Substance Use Disorders in the U.S. Armed Forces (2013) / Chapter Skim
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2 Understanding Substance Use Disorders in the Military
2 Understanding Substance Use Disorders in the Military
Pages 25-68
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From page 25... ...
Indeed, it has been estimated that more than one in four deaths in the United States each year can be attributed to the use of alcohol, illicit drugs, or tobacco (Horgan et al., 2001)
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From page 26... ...
Early detection of problem drinking should lead to further evaluation and specific intervention according to the needs of the individual. Environmental strategies that have been effective in preventing alcohol problems include such approaches as raising the minimum legal drinking age to 21, enforcing minimum purchase age laws, increasing alcohol taxes and reducing discount drink specials, and holding retailers liable for damage inflicted on others by intoxicated and underage patrons.
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From page 27... ...
SUBSTANCE USE DISORDERS IN THE MILITARY 27 Department of Veterans Affairs (VA) did not have to pay benefits to alcoholics because their drinking was due to "willful misconduct."1 As a result of the pioneering work of scientists at the Public Health Service Hospital in Lexington, Kentucky (Ludwig et al., 1978)
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From page 28... ...
Genetic influences on addiction have been studied in both humans and animals. Large population studies have shown that many humans try drugs and do not particularly like the experience, while others experience pleasure and repeat the drug taking and, within a period of time that depends on genetic variables, become compulsive users (Anthony et al., 1994)
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From page 29... ...
Service members have engaged in illicit drug use (i.e., the use of illegal drugs such as cocaine, heroin, and marijuana and the nonmedical use of prescription drugs) since discovering that they reduced pain, lessened fatigue, or helped in coping with boredom or panic that accompany battle.
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From page 30... ...
Indeed, Bray and colleagues (2012) found that the key driver of prescription drug misuse in the military is misuse of pain medications.
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Treatment was provided for problem users, with the goal of returning them to service. A urinalysis testing program was established to help deter illicit drug use, but the program was challenged in the courts3 and was discontinued from 1976 until the early 1980s.
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From page 32... ...
The active duty component includes personnel from the Army, Navy, Marine Corps, and Air Force; the reserve component includes personnel from the Army National Guard, Army Reserve, Navy Reserve, Marine Corps Reserve, Air Force National Guard, and Air Force Reserve. All Reserve and Guard members are assigned to one of three groups: the Ready Reserve, the Standby Reserve, or the Retired Reserve.
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From page 33... ...
TABLE 2-1 Size of the Military Active Duty and Reserve Components in Fiscal Year 2010 Enlisted Officers Total Percent of Number Percent Number Percent Number Component Active Duty Component Army 467,537 83.2 94,442 16.8 561,979 39.6 Navy 270,460 83.7 52,679 16.3 323,139 22.8 Marines 181,221 89.4 21,391 10.6 202,612 14.3 Air Force 263,439 79.9 66,201 20.1 329,640 23.3 Total Active 1,182,657 83.4 234,713 16.6 1,417,370 62.5 Reserve Component Army National Guard 319,846 88.3 42,169 11.7 362,015 42.6 Army Reserve 168,717 82.2 36,564 17.8 205,281 24.2 Navy Reserve 50,718 78.0 14,288 22.0 65,006 7.6 Marine Corps Reserve 35,423 90.3 3,799 9.7 39,222 4.6 Air National Guard 93,287 86.6 14,389 13.4 107,676 12.7 Air Force Reserve 55,559 79.2 14,560 20.8 70,119 8.3 Total Reserve 723,550 85.2 125,769 14.8 849,319 37.5 Total Active and Reserve 1,906,207 84.1 360,482 15.9 2,267,349 100.0 NOTE: Reserve component refers to the Selected Reserve, which comprises traditional drilling Reservists.
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From page 34... ...
The Army National Guard and Army Reserve account for about two-thirds of the Selected Reserve. Together, the active duty and reserve components have just over 1.9 million members -- 62.5 percent in the active duty component and 37.5 percent in the reserve component.
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From page 35... ...
