Drug and Alcohol Abuse in the Army

Military service can be very stressful, especially for personnel deployed to active combat zones. Sometimes, service members can develop unhealthy behaviors like turning to substances while in active duty, or even after, to deal with stress, pain, and long hours put service members at increased risk of developing alcohol or substance use disorders.

However, many resources are available that meet the specific needs of members of the military (past or present) to help them regain a better, healthier life.

The Army and Substance Abuse

Alcohol and substance use disorders, and even binge drinking, are not a recent phenomenon for the U.S. military, although trends and areas of focus have changed in recent years. The amount and frequency of alcohol misuse continue to increase in all branches of the military, while illegal drug use has declined.1

Instances of substance use disorders involving prescription medication are another issue for service members and veterans. Standardizing pain management and reducing the use and misuse of opioid pain medications, particularly within the Army, remains an important challenge.

Soldiers and Alcohol Use

US army soldiers salutingThe military isn’t just one of the hardest-working professions, they are also the hardest-drinking profession, according to a review of survey data collected from 2013 to 2017 by the Centers for Disease Control and Prevention (CDC).2 Results showed that members of the Armed Forces led all other professions in number of days per year spent drinking, with service members reporting alcohol consumption on 130 days of the year (the average among other professions was 91 days per year).

Worse, this problem is only increasing—over the course of the 4 years in which data was collected, the average number of drinking days per year reported by service members increased by 34 and continues to climb.2

Excessive alcohol consumption is also a large part of daily Army life, particularly among enlisted members. The Department of Defense (DoD) reported that almost 30% of service members in the Army report binge drinking, and almost 35% met criteria for hazardous or disordered drinking (drinking that meets criteria for a possible alcohol use disorder).3

Male Army personnel, especially younger enlisted members, are more likely than their female counterparts to drink excessively (32.2% for Army men aged 18-25 versus 8.2% of Army women of the same age),3,4 although junior officers have the highest rates of hazardous or disordered drinking.3

Binge drinking is defined as having at least 4 (for women) or 5 (for men) drinks in one sitting. Binge drinking is a very common form of excessive alcohol use both in the military and among civilians.

It’s also a very costly form of excess—both financially, due to missed work or damaged property, and personally, in increased health risks and damaged relationships.5 However, while binge drinking does have serious risks, it does not necessarily indicate an alcohol use disorder. Approximately 90% of people who binge drink or drink excessively do not meet the criteria for a diagnosis of an alcohol use disorder.6

Alcohol use disorder is a chronic disease that causes problems in relationships, school, social activities, and in how people think and feel about themselves and about drinking.7

Common signs and symptoms of an alcohol use disorder include:7

  • An inability to limit drinking.
  • Drinking more than intended or drinking for a longer period of time than intended.
  • Continuing to drink even when it is causing personal, school-related, or professional problems.
  • Needing to drink more to get the wanted effects.
  • Being unable to think about anything other than wanting to drink.
  • Having withdrawal symptoms, such as trouble sleeping, restlessness, nausea, anxiety, or depression when the effects of alcohol wear off.

Drug Use in the Army

The physical and psychological stressors of military life can pave the way to the misuse of drugs to cope with pain, stress, or fatigue, especially for soldiers who have been through multiple deployments or suffered a training or combat-related injury.

While the use of illegal drugs is lower in the military than reported rates in the general public, misuse of prescription drugs, particularly opioid pain medication, remains a challenge.8 The highest rates of use and misuse of pain medications are among military personnel serving in the Army.3

According to annual Army reports, approximately 55% of all active-duty soldiers experience at least 1 injury per year, and some have multiple injuries. For female service members, injury is even more prevalent; approximately 66% of female soldiers are diagnosed with an injury each year.9

Prescription drug misuse includes: 10

  • Taking a medication in a way that was not prescribed.
  • Taking an old prescription for a new injury.
  • Sharing medications.
  • Taking the medication to get a “high.”

