnel. The military provides resources like smoking cessation programs and aims for tobacco-free installations.

Prescription Medications

Another factor is the availability of prescription medications. There has been concern over the volume of prescription pain medications provided to injured military personnel, especially during transitions to medical discharge. While self-reported use of prescription opioids and sedatives has decreased, the initial high rate of prescriptions raised questions about the potential for misuse.

Stigma and Barriers to Treatment

Lastly, the stigma associated with seeking help for SUDs and the perceived risk to one’s military career can be significant barriers to receiving treatment. Efforts to reduce stigma, increase access to evidence-based treatment, and support reintegration are crucial in addressing substance use in the Army.

The Link Between Stress, Trauma, and Substance Abuse in Army Personnel

The high-stress environment and traumatic experiences inherent in military service are significant factors contributing to substance use among army personnel. Exposure to combat, witnessing death or injury, and the pressures of military life can lead to psychological distress, which may manifest as posttraumatic stress disorder (PTSD) or other mental health issues.

Studies have shown that up to 23% of post-9/11 service members may have PTSD, with many also experiencing comorbid conditions such as depression, anxiety, and substance use. Research indicates that the rates of PTSD among military personnel are notably higher than those in the general population.

Coping Mechanisms and Substance Use

Substance use disorder (SUD) in the military is often linked to the need to cope with the aftermath of traumatic events and the stress of reintegration into civilian life. The use of substances like alcohol, tobacco, and prescription drugs can become a maladaptive coping mechanism for managing stress and trauma. 

For instance, the National Institute on Drug Abuse reports that veterans are more likely to use alcohol heavily and that 65% of veterans entering treatment programs report alcohol as their most frequently misused substance. Additionally, the incidence of smoking and prescription drug misuse is significant among service members, with deployment and combat exposure being risk factors for substance initiation and use.

Challenges in Intervention

Addressing substance use in military settings requires a nuanced understanding of the unique stressors faced by service members. Interventions must consider the stigma and barriers to seeking help, the importance of trust in therapeutic relationships, and the need for evidence-based practices that are sensitive to military culture. 

The Department of Defense has initiated prevention and cessation programs. Still, the challenge remains to provide comprehensive care that addresses both the psychological impact of military service and the associated risk of SUDs.

The Influence of Peer Pressure and Military Culture on Substance Abuse

Peer pressure and the ingrained culture within the military are significant factors contributing to substance use among army personnel. Military life is often associated with a unique set of social norms and cultural practices that can influence individual behaviors, including substance use. 

The historic romanticization of alcohol use in the military, combined with a culture that may implicitly encourage or tolerate substance use, can create an environment where individuals feel compelled to conform to group behaviors.

Prevalence and Cultural Influences

Research has shown that the prevalence of substance use is higher among military personnel when compared to civilian populations, with alcohol being the most commonly used substance. A systematic narrative review by Osborne et al. (NCBI) highlights the role of cultural and social factors in alcohol use within the military. The review indicates that military characteristics, deployment consequences, and mental health implications all intersect with cultural and social influences to affect substance use behaviors.

Peer Influence

Furthermore, peer influence is one of the strongest predictors of substance use, particularly among younger service members. The pressure to fit in and the desire for social acceptance can lead individuals to engage in risky behaviors, including substance use. This is not unique to the military, as studies on adolescent and emerging adult behavior demonstrate the impact of peer pressure on substance use across various contexts (PubMed).

Balancing Tradition and Responsibility

The military’s acknowledgment of these issues has led to implementing initiatives to promote sensible approaches to alcohol use. Nonetheless, the challenge remains to balance the traditional military culture with the need for healthy and responsible behaviors among service members.

Detrimental Effects of Substance Abuse on Army Personnel and Operations

Substance use within the army has far-reaching implications, both for the individual service members and the operational effectiveness of military units. The prevalence of substance use, particularly alcohol, poses significant challenges to the health and readiness of army personnel.

Negative Outcomes

Substance use can lead to a range of negative outcomes, such as increased risk for mental health issues like depression, posttraumatic stress disorder (PTSD), and traumatic brain injuries (TBI), as highlighted in a meta-analysis.

Alcohol Misuse Statistics

Furthermore, the Army Substance Abuse Program (ASAP) study indicates that alcohol is the most commonly misused substance, with a substantial number of soldiers meeting the criteria for treatment referral post-deployment.

Physical and Mental Health Consequences of Substance Abuse in Army Personnel

Substance use among army personnel has far-reaching consequences on both physical and mental health, impacting individual service members and the broader military community. The prevalence of substance use disorders (SUDs) in the military is associated with an array of negative outcomes, including a heightened risk of suicide, sexual assaults, and other forms of violence, particularly when alcohol is involved. According to the US Army, up to 50% of these incidents are alcohol-related, undermining unit morale and service member well-being.

Mental Health Implications

Mental health is also significantly affected by substance use. Research indicates that service members with SUDs are more likely to experience co-occurring mental health disorders such as post-traumatic stress disorder (PTSD), depression, and anxiety. 

For instance, a study found that a strong military identity is associated with a greater likelihood of non-medical use of prescription drugs (NMUPD) and increased symptoms of anger, generalized anxiety, depression, and PTSD among US Army Reserve and National Guard soldiers.

