As we honor those who have served our country in uniform, we should keep in mind that service men and women are not immune to the substance use problems that affect the rest of society. Indeed, the unique culture of the military and the unique stresses of deployment during wartime create unique problems. The Institute of Medicine (IOM) issued a report on September 17, 2012, examining the state of substance use in the armed forces and making recommendations for how the military can enhance its prevention and treatment efforts.
It is a pressing need. For even though illicit drug use is lower among military personnel than among age-matched civilians, heavy alcohol and tobacco use, and especially prescription drug abuse, are much more prevalent and are on the rise. For example, almost half of active duty service members reported binge drinking in 2008 (the latest year for which data were available)—up significantly from 10 years earlier. The growing abuse of prescription drugs is even more striking: 11 percent of service members reported abusing prescription drugs, mostly painkillers, in 2008, up from 2 percent in 2002 and 4 percent in 2005. As in the society at large, the greater availability of opioid pain medications is likely a major factor in their growing abuse; the number of pain reliever prescriptions written by military physicians quadrupled between 2001 and 2009—to almost 3.8 million.
The IOM report contains many recommendations for how the military can address these problems, including limiting access to alcohol on bases and training healthcare providers to better recognize and screen for substance use problems and refer patients to appropriate, evidence-based treatment. The report notes that many obstacles will need to be overcome, including a lack of available services, inadequate insurance coverage for effective outpatient treatments, and a cultural climate in which drug problems are stigmatized and evoke fear in people suffering from them. For those in the military, discovery can mean a dishonorable discharge. The report emphasizes the need to develop and test targeted substance abuse prevention and treatment interventions and explore the utility of existing evidence-based substance abuse prevention programs and services across the deployment cycle. It also recommends wide adoption throughout the military of a successfully tried Army pilot program for providing confidential treatment.
NIDA provided input to the IOM study, and together with other NIH agencies and the Department of Veterans Affairs, we are supporting research to enhance our understanding of prevention and treatment of substance use and other mental health problems among current and prior service members and their families. Topics include:
- The use and abuse of prescription opioids among combat veterans;
- Treatment integration for the interrelated problems facing returning military personnel, including depression, anxiety, sleep disturbances, and substance abuse;
- Veterans’ treatment-seeking patterns (how and why they do or do not seek out treatment); and
- The benefits of early identification of substance abuse problems among returning veterans.
We have also been involved in initiatives such as the Military Operational Medicine Research Program and the Annual Trauma Spectrum Conference, which last year focused on prevention, diagnosis, treatment, and recovery for those who have served in Iraq and Afghanistan.
NIDA will continue working with the Department of Defense and other agencies to address substance use problems faced by those who bravely serve the Nation in our armed forces.