(%) Service Branch Army 24.2 38.5 Army National Guard 42.6 Navy 7.6 22.1 Marine Corps 4.6 13.9 Air Force 8.3 22.6 Air National Guard 12.7 Gender Male 82.1 85.6 Female 17.9 14.4 Race White 75.9 70.0 African American 14.9 17.0 Asian 2.8 3.7 American Indian or Alaska Native 0.9 1.7 Native Hawaiian or Other Pacific Islandera 0.6 0.6 Multiraciala 0.7 2.1 Ethnicity Hispanic 9.5 10.8 Education No high school diploma 2.9 0.5 Less than a bachelor's degreeb 76.7 79.5 Bachelor's degree 14.0 11.0 Advanced degree 5.4 6.7 Age 25 or younger 33.3 44.2 26-30 18.6 21.1 31-35 12.2 13.8 36-40 12.1 11.1 41 or older 23.8 8.8 Marital Status Not married 51.8 43.6 Married 48.2 56.4 Pay Grade E1-E3 19.5 24.6 E4-E6 53.9 49.3 E7-E9 11.8 9.5 W1-W5 1.4 1.4 O1-O3 6.3 9.0 O4-O10 7.1 6.2 NOTE: Reserve component refers to the Selected Reserve of DoD, which comprises traditional drilling Reservists and excludes Department of Homeland Security's Coast Guard Reserve.
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From page 36... ...
52. Figure 2-1a R02254 vector editable 370,700, 43% 486,561, 57% With Children Without Children FIGURE 2-1b Reserve component members with and without children.
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FIGURE 2-2a Active duty component family status. NOTE: Single includes annulled, divorced, and widowed.
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From page 38... ...
, a 12 percentage point increase in a decade. The prevalence of any reported illicit drug use (including prescription drug misuse)
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From page 39... ...
and did not change across these three iterations of the survey. To better illustrate the relationship between overall illicit drug use and prescription drug misuse, Figure 2-4 presents three summary measures of illicit drug use in the past 30 days from 2002 to 2008: use of any illicit drug including prescription drug misuse, use of any illicit drug excluding prescription drug misuse, and any prescription drug misuse.
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From page 40... ...
Any illicit drug use excluding pre Figure 2-4 scription drug misuse = use of marijuana, cocaine (including crack) , hallucinogens (PCP, LSD, MDMA, and other hallucinogens)
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From page 41... ...
2008 indicated a positive rate of 1.07 percent. This figure can be compared with a rate of 2.3 percent illicit drug use (excluding prescription drug misuse)
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From page 42... ...
The demographic profile shown in Table 2-3 is highly similar for heavy alcohol users and cigarette users. The overall prevalence of illicit drug use (including prescription drug misuse)
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From page 43... ...
among military personnel compared with civilians suggest either that military policies and practices deter drug use or that military personnel hold attitudes and values that discourage this behavior. However, the military is facing increasing challenges in managing drug abuse, as indicated by the apparent rise in prescription drug misuse.
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From page 44... ...
Any illicit drug use, including prescription drug misuse, is defined as the use of marijuana, cocaine (including crack) , hallucinogens (PCP, LSD, MDMA, and other hallucinogens)
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d Refers to personnel who were stationed within the 48 contiguous states in the continental United States. e Refers to personnel who were stationed outside the continental United States or aboard afloat ships.
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8 4* 0 18-25 26-35 36-45 46-64 18-25 26-35 36-45 46-64 Age Group FIGURE 2-5a Standardized comparisons of active duty component personnel and civilians, heavy alcohol use and past 30-day smoking, by age group, 2008.
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From page 47... ...
0.3* + 0 18-25 26-35 36-45 46-64 18-25 26-35 36-45 46-64 Age Group FIGURE 2-5b Standardized comparisons of active duty component personnel and civilians, past 30-day illicit drug use, by age group, 2008.
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From page 48... ...
reported past month heavy drinking, 40.4 percent reported binge drinking, and 23.7 percent reported cigarette smoking. Analyses that adjusted for demographic differences between the active duty and reserve components found that the rates for the reserve component were significantly lower than those for the active duty component on all three measures (Hourani et al., 2007)
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From page 49... ...
First, in combination with other data presented above, they indicate that alcohol is a much larger substance use problem in the military than illicit drug use or TABLE 2-4 Alcohol AUDIT Scores of Active Duty and Reserve Component Personnel Active Duty Component Reserve Component Drinking Level (N = 24,640)
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From page 50... ...
