Report Details Substance Abuse Problems in Military

Moderator David C. Lewis, MD, discusses an Institute of Medicine report on substance abuse in the U.S. military.

Moderator David C. Lewis, MD, discusses an Institute of Medicine report on substance abuse in the U.S. military.

Reacting to growing concerns about rising rates of alcohol and prescription drug abuse in the U.S. military, the Department of Defense (DoD) asked the Institute of Medicine (IOM) to analyze military policies and programs related to substance use disorders. Members of the IOM committee charged with that task reviewed its findings at a symposium Friday.

Committee members painted a picture of frustration when faced with out-of-date treatment approaches and an unwillingness to accept modern addiction medicine treatments, they said in Symposium 3, “Treatment of Military Personnel and Their Families.” The committee published the report¬†Substance Use Disorders¬†in the U.S. Armed Forces last fall.

“One of the most important things we learned is that the military has a different culture than civilian or VA cultures,” said the session moderator, David C. Lewis, MD, Professor Emeritus of Community and Health Medicine and Donald G. Millar Distinguished Professor of Alcohol and Addiction Studies at Brown University. “It is much more complex.

“We spent a lot of time in the report spelling out what evidence-based treatment is about. In a culture where you have to be battle-ready and you have to worry about testing positive, the issue of confidentiality is huge.”

Constance Weisner, PhD, MSW, Professor of Psychiatry, University of California, San Francisco, and Associate Director for Health Services Research, Kaiser Permanente, talked about the levels of substance abuse.

Substance use disorder ranked seventh among 139 conditions, and first in hospital bed days in the military, she said.

“What is the current situation in the military? The levels of drinking and substance use are a concern,” Dr. Weisner said. “The military population is young and impulsive.”

Complicating matters was a zero tolerance policy for drug use; drug testing is the main screening mechanism, she said.

“Primary care is the single largest missed opportunity for early and confidential identification of alcohol or drug misuse,” Dr. Weisner said. “DoD and service branch policies and practices do not encourage primary care interventions.”

Charles P. O’Brien, MD, PhD, Chair of the committee was blunt in discussing the military’s approach toward addiction treatment.

“The way treatment is given is not modern and is not evidence-based. It is hard to get things changed,” said Dr. O’Brien, Kenneth E. Appel Professor of Psychiatry and Vice Chair of Psychiatry at the University of Pennsylvania School of Medicine.

While contemporary treatment of substance use disorder is maintenance medication, the military has no long-term programs and does not allow the use of maintenance mediations, he said.

“The VA/DoD treatment manual for substance abuse is excellent, but it is not followed,” Dr. O’Brien said. “Everyone agrees this is a major problem in the military.”

Discussing prevention options was Mathea Falco, JD, President of Drug Strategies, Inc., Washington, D.C., who joined the parade of criticism with her opening statement, “The military is a universe of its own.”

An example of the attitude problem in the military is that drug testing is often considered a prevention strategy. “Drug testing does not deter drug use,” she said.

“The IOM committee came out with a recommendation that should implement comprehensive policy,” O’Brien said. “This is not happening. Current prevention efforts fall short. There is no consistent or systematic evaluation of prevention programs that are currently in place.”

She agreed that alcohol and drug abuse is tied to an attitude problem.

“I would start with a change in attitude. Heavy drinking is just not acceptable. The norm today in the military is that drinking is the macho thing to do,” O’Brien said, adding that even females in the military drink heavily.