How the Military Stumbled in Treating Substance Abuse

We welcome you to weigh in with your comments on Bingham's latest blog, 'How the Military Stumbled in Treating Substance Abuse' his critique on the Institute of Medicine's latest report, 'Substance Use Disorders in the U.S. Armed Forces'.

In its latest report entitled “Substance Use Disorders in the U.S. Armed Forces,” the Institute of Medicine tells us mostly what we already know:  the military has a drinking problem, a growing painkiller problem, and outdated recovery options for those with substance abuse troubles.  The report goes so far as to decree that alcohol and drug use in the armed forces represents a public health crisis.  Barriers inherent to the military that limit access to treatment for substance abuse include a lack of availability of rehabilitation services, gaps in TRICARE coverage, stigma, fear of negative consequences, and lack of confidential services.

In 2008, according to the report, 47% of active duty service members engaged in binge drinking, and 11% reported misusing prescription drugs.  These figures are staggering.  But consider this:  thanks to a prevailing attitude of “keep-your-personal-problems-to-yourself” in the military, combined with the fear that an honest response on an anonymous survey would somehow be attributed to a particular individual, there is a significant bias for troops to underreport their risky behaviors like drinking and drugging.  Simply put, the actual statistics are probably much worse than reported.

Substance use and abuse is often borne of war.  Dating back to the Civil War and beyond, soldiers that return from combat are particularly vulnerable to seeking refuge from a bottle.  Whether it’s full of whiskey or Hydrocodone pills, turning to the bottle for relief can be a natural response to allay the stress, anxiety, shame, and guilt brought home from war. 

After 11 years of combat along two fronts, our military is over-deployed, over-tired, and over-stressed.  An estimated 20% of our returning veterans come home from Iraq and Afghanistan with post-traumatic stress disorder (PTSD).  40% of these warriors with PTSD are prescribed both painkillers and benzodiazepines (addictive anti-anxiety medication) by military and VA doctors – it’s no surprise, then, that substance use and abuse is becoming a bigger and bigger problem within the military. 

Soldiers, sailors and Marines by and large aren’t going to drug dealers to buy illegal drugs; instead, they are going to their military doctors to receive legal, yet potent, drugs.  Oftentimes these doctors are quick to write prescriptions for powerful narcotics, regardless of the medications’ dangerous side effects, because they feel obligated to lessen their suffering patients’ misery.  In 2009 alone, military physicians wrote nearly 3.8 million prescriptions for pain medication (which equates to more than 2.5 prescriptions per active duty service member).     

The report provides recommendations for dealing with the growing substance abuse problem within the military.  One particular recommendation sounds promising:  “Health care professionals at all levels need training in recognizing worrisome patterns of substance abuse and misuse and clear guidelines for referring patients to specialists such as pain management experts and mental health providers.”  Although it’s hard to believe, many general practitioner physicians that write prescriptions for narcotic pain meds are not well versed in the side effects and hyper-addictive qualities of these medications.  Subsequently, without proper training, the very doctors that prescribe these powerful medications can miss clear signals that their patients are becoming addicted.

Other recommendations I believe are unlikely to succeed:  “The armed forces should enforce regulations on underage drinking, reduce the number of outlets that sell alcohol on bases, and limit their hours of operation.”  Limiting the amount and availability of alcohol on military bases will be about as effective at tempering alcohol intake as Mayor Bloomberg’s campaign against large sodas in New York City will be at keeping people from getting fat.  If people are thirsty (for booze or for soda), they will find a way to indulge themselves, regardless of edicts that limit the supply of their “fix.” 

Thankfully, the experts agree that substance abuse does not happen in a vacuum, and is more often than not experienced alongside PTSD and/or depression.  Since these afflictions tend to occur together, they should be treated concurrently as well.  According to the report, “The emerging model of care relies on multidisciplinary treatment teams with carefully prescribed roles and training.”  Unfortunately, the military is lacking in joint PTSD/substance abuse rehabilitation options.  The treatments are generally either for PTSD or for addiction, but not for both. 

The need for Veterans Healing Initiative (VHI), and the dual-diagnosis treatment centers they provide, has never been greater.  VHI offers confidential, dual-diagnosis treatment for PTSD and substance abuse that can be free of charge to veterans from any conflict – within a safe and friendly environment, veterans are able to finally take charge of their problems and find serenity in their lives.    

VHI’s model of care can be the solution, but only after military leaders begin encouraging their troops to freely seek the help they need without fear of reprisal.  Only then may we begin to chip away at the relentless stigma that prevents many of our service members from getting the PTSD and substance abuse help they so desperately need.  It’s time we did right by our service members, and give them the treatment and respect they deserve – as Churchill once said, “The era of procrastination, of half-measures, of soothing and baffling expedients, of delays, is coming to its close.  In its place we are entering a period of consequences.”  Talk is cheap; let’s commit to seeing these improvements through.  Our soldiers, sailors, and Marines deserve better.