Second, they indicate that substantial percentages of military personnel in both the active duty and reserve components are drinking alcohol at rates that place them at risk for alcohol problems, even though they do not meet the current criteria for alcohol dependence. Third, the data suggest that many problem drinkers would benefit from some type of alcohol intervention or treatment before reaching the most severe problem levels.
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From page 51... ...
(Rates per 100K) Prevalence per 100,000 People Calendar Year FIGURE 2-6 Prevalence of alcohol-related disorders among the active duty component (rates per 100,000)
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52 Prevalence per 100,000 People Calendar Year FIGURE 2-7 Prevalence of drug-related disorders among the active duty component (rates per 100,000)
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Prevalence per 100,000 People FIGURE 2-8 Prevalence of alcohol- and other drug-related disorders among the reserve component (rates per Calendar Year 100,000)
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From page 54... ...
found that 3.9 percent reported illicit drug use, 12.4 percent reported binge drinking, and 27 percent reported tobacco use. Unfortunately, this was a small convenience sample of 105 spouses from a family readiness group, so the results are of limited generalizability.
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From page 55... ...
It is of interest that the pattern for dependents is similar to that for the active duty and reserve components, suggesting that there may be family patterns of alcohol and drug use leading to SUD diagnoses. HEALTH CARE BURDEN OF SUBSTANCE USE DISORDERS DoD recently published analyses of the absolute and relative morbidity burden among the armed services in 2011, grouping all medical encounters into 139 diseases and conditions (Armed Forces Health Surveillance Center, 2012a)
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From page 56... ...
56 (Rates per 100K) Prevalence per 100,000 People Calendar Year FIGURE 2-9 Prevalence of alcohol- and other drug-related disorders among dependents (rates per 100,0000)
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From page 57... ...
d Total bed days for hospitalization and lost duty days due to the condition, measured as days confined to quarters and one-half day for a visit for the condition. SOURCE: Adapted from Armed Forces Health Surveillance Center, 2012a, Table 1.
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From page 58... ...
examined trends and demographic characteristics for acute, chronic, and "recurrent" alcohol-related diagnoses over a 10-year period from January 1, 2001, through December 31, 2010, for the active duty component of the military. Records of health care encounters, including hospitalizations and ambulatory care, in the Defense Medical Surveillance System were searched to identify those encounters that were associated with ICD-9 diagnostic codes encompassing both alcohol abuse and dependence indicators and were classified as acute or chronic cases.
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From page 59... ...
SOURCE: Armed Forces Health Surveillance Center, 2011. Figure 2-10 R02254 bitmapped, not editable
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From page 60... ...
The number of bed days attributable to chronic alcohol abuse diagnoses roughly quadrupled over the 10-year period. This finding highlights the need for continued emphasis on the prevention, early identification, and treatment of alcohol-related disorders.
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From page 61... ...
A third group of individuals includes those who are engaging in risky drinking but have not yet developed problems associated with their drinking. Individuals in this group can be identified through screening in primary care or other appropriate settings, such as the armed services' substance abuse programs, or possibly by military buddies or noncommissioned officers in their units.
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From page 62... ...
• Illicit drug use in the past 30 days among the active duty component declined sharply from 28 percent in 1980 to about 3 percent in 2008. • Prescription drug misuse among the active duty component dou bled from 2 percent in 2002 to 4 percent in 2005 and almost tripled from 2005 to 2008, from 4 percent to 11 percent.
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From page 63... ...
• Analyses of record data by the military indicate that alcohol and other drug use disorders have been increasing in recent years for the active duty component, the reserve component, and military dependents. • Rates of acute and chronic incident alcohol diagnoses increased from 2001 through 2010, especially during the latter part of the decade for the active duty component.
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From page 64... ...
:9-13. Armed Forces Health Surveillance Center.
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From page 65... ...
2011b. Comprehensive plan on prevention, diagnosis, and treatment of substance use disorders and disposition of substance use offenders in the armed forces.
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From page 66... ...
ARMED FORCES Foa, E
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From page 67... ...
2007. National drug control policy and prescription drug abuse: Facts and fallacies.
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From page 68... ...
1977. Alcohol problems in the United States armed forces.
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