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Drug Abuse in the Military: Illicit and Prescