Military, Drug And Alcohol Abuse In The United States (Encyclopedia of Drugs, Alcohol, and Addictive Behavior)
Drug and alcohol use have historically been common among military personnel. Drugs have been used by soldiers to reduce pain, lessen fatigue, and increase alertness, or to help them cope with boredom or panic that accompany battle. During the U.S. Civil War, medical use of opium resulted in addiction among some soldiers. In the modern U.S. military, drug use became a recognized problem during the Vietnam War in the late 1960s and early 70s. Approximately 20 percent of Vietnam War veterans reported having used narcotics (e.g., heroin, opium) on a weekly basis, and 20 percent also were considered to be addicted based on reported symptoms of dependence (Robins, Helzer, & Davis, 1975). Although few personnel continued using heroin when they returned home, there were concerns about addiction.
Similar to drug use, heavy drinking in the military has been an accepted custom and tradition (Bryant, 1979; Schuckit, 1977). In the past, alcohol was thought to be a necessary item for subsistence and morale and, as such, was provided as a daily ration to sailors and soldiers. Within the predominantly male U.S. military population, heavy drinking and being able to "hold one's liquor" have served as tests "of suitability for the demanding masculine military role" (Bryant, 1974). A common stereotype has been to characterize hard-fighting soldiers as hard-drinking soldiers. Alcoholic beverages have been available to military personnel at reduced prices at military outlets and until recently during "happy hours" at clubs on military installations (Bryant, 1974; Wertsch, 1991). In addition, alcohol has been used in the military to reward hard work, to ease interpersonal tensions, and to promote unit cohesion and camaraderie (Ingraham, 1984).
Drug and alcohol abuse are strongly opposed within the U.S. armed forces because of their negative effects on the health and well-being of military personnel and because of their detrimental effects on military readiness and the maintenance of high standards of performance and military discipline (Department of Defense, 1997). In the U.S. military, drug abuse is defined as the wrongful use, possession, distribution, or introduction onto a military installation of a controlled substance (e.g., marijuana, heroin, cocaine), prescription medication, over-the-counter medication, or intoxicating substance (other than alcohol). Alcohol abuse is defined as alcohol use that has adverse effects on the user's health or behavior, family, community, or the Department of Defense (DoD) or that leads to unacceptable behavior.
DEVELOPMENT OF MILITARY POLICY
The DoD convened a task force in 1967 to investigate drug and alcohol abuse in the military and in 1970 formulated a drug and alcohol abuse policy based on task force recommendations. The policy emphasized the prevention of drug and alcohol abuse through education and law enforcement procedures focusing on detection and early intervention (DoD, 1970, 1972). However, treatment was provided for problem users with an emphasis on returning them to service.
In response to continuing public concern about reports of serious drug addiction among U.S. forces in Southeast Asia, President Nixon in 1971 directed the DoD to take additional measures to address the drug problem. The result was the establishment of a urinalysis testing program that initially consisted of mandatory testing for service members leaving Southeast Asia and grew to include mandatory, random urinalysis for all U.S. forces worldwide. The program was discontinued for a period because of difficulties implementing it on a large scale, its high costs, and a court challenge that the Fifth Amendment protection against self-incrimination was being violated (U.S. v. Ruiz 1974).
The reaction to the crash of a jet on the aircraft carrier Nimitz in 1981 again focused public attention on the military's drug abuse problem, particularly marijuana use. Autopsies of fourteen Navy personnel killed in the crash showed evidence of marijuana use among six of the thirteen sailors and nonprescription antihistamine use by the pilot. The armed forces reinstituted urine testing for drugs in 1981 as a result of this incident and other concerns about drug use in the military. New breakthroughs in drug-testing confirmation procedures and more rigorous procedures for tracking urine samples overcame earlier legal objections. Urine tests, which are conducted either randomly or when a person is suspected of using drugs, are a major tool for the detection and deterrence of illicit drug use (DoD, 1997).
U.S. military substance use policy has been updated periodically since the early 1970s and currently is one of zero tolerance that includes an emphasis on preventing and detecting abuse and either discharging abusers from the military (the approach generally followed for drug abuse) or providing treatment and rehabilitation (the approach generally followed for alcohol abuse) (see Bray et al., 1993, 1999a for more detailed discussions of the development of military policy).
WORLDWIDE SURVEY SERIES
To help monitor the extent of drug and alcohol abuse, the DoD initiated a series of worldwide surveys among active-duty military personnel in the Army, Navy, Marine Corps, and Air Force. The first survey was conducted by Marvin Burt Associates in 1980 (Burt et al., 1980) and the others by Robert Bray and his colleagues at Research Triangle Institute in 1982, 1985, 1988, 1992, 1995, and 1998 (Bray et al., 1983, 1986, 1988, 1992, 1995, 1999b). The goals of the surveys have been to provide data to help assess the prevalence, correlates, and consequences of substance abuse and health in the military.