Misuse can lead to the development of a substance use disorder, or an addiction, to the drug.

A substance use disorder is a chronic, relapsing brain disorder that is characterized by a compulsive desire to get and use a drug, despite the negative consequences involved. Signs of addiction (substance use disorder) include:11

  • Using a medication for longer than prescribed or in larger quantities than prescribed.
  • Being unable to slow or stop use despite repeated attempts.
  • Having cravings or strong urges to use the medication or drug.
  • Spending excessive time getting the drug or recovering afterward.
  • Neglecting family, work, or relationships in favor of drug-seeking or use.
  • Losing interest in social, recreational, or occupational activities.
  • Ignoring the possible danger of a situation in order to get or use the drug.
  • Continuing to use the drug despite negative health consequences.
  • Needing or wanting more of the drug to get the same effect.
  • Experiencing distressing physical or psychological symptoms when a drug wears off.

Drug and Alcohol Abuse Resources for Army Personnel

The Army has a dedicated program (ASAP) to provide proactive treatment for substance use disorders, emphasizing deterrence, prevention, education, and rehabilitation.12

Additional Army-specific information on substance and alcohol use disorders is available on Thin Line, which describes the behaviors on both sides of the thin line dividing prescribed use of a medication and misuse of medication.

This resource also has details on the potential consequences of drug misuse for Army personnel (including dishonorable discharge, court-martial, and loss of military benefits) and has detailed information on the ways Army personnel can self-refer for substance use treatment without suffering negative consequences to their military career.13

The DoD has also expanded treatment options available through TRICARE starting in 2016 to include inpatient residential treatment and medication-assisted treatment for substance use disorder, as well as removing limits on the number of visits allowed for substance use disorder and outpatient treatment.14  More information on substance use disorders and medication-assisted treatment options is available on the TRICARE website.

Additional information on recognizing the signs and symptoms of substance use disorders, as well as resources for treatment of these and other mental disorders can be found on the DoD’s Military OneSource website. You’ll find an online tool to locate treatment facilities in the United States or US Territories for substance use disorder, addiction, and/or mental health problems, provided by the Substance Abuse and Mental Health Services Administration.

Depression, PTSD, and Anxiety: Mental Health Concerns in the Army

Members of the Army undergo physical and psychological stresses that, for some, contribute to the development of mental health disorders; active-duty Army personnel have higher rates of mental health diagnoses than members of any other services.15, 16

Soldiers who experience combat or daily life in a threatening or dangerous area of the world, especially those who experienced long or repeated combat-zone deployments, can develop anxiety disorders or post-traumatic stress disorder (PTSD), a psychological response to the experience of trauma or fearing for one’s safety.

PTSD can also result from surviving an assault, especially sexual assault. Depression is also common among soldiers, particularly post-deployment. Many service members struggle with readjusting to life outside the military and with the experiences and memories they brought home with them.8

PTSD and substance use disorders often co-occur. This is thought to go both ways—military personnel with PTSD are more likely to misuse alcohol or drugs to try to shut down the symptoms of PTSD, and those with a history of alcohol or substance use disorders are more likely to develop PTSD.17

Female service members are more likely to develop PTSD than male service members, although males are more likely to be diagnosed with alcohol or substance use disorders.3, 16

Suicide Among Soldiers

The Veteran’s Crisis Line and Military Crisis Line (1-800-273-8522) is available free of charge to all service members, including members of the National Guard and Reserve. Contact the Military Crisis Line at 800-273-8255, then press 1, or start an online chat by texting 838255.

Suicide is the second-leading cause of death for members of the U.S. military, and the suicide rate of active-duty service members has risen by an average of 6% every year of the last 5.18 The DoD reported that 325 active-duty members died by suicide in 2018 (the highest number since data collection started in 2001). Of those, 139 were active-duty soldiers, an increase from 114 suicide deaths among active-duty soldiers in 2017.19

The high rate of mental health disorders among soldiers and their common co-occurrence with substance use disorders may contribute to these disturbing numbers of death by suicide among active-duty Army personnel. The double blow of mental health and substance use disorders can result in a downward spiral of suicidal thoughts and actions if not diagnosed and treated.

