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Indiana Prevention Resource Center (IPRC)

Military and Behavioral Health Problems: Substance Abuse and Problem Gambling

This article is the third in a series of three articles on the military leading up to Memorial Day of 2012.

Substance abuse is a key concern for active military and veterans, and for their families. The stresses of military service, of combat, and of reintegration upon returning home are all contributors to increased risk for substance abuse and other behavioral health problems. Last week’s article on this topic discussed mental health issues facing military personnel. This week’s topic is closely related.  (The resources and publications mentioned in this article can be found in the IPRC searchable database of online resources, www.vetresources.org, also linked from IPRC homepage.)

Source: http://www.cchrint.org/2011/01/18/militarys-drug-policy-threatens-troops-health-doctors-say/

Alcohol Abuse. The most commonly abused drug among soldiers is alcohol. Twenty-seven percent of Army soldiers were found to meet criteria for referral to treatment when screened within 3-4 months after returning home from service in Iraq. These soldiers were found to be at high risk for such harmful behaviors as drinking while driving and use of illicit drugs. One recommendation from NIDA is for increased screening, which could result in a decrease in alcohol-related problems. (NIDA, 2011)

The study, Army 2020, released in 2012 found that many military personnel try to keep their drug and mental health problems hidden. They eventually become manifest in such behaviors as domestic violence, which increased among military personnel by 33% from 2006 to 2011. The same study found that the association between alcohol abuse and domestic violence rose by 54%. Also disturbing is the study’s finding that up to 43% of active-duty military self-reported binge drinking within the past 30 days.  (Army, 2012) According to Army Vice Chief of Staff, Gen. Peter W. Chiarelli, persons suffering from untreated post-traumatic stress often drink to self-medicate. (McIlvaine, 2012)  

This finding was recently confirmed in a study by Brandon Marshall of Columbia University who studied members of the Ohio Army National Guard. Among the 963 surveyed he found there was a high risk that soldiers who had never abused alcohol before assignment to active duty would develop alcohol abuse (12%) either during deployment or afterwards. (Preidt, 2012)

The Department of Defense Army Substance Abuse Program recognizes the value of screening and participated in National Alcohol Screening Day on April 5, 2012. Efforts are being made to peel away the stigma associated with drug and mental health problems, and there are signs these efforts are resulting in a decrease in stigmatization and an increase in soldiers seeking treatment. (McIlvaine, 2012)

Another example of a tool created to assist in this area is the extensive infographic online from Military Pathways® that helps a person decide if they have a drinking problem and, if so, how to slow down, or if they cannot control their drinking, how to connect with a 12-step program or other help. (Screening for Mental Health, Inc.) .

Prescription Drug Abuse. Prescription drug abuse has soared among military personnel, having doubled from 2002 to 2005 and then almost tripled from 2005 to 2008. (NIDA, 2011) According to a Department of Defense study of military lifestyle, while the overall civilian rates of prescription drug misuse for all populations of civilians was 4.4%, the rate for the Department of Defense was 11.7%, over two-and-a-half times higher than the civilian rate. The rate for the Army branch of the military was highest at 15.6% for men of all ages and 18.8% for women of all ages, nearly 3.5 times higher than the civilian rate. While the rate of misuse for civilians dropped sharply after age 25 and continued to drop as age increased, for the all military branches the rate rose with age to a high of 13% for male military ages 46-64 (the highest age group studied), compared to 1.7% for male civilians and to 12.8% for female military, versus 2.4% for female civilians. Rates for the Army branch were even higher. (DoD, 2009)

More recently, a study released by the Department of Defense’s  Inspector General found a significant problem with overmedication of soldiers recovering from combat injuries. Wounded Warrier Battalions are special units of the military to which severely wounded service members can be reassigned after their return to the U.S. There are over three dozen such units which for recovery while continuing their military career. The Pentagon recently recognized that over use of prescription drugs is a serious problem in these units. Overmedication can take the form of multiple medications that result in excessive dosages. The meds may be taken for different or the same condition. The Army is moving to correct the situation, using a computerized patient database method currently employed at the Wounded Warrior Battalion in Fort Sam Houston, Texas. Similar monitoring systems are being considered by the Navy and Marines. (DoD, 2012)