The surveys have all been conducted using similar methods. Civilian researchers first randomly selected a sample of about sixty military installations to represent the armed forces throughout the world. At these designated installations, they randomly selected men and women of all ranks to represent all active-duty personnel. Civilian research teams administered printed questionnaires anonymously to selected personnel in classroom settings on military bases. The few personnel (about 10%) who were unable to attend the group sessions (e.g., were on leave, sick, or temporarily away from the base) were mailed questionnaires and asked to complete and return them. Participants answered questions about their use of illegal drugs (e.g., marijuana, cocaine, heroin), the misuse of prescription drugs (e.g., stimulants, tranquilizers), about the frequency and amount of alcohol use, and problems resulting from drug or alcohol use. These data collection procedures yielded from over 15,000 to nearly 22,000 completed questionnaires for the various surveys. From 59 percent to 84 percent of those eligible to take part actually did so.
TRENDS IN DRUG AND ALCOHOL USE
Figure 1 presents trends over the seven worldwide surveys on the percentage of the active-duty military force who engaged in any illicit drug use or heavy alcohol use during the thirty days prior to the survey. Any illicit drug use was defined as use one or more times during the past thirty days of marijuana/hashish, cocaine, inhalants, hallucinogens, heroin, and nonmedical use of prescription-type drugs, including stimulants, sedatives, tranquilizers, or analgesics. Heavy alcohol use was de-fined as five or more drinks per typical drinking occasion at least once a week. As shown in Figure 1, use of any illicit drug declined sharply from just under 28 percent in 1980 to about 3 percent in 1998; heavy drinking declined significantly from approximately 21 percent in 1980 to just above 15 percent in 1998, although the decrease was less dramatic than for drug use. Heavy drinking by itself does not constitute alcohol abuse, but it does indicate drinking levels that are likely to result in negative consequences.
EFFECTS OF DEMOGRAPHIC CHANGES
Despite the significant downward trends in illicit drug use and heavy drinking noted in Figure 1, the question arises whether these declines are due to military programs and policies or to some alternative explanation. One possible explanation for the changes could be shifts in the demographic composition of the armed forces between 1980 and 1998. Members of the military in 1998, for example, were more likely to be older, to be officers, to be married, and to have more education than in 1980. These characteristics are also associated with less substance use. For example, 60 percent of personnel in 1998 were married compared to 53 percent in 1980; 61 percent were aged twenty-six or older in 1998 compared to 43 percent in 1980.
Analyses that adjusted for demographic differences across survey years from 1980 to 1998 showed that illicit drug use had the same significant decline as found before the adjustment, whereas heavy alcohol use did not. This suggests that the decline in illicit drug use shown in Figure 1 was not explained by shifts in the demographic composition of the military population, whereas the decline in heavy drinking was largely explained by demographic changes. Stated another way, if the demographic composition of the military in 1998 was like the composition in 1980, rates of illicit drug use in 1998 would still be notably lower, but rates of heavy drinking between these two survey years would have been about the same.
MILITARY AND CIVILIAN COMPARISONS
Another possible explanation for the trends in drug and alcohol use observed in Figure 1 is that the military may simply mirror similar trends occurring among civilians. Drug use among civilians has declined substantially in recent years (Office of Applied Studies [OAS], 1999), whereas declines in alcohol use among civilians have been more moderate (Clark & Hilton, 1991). To address this issue, data were compared for illicit drug use and heavy alcohol use among military personnel and civilians. Military data were drawn from the 1998 DoD survey, and civilian data from the 1997 National Household Survey on Drug Abuse (NHSDA), a nationwide survey of drug abuse. Military and civilian datasets were equated for age and geographic location of respondents, and civilian substance use rates were standardized (adjusted) to reflect the demographic distribution of the military.
Standardized comparisons showed that military personnel (about 3 percent) were significantly less
The findings indicate that substance-use trends in the military do not simply mirror similar changes among civilians. The lower rates of drug use among military personnel than civilians suggest either that military policies and practices deter drug use in the military or that military personnel hold attitudes and values that discourage substance use. Because of the military's stringent policy about no drug use and the urinalysis testing program to enforce it, it seems likely that the difference between military personnel and civilians results from military policies and practices. In contrast, the higher rates of heavy drinking among military personnel suggest that certain aspects of military life may foster heavy drinking and/or that military policies and programs directed toward reducing heavy alcohol use have not been as effective as similar efforts among civilians.
Overall, these findings indicate that the military has made steady and notable progress in combating illicit drug use, particularly during the 1980s and 1990s. In 1998, illicit drug use was at minimal levels and rates were substantially lower than among civilians. In contrast, the military has made less progress in reducing heavy drinking. In 1998, heavy drinking affected nearly one in six active-duty personnel and was significantly higher than among civilians. Declines in heavy drinking between 1980 and 1998 were largely explained by changes in the demographic composition of the military. The military appears to have developed an effective formula to reduce illicit drug use and now needs to develop a comparable plan to reduce heavy drinking. Such an effort is currently in the initial stages. The DoD has begun a new prevention initiative that will target alcohol abuse as one of its key components.
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ROBERT M. BRAY