Discussions of addiction in the military often bring to mind the Vietnam War. Many soldiers developed crippling addictions during this conflict, which resulted in thousands of casualties. Hundreds of thousands, according to some estimates. Drugs such as heroin and marijuana enabled our troops to numb themselves from the horrors of war, a need which was most visceral in the face of the atrocities occurring all around them. But addiction in the military did not end when the last of our troops boarded the chopper home. It persists today, and we regularly encounter veterans of Iraq and Afghanistan who continue to suffer.
Given the persistence of this problem, it seems prudent to discuss the possible causes. We also wish to address the extent of the problem today, and how the issue may be handled effectively.
Causes of Addiction in the Military
While we may focus on the horrors of warfare, both positive and negative triggers can lead to substance use. This is noted in the fourth issue of AA’s Grapevine magazine (published in 1944, near the end of World War II). A contributor, Bill X., writes that the stress of the invasion led him to slip into drunkenness. At the time, he had also “just been promoted to sergeant, and that in itself calls for a little good-humored drink of celebration or possibly two, in itself.”
This style of justification occurred often during his drinking sprees. He reasoned that he was “hundreds of miles from the action,” that his drinking was not as harmful as “the thousands of casualties on the beachhead.” Furthermore, he believed that no one would notice his inebriation in the midst of “such a catastrophic, world-shaking event.”
Another Grapevine contributor, John S., wrote in December of 2010 about his own struggles with addiction in the military. He drank at his post. He drank on medical leave. Yet he never worried about it. “I had made a few friends on the post and they would see me drinking,” wrote John, “but it was not a problem, as I was a functional drinker.”
The sheer stress of warfare is a well-known causes of substance abuse in active duty. But what about the soldiers who begin using after their return home? In these cases, one of the most commonly cited causes of addiction and alcoholism is post-traumatic stress disorder, or PTSD. Due to what some have labeled “the happy hour effect,” stress-related drinking will usually spike after trauma rather than during.
Another possible cause of addiction in the military is traumatic brain injury, or TBI. Studies on both TBI and substance use disorders show that their relationship is often a two-way street. Those who abuse drugs and alcohol prior to injury are more likely to increase their use after injury is sustained. Meanwhile, prior use also increases the risk of TBI, especially if intoxicated at the time of injury. Furthermore, cognitive deficits arising from such injury may lead to drinking or drug abuse as a result of impaired decision-making.
Even injuries that do not lead to such cognitive deficits may still result in addiction, as in cases resulting in chronic pain. The National Institute on Drug Abuse notes that it can be a bit difficult to predict the likelihood that chronic pain will lead to addiction, with estimates ranging from 3% to 40%. Sometimes the sufferer will seek methods of self-medication on their own. Other times they will become addicted after the pain has been treated through addictive prescription drugs.
This actually brings us to the last cause of addiction in the military that we will discuss. Currently, many develop addiction due to the heavy use of pharmaceuticals to treat a wide array of symptoms. Air Force personnel acknowledge this problem, in light of numerous sudden deaths and suicides over the past ten years. “You get a cocktail,” Lt. Col. Charles Ruby told The American Conservative, “and it’s usually a sleeping pill, anti-anxiety medication, an anti-depressant, and an anti-psychotic—and sometimes even a stimulant like Ritalin or Adderall.” As the military becomes increasingly dependent on these pharmaceutical cocktails, so too will the men and women who serve them.
The Extent of the Problem Today
The issue of addiction in the military has had some very negative effects on our troops. Not only have there been rises in suicides and sudden deaths over the past decade, but suicide rates in the armed forces are actually beginning to rival suicide rates among civilians. The National Institute on Drug Abuse notes that suicide rates in the United States Army surpassed civilian suicide rates in 2008. In 2010, the Army Suicide Prevention Task discovered that approximately 29% of Army suicides between 2005 and 2009 were substance-related. In 2009, approximately one-third of those suicides were related specifically to prescription drugs.
Prescription drugs seem to be the primary offender as far as addiction in the military is concerned. Regarding illicit drugs in general, the 2008 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel found that only 2.3% of surveyed personnel members were recent users (3.9% aged 18-25). By contrast, 12% of civilians (17.2% aged 18-25) had admitted to using within a month of that same survey. With prescription drugs, however, 11% of surveyed military personnel were found to have been using. This is actually much higher than the civilian rate. It also indicates a major spike in use, up from 2% in 2002 and 4% in 2005. This matches an overall spike in prescription drug overdoses in the past several years, as prescription overdose deaths have risen from just 4,000 in 1999 to 14,800 in 2008.
Aside from prescription drug use, one of the major concerns for the military is binge drinking. The stresses of war, the loneliness of being away from home and family, and the long waiting periods on base are all contributors to the need for escapism. But with a zero-tolerance policy enacted since 1982, the worry of random drug screens, and the threat of being court marshalled or dishonorably discharged, it stands to reason that most members of our military would be smart enough to avoid illicit drugs. According to WebMD, nearly 47% of military personnel are prone to binge drinking.