Physical Health Consequences

Physical health consequences are equally concerning, with increased rates of chronic pain, lumbosacral spine disease, headaches, and hearing loss reported among army personnel with PTSD, as noted in an NCBI Bookshelf resource. 

The physical toll of substance use is further exacerbated by the culture of prescription medication use within the military, particularly opioids for pain management. This has led to a significant financial burden on healthcare systems, such as the Veterans Health Administration (VHA), and underscores the need for comprehensive substance use prevention and treatment strategies within the military.

Impact of Substance Abuse on Army Effectiveness and Safety

Substance use within the army has far-reaching consequences that can significantly undermine military operations and personnel safety. 

Rise in Substance-Related Fatalities

The misuse of substances such as opioids, including fentanyl, has led to a notable increase in overdose deaths, mirroring a national trend. This rise in substance-related fatalities has prompted legislative action, including the requirement for the Pentagon to compile data on overdoses and provide opioid overdose antidotes like naloxone to troops. Military.com reports that the number of military deaths involving fentanyl doubled between 2017 and 2021.

Impaired Judgment and Performance

Substance use can lead to impaired judgment, decreased performance, and an increase in risky behaviors, all of which are detrimental to the operational readiness and effectiveness of the army. The National Center for Biotechnology Information highlights that substance misuse may precipitate psychiatric disorders, negatively affect performance, and is associated with a high rate of suicides and other deaths in the military.

Impact on Unit Cohesion and Morale

Moreover, the use of substances can disrupt the cohesion and morale of military units, essential for maintaining combat effectiveness.

Prevention and Management Strategies

Substance use prevention and management are critical to maintaining the safety and effectiveness of army operations. The Department of Defense operates programs focused on prevention, treatment, and research to combat the issue. 

However, the presence of substance use in military environments continues to pose a significant challenge, emphasizing the need for ongoing and enhanced efforts to address this critical issue within the ranks.

Army’s Strategies for Substance Abuse Prevention and Treatment

The United States Army has developed comprehensive strategies to prevent and treat substance use among its personnel, recognizing the critical impact of substance use on soldier readiness and unit cohesion. 

Army Substance Abuse Prevention Initiatives

The US Army has implemented a multifaceted approach to prevent substance use among its personnel, recognizing the importance of maintaining a fit and ready force. 

Army Substance Abuse Program (ASAP)

The Army Substance Abuse Program (ASAP) is pivotal in this initiative, providing education, deterrence, and various health and wellness services. ASAP’s mission is to enhance the combat readiness and effectiveness of the Army’s workforce by addressing alcohol and other drug use issues.

Department of Defense Campaigns

Further supporting these efforts, the Department of Defense (DoD) has launched several educational campaigns. Too Much To Lose focuses on the risks associated with the misuse of prescription drugs and the use of illicit substances. The campaign aims to protect service members’ health, careers, and well-being. Additionally, the DoD promotes responsible drinking through the Own Your Limits campaign and supports tobacco cessation with the YouCanQuit2 initiative.

Integrated Primary Prevention Approach

The Army also emphasizes integrated primary prevention, which addresses multiple harmful behaviors, such as sexual assault, harassment, domestic abuse, child abuse, and suicide, alongside substance use. This approach, detailed on the Department of Prevention website, focuses on shared risk and protective factors to enhance overall resilience and readiness.

Training and Education

Training and education are also crucial components of prevention. The Joint Staff Alcohol and Substance Abuse Prevention Course, for example, educates service members on the impact of substance use on public health and safety. By providing comprehensive resources and proactive services, the Army seeks to foster a culture of awareness and prevention regarding substance use.

Treatment and Rehabilitation Programs for Substance Abuse in the Army

The Army Substance Abuse Program (ASAP) offers a comprehensive approach to address substance use among Army personnel, providing a variety of treatment and rehabilitation options. Key components include non-clinical policy guidance, clinical care, and coordination with other programs to enhance soldiers’ combat readiness and overall wellness.

Substance Use Disorder Clinical Care (SUDCC)

ASAP’s Substance Use Disorder Clinical Care (SUDCC) provides soldiers with access to assessments, short-term counseling, crisis intervention, and follow-up services. In cases of substance overdose, such as from opioids, the program advises the administration of naloxone, reflecting a commitment to immediate and effective response protocols.

Training Initiatives

Training is another critical aspect of the program, with initiatives like the Applied Suicide Intervention Skills Training (ASIST) and the ‘Ask, Care, Escort’ (ACE) program, which focus on suicide prevention and substance use education. 

The Employee Assistance Program (EAP) further supports civilian employees and military retirees with substance-related challenges, offering a range of services from stress management to coordination with treatment facilities.

Drug-Free Workplace Program

ASAP also manages the Army’s Drug-Free Workplace program, ensuring compliance and providing training for supervisors and employees. The ADAPT course, consisting of 12 hours of material, is designed to intervene with individuals demonstrating high-risk substance use behaviors.

Commitment to Health and Readiness

Overall, the Army’s commitment to preventing and treating substance use is evident through the multifaceted ASAP, which prioritizes the health and effectiveness of its workforce and the combat readiness of its soldiers.

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