- Psychiatric Times Vol 28 No 7
- Volume 28
- Issue 7
Returning Veterans With Addictions
Members of the military returning from combat operations have high rates of substance abuse. They also often exhibit a co-occurring triad of posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), and pain, which complicates the problems with substance abuse.
Members of the military returning from combat operations have high rates of substance abuse. They also often exhibit a co-occurring triad of posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), and pain, which complicates the problems with substance abuse.
After detailing what is known concerning the epidemiology of substance abuse among military members and veterans and how substance abuse relates to these other disorders, this article offers some thoughts about the assessment and management of substance use disorders in these populations.
Epidemiology
Considerable knowledge exists about alcohol use among military members, some knowledge exists about tobacco use, but only scant data inform us about use of other substances. Even before there were extensive deployments to Iraq and Afghanistan, a large-scale survey found that prevalence of frequent, heavy drinking in the military from 1980 through 2005 ranged from 15% to 20%.1 A subsequent survey of 88,205 soldiers recently deployed to Iraq showed that 12% to 15% screened positive for alcohol problems.2 Rates of binge drinking were 53% in a sample of recently deployed personnel with combat exposure.3
In a 2-item survey of 6527 US Army soldiers who were screened after returning from deployment to Iraq, 27% screened positive for alcohol misuse, and rates of drinking and driving and reporting late to duty because of hangovers were high.4 In a separate survey of 1120 recently deployed soldiers, 25% screened positive for alcohol misuse and 12% for alcohol-related behavioral problems. Exposures to life-threatening situations and to atrocities were significantly associated with a positive screen.5
A survey of 156 military members deployed to Iraq also found that among men, 51.9% used tobacco before being deployed, and 58.3% used tobacco during deployment. For women, 41.7% used tobacco before being deployed and 51.2% used tobacco during deployment. Stress served as the primary motivating factor for tobacco use among 47.7%; 25.1% blamed boredom and 22.7% blamed addiction. A majority indicated an intention to stop smoking on returning from deployment.6 A longitudinal study of 48,304 military members showed deployment as a risk factor for ex-smokers to resume smoking.7 Among military veterans, the rate of tobacco smoking in 2007 was estimated at 25% compared with 21% in the general population. For younger veterans, those born between 1975 and 1989, the rate of tobacco smoking was 36% to 37%.8
Little information exists on illicit substance use among military members because such use is a crime. If illicit substance use is detected, it typically results in discharge from military service. A large survey suggests that while illicit drug use was common among active duty military members in 1980, it dropped to very low levels by 1992 and has remained low.1 Articles in the lay press report that opioids are frequently prescribed for pain in active duty military members and that some proportion of the individuals for whom these medications have been prescribed have become addicted to them.9 Supporting these anecdotal reports, a survey of 28,546 active duty military members indicated that 11.1% reported misuse of prescription medications in 2008.10