Since one of the common causes of addiction in the military is PTSD, a discussion of the current extent of the addiction problem would be incomplete without an assessment of how widespread PTSD has become. Between Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom in Iraq, massive quantities of troops have been deployed in the Middle East. Almost all of them have been shot at and have seen dead bodies. Most of them have been ambushed and been subjected to mortar fire. And a great deal of them know someone who has been killed or seriously injured. This is especially true of those who have served in Iraq. The United States Department of Veteran Affairs estimates that up to 18% of these veterans now suffer from PTSD. Up to 25% also suffer from depression, and many are prone to excessive drinking.
These circumstances are troubling. Especially considering that, of 1 million troops who left active duty between 2002 and 2009, only 46% sought VA health services. Given that 48% of them were diagnosed with mental health issues, one might assume that nearly half of untreated veterans are in a similar bind. This may seem like a far-fetched extrapolation, and it quite possibly is. Still, the fact of the matter is that many veterans who developed addiction in the military are likely untreated. And many of those same veterans are likely suffering from severe co-occurring disorders of addiction and alcoholism.
The fact that there is no solid data on just how many veterans are suffering from this tempest of mental and physical turmoil indicates that we truly do not know just how many veterans are in need of treatment. This is a truly frightening circumstance for both our veterans and their families.
How Can This Problem Be Rectified?
In our article on the myth of the geographical cure, we made mention of the Vietnam War. Specifically, we mentioned the fact that approximately 95% of soldiers addicted to heroin had recovered upon their return home. We didn’t necessarily agree that environment is the sole determinant of addiction; however, we did agree that a positive environment could be beneficial to addiction recovery. Unfortunately, addiction in the military is a bit more complicated. The war on substance abuse among our troops is essentially a war fought on two fronts. We cannot handle the addictions of veterans through the exact same means by which we handle the addictions of active military personnel.
We’ll begin by speaking of active military personnel. Those who abuse substances while on active duty are not necessarily addicts in the sense we often think of them. They are not necessarily people with a crippling ailment that will follow them for life. Instead, some of them merely people who found a way of numbing themselves in a stressful situation. Many of these types quit using upon returning to the States.
Those who become full-blown addicts and alcoholics, however, often continue using at home if their affliction remains untreated. But for some, an environmental change might actually work. This is explained by psychologist David Neal, who states: “People, when they perform a behavior a lot—especially in the same environment, same sort of physical setting—outsource the control of the behavior to the environment.”
In other words, geographical cures may work better for military personnel than for civilians. They often use in a specific setting, and they leave this setting upon the end of their deployment. Meanwhile, civilians often use in a wide variety of locations. Such locations may include bars, parties, flophouses, and other various locations where they have elected to use their substance of choice. This means that civilians are not as likely to “outsource” their control in the fashion Neal describes. For them, the geographical cure is a hopeless fantasy.
The same goes for veterans who continue their substance abuse upon their return home. For such veterans, we must often rely on general methods. We must hope that we can achieve staging a successful intervention, so that they may receive the treatment they need at a qualified facility. If helps if they are willing to seek the help of VA services. Many facilities specialize in the treatment of addicted servicemen and women. The VA can connect them with such facilities.
Of course, the issue may become complicated when a mental disorder such as PTSD is involved. Whether active or retired, military personnel with PTSD will likely need the aid of a dual diagnosis facility. It has been found in recent years that one of the best methods of fighting PTSD and addiction simultaneously is exposure therapy. This is where the sufferer is exposed to reminders of the circumstances that caused their trauma. Through their exposure, they learn to desensitize and to lessen the degree of trauma that rises to the surface when uncomfortable memories are triggered. As the trauma subsides, their need to abuse chemicals will begin to subside as well.
There is another treatment for PTSD as well, known as EMDR trauma therapy. This form of therapy uses coordinated eye movements to help the trauma sufferer relive their troubling memories without experiencing the same internal turmoil generally associated with them. EMDR is a little newer, but more than twenty clinical trials to date support its use. We provide access to this and other forms of trauma therapy in our programs, as many addicts suffer trauma. Veterans seeking aid at our facilities should inquire about our forms of trauma therapy, as they often prove beneficial.
Addiction in the military is a troubling issue, and it isn’t going away any time soon. In a perfect world, there would be less dependence on potentially addictive pharmaceuticals, and there would be more insistence on ensuring that our veterans meet with VA health services to assess their state of mind upon returning home. In a truly perfect world, the members of our armed forces would not be so frequently exposed to the horrors of mankind that develop their depression, PTSD, and other causes of addiction in the first place. Without such a world, we are forced to handle addiction in the military on an individual basis.