Data from completed suicides of military personnel seem to support the importance of diagnosis and effective treatment of substance use disorders; one study reported that approximately 30% of veteran deaths by suicide followed an episode of alcohol or drug misuse, and it has been suggested that preceding drug or alcohol misuse was involved in up to 45% of suicide attempts.20

Other Crisis Resources

The National Suicide Prevention Hotline (1-800-273-8255) or TTY: 1-800-799-4889 is a 24-hour suicide prevention service freely available to anyone in suicidal crisis. Calls are routed to the closest possible crisis center to the caller’s location. All calls are free and confidential.

TRICARE provides a list of crisis resources on its website, all free of charge for military personnel and veterans in need.

Help for Veterans Through American Addiction Centers

Recovery First has a rehab program specifically designed to provide treatment for military veterans with mental health issues, such as PTSD, and substance use disorders.

The Salute to Recovery program was created for military veterans and first responders who are struggling with substance use and mental health challenges and want to reclaim their lives and their health.

The evidence-based treatment program offers a number of therapy options, including eye movement desensitization and reprocessing, which has been shown to help veterans process traumatic events experienced during service, as well as other negative experiences since. Among other innovative and proven therapies, Recovery First’s military veteran rehab program includes cognitive-behavioral therapy and a pain management group to address the long-term consequences that service-related injuries can have on a veteran’s mental and physical health.

 

Resources:

  1. Military.com (2018). Binge-drinking rates are highest in these military services.
  2. Military.com (2020). US military is America’s heaviest-drinking profession, survey finds.
  3. Meadows, S.O., Engel, C.C., Collins, R.L., Beckman, R.L., Cefalu, M., Hawes-Dawson, J., Waymouth, M., Kress, A.M., Sontag-Padilla, L., Ramchand, R., and Williams, K.M. (2018). 2015 Health related behaviors survey: Substance use among U.S. active-duty service members.
  4. Ames, G. and Cunradi, C. (n.d.) National Institute on Alcohol Abuse and Alcoholism: Alcohol use and preventing alcohol-related problems among young adults in the military.
  5. Centers for Disease Control and Prevention. (2020). Alcohol and public health: Binge drinking.
  6. Centers for Disease Control and Prevention. (2020). Alcohol and public health: Frequently asked questions.
  7. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol use disorder.
  8. National Institute on Drug Abuse. (2019). Substance use and military life.
  9. Army. (2019). 2018 health of the force report.
  10. National Institute on Drug Abuse. (2018). Misuse of prescription drugs.
  11. National Association of Addiction Treatment Providers. (2016). Warning signs of substance misuse and substance use disorder.
  12. Army. (2019). Army Substance Abuse Program (ASAP).
  13. Army. (2019.) Thin line.
  14. TRICARE. (2020). Struggling with a substance use disorder? TRICARE has you covered.
  15. Deployment Health Clinical Center. (2017). Mental health disorder prevalence among active duty service members in the military health system, fiscal years 2005-2016).
  16. Military.com. (2019). Mental health disorders in troops far below national average.
  17. U.S. Department of Veterans Affairs. (2019). PTSD: National Center for PTSD.
  18. MilitaryTimes.(2019). Active duty suicides are on the rise, as the Pentagon works on new messaging and strategy.
  19. ArmyTimes. (2019). Suicides among active-duty soldiers are up about 20 percent.
  20. Larson M.J., Wooten N.R., Adams R.S., and Merrick E.L. (2012). Military combat deployments and substance use: Review and future directions. Journal of Social Work Practice in the Addictions. 2012;12(1):6-27.