Tobacco Use. After having decreased over the past two decades, smoking rates among the military have risen again since 1998. (IoM, 2009; Jahnke, SA, et al, 2010). Smoking prevalence decreased from 51% in 1988 to 31% in 2008. (DoD, 2009) Tobacco use in the short-term impairs military readiness and in the long-term causes serious health problems and premature death. Less than 20% of Americans use tobacco, but more than 30% of active-duty and 22% of veterans use it. It is a goal of the DoD and theArmy, Navy, Marine Corps and Air Force to be tobacco-free. The IOM has recommended that the DoD set a timeline for all military installations for the benefit of both military and civilians. (IOM, 2009)

Like alcohol use, tobacco use often begins after entering the military. One study estimates that up to 40% of junior enlisted smokers began smoking after joining. (Hoffman, et al, 2008) Another reports that 30% of current military personnel who smoke began after joining. (Jahnke, Sara, et al, 2011) The Department of Defense Health Survey found that smoking prevalence was highest among the Marines at about 37%, with the lowest rate in the Air Force and an overall rate of 31% for deployed service members and 29% for non-deployed.  (DoD, 2008) In 2009 tobacco use in the Marine Corps alone was estimated to have cost the DoD "$51 million … in direct medical expenses and $8.1 million in lost productivity and absenteeism." (ENC, 2010)

Just as rates of prevalence differ across branches of the service, they also differ by gender. Males smoke more than females. With the exception of nonmedical use of prescription drugs, young female veterans have been found to use most substances, including cigarettes, at rates lower than males of the same age, so that while 40.9% of male veterans smoke cigarettes, 33.4% of female veterans do. (SAMHSA, 2010)  These figures compare to 21.5% and 17.3% of adult U.S. men and women in 2010 (CDC, 2011) [Adult Cigarette Smoking in US] It is a goal of the DoD and theArmy, Navy, Marine Corps and Air Force to be tobacco-free. The IOM has recommended that the DoD set a timeline for all military installations for the benefit of both military and civilians. (IOM, 2009) While a complete ban on smoking on military installations has been recommended, there is concern among some experts and military personnel about unintended consequences that could result from a complete ban. (Jahnke, Sara, et al, 2010)

Problem Gambling is another issue of concern. Some research has found problem gambling to be more prevalent among veterans with PTSD (Dirk, 2005) Research on pathological gambling among American Indian and Hispanic American veterans found both groups to have higher rates than their civilian counterparts. (Westermeyer, et al, 2005). Having a high score for PTSD symptoms has been associated with greater impulsivity and other symptoms that put this population at greater risk for problem gambling (Ledgerwood and Petry, 2006)

The Department of Defense has made great strides in the promotion of decreasing stigma associated with substance use and mental health issues. The military has mandated that treatment services be available on each and every military installation. There any member of the military has access to both counseling and medical treatment, including for tobacco cessation. Through health surveys, educational campaigns, and provision of treatment services, the military is striving to reduce and eliminate substance use and mental health problems.

