This Director’s message has been adapted from NIDA NOTES (Volume 22, Number 5 - November 2009.)
With a New Year coming our way, it is a good time to send good wishes to the men and women in the military service. Military experts are concerned that the wars in Iraq and Afghanistan may be precipitating a rise in problems related to substance use and abuse among the military personnel who have been deployed to those fronts. NIDA has joined forces with the Department of Defense, Department of Veterans Affairs, and other Federal agencies in a campaign to assess and find solutions to this threat to the health and well-being of our service men and women, veterans, and their families.
Demographic factors and the military's unique organizational structures, culture, and experiences contribute to service members' overall high prevalence of smoking and binge drinking and low prevalence of illicit substance abuse, when compared with civilian rates. The patterns of tobacco use illustrate the impact that war can have on substance use: Tobacco use is about 50 percent higher among the Nation's active duty military personnel and veterans than in the civilian population. Yet studies reported at a recent NIDA-cosponsored meeting indicate that smoking rates are an additional 50 percent higher among personnel who have served in war zones.
Combat exposure appears to be a primary mediator of the impact of war deployment on substance abuse rates. In one study, one in four veterans of Iraq and Afghanistan reported symptoms of a mental or cognitive disorder; one in six reported symptoms of post-traumatic stress disorder (PTSD). These disorders are strongly associated with substance abuse and dependence, as are other problems experienced by returning military personnel, including sleep disturbances, traumatic brain injury, and violence in relationships.
NIDA research has established effective principles for preventing and treating substance abuse and co-occurring problems and has proven the efficacy of a variety of interventions. This knowledge may provide a basis for reducing substance abuse and its consequences among the military. Modifications may be required, however. Ways will have to be found, for example, to counter some service members' reluctance to seek treatment, which may reflect a cultural emphasis on showing strength rather than needs, or perhaps worries about potential disciplinary consequences. We will need to learn how factors associated with deployment affect service members' risks for substance abuse and their recovery pathways. The high rates of co-occurring PTSD and substance abuse among those who have directly experienced combat have put a premium on research to develop stronger responses to these difficult problems.
NIDA and its coalition partners have issued a call for research on the epidemiology, causes, prevention, and treatment of substance use and abuse and co-occurring problems among service members, veterans, and their families (RFA-DA-10-001 and RFA-DA-10-002). In this and other efforts, NIDA is working with military and mental health specialists to help those who have served the Nation. The RFA will close on December 22nd, and we look forward to reviewing these important proposals.
Sincerely,
Nora D. Volkow, M.D.
Director