Select Bibliography

CDC. Smoking & Tobacco Use: Adults Cigarette Smoking in the United States: Current Estimate. (2011) Accessed 5-17-2012 at http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm

ENC Today. Smokeout’ Highlights Tobacco Problem among Active, Former Military (Nov. 18, 2010) Accessed 5-3-2012 at http://www.enctoday.com/articles/tobacco-84902-jdn-favor-american.html

Hoffman, KM, Haddock CK, Poston WS, Taylor JE, Lando HA, and Shelton S. “A Formative Examination of Messages That Discourage Tobacco Use among Junior Enlisted Members of the United States Military.” Nicotine & Tobacco Research (2008) Accessed at: http://www.ncbi.nlm.nih.gov/pubmed/18418788

Institute of Medicine. Combating Tobacco in Military and Veteran Populations (IoM Report Brief, June 2009) Accessed 5-3-2012 at : http://www.iom.edu/~/media/Files/Report%20Files/2009/MilitarySmokingCessation/Combating%20Tobacco%20Military%20for%20web.pdf

Jahnke, SA, Haddock, CK, Poston WS, Hoffman KM, Hughey J, and Lando HA. “A Qualitative Analysis of the Tobacco Control Climate in the U.S. Military,” Nicotine & Tobacco Research (2010). Accessed 5-17-2012 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816195/

Jahnke, SA, Hoffman KM , Haddock CK, Long MA, Williams LN, Lando HA, and Poston WS. “Military Tobacco Policies: The Good, the Bad, and the Ugly,” Military Medicine (2011) Accessed 5-17-2012 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282985/?tool=pubmed

NIDA. Substance Abuse among the Military, Veterans, and Their Families – April 2011,” Topics in Brief. (2011) Accessed 5-2-2012 at http://www.drugs.indiana.edu/repository/veterans.pdf

SAMHSA. Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment. 2011. Accessed 5-2-2012 at http://www.youtube.com/watch?v=1n2QZlheuzc

SAMHSA. “Female Veterans Aged 20 to 39 Less Likely to Use Most Substances than Male Counterparts,” Data Spotlight (November 11, 2010). http://oas.samhsa.gov/spotlight/FemaleVeterans.pdf

U.S. Department of Defense (DoD) Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel. 2008. Accessed 4-16-2012 at: http://www.tricare.mil/tma/studiesEval.aspx

McIlvaine, Rob. “Army Study Shows Decline in Behavioral Health Stigma,” News, American Forces Press Service, Jan. 20, 2012. Accessed on 5-3-2012 at http://www.defense.gov/news/newsarticle.aspx?id=66871

Military Pathways®. “Do You Have a Problem with Drinking?” 2012 Accessed on 5-3-2012 at http://www.militarymentalhealth.org/blog/2012/04/what-exactly-is-alcohol-abuse-who-has-a-problem/

Mulrine, Anna. Army Report: Suicide Rate sets record; some alcohol abuse up 54%, The Christian Science Monitor, Jan. 20, 2012. Accessed 5-3-2012 at: http://www.csmonitor.com/USA/Military/2012/0120/Army-report-Suicide-rate-sets-record-some-alcohol-abuse-up-54-percent

National Public Radio (NPR). Wounded Warriors Face New Enemy: Overmedication. 2012. Accessed 4-28-2012 at http://www.npr.org/2012/04/26/151443507/wounded-warriors-face-new-enemy-over-medication

Preidt, Robert. Soldiers with Post-Traumatic Stress, Depression Might Self-Medicate, Research Suggests, HealthDay, Feb. 20, 2012. Access on 5-3-2012 at http://www.nlm.nih.gov/medlineplus/news/fullstory_122112.html

Screening for Mental Health, Inc. Military Pathways®. “Information on Alcoholism & Alcohol Abuse” 2012 Accessed on 5-3-2012 at http://www.militarymentalhealth.org/alcohol_abuse_facts/

U.S. Department of the Army. “Army 2020: Generating Health And Discipline in the Force Ahead of the Strategic Reset, Report 2012,” 2012. Access 5-3-2012 at: http://usarmy.vo.llnwd.net/e2/c/downloads/232541.pdf

U.S. Department of Defense, Inspector General. Assessment of DoD Wounded Warrior Matters -- Camp LeJeune (2012). Accessed 5-1-2012 at  http://www.dodig.mil/spo/Reports/DODIG-2012-067.pdf

By Barbara Seitz de Martinez, 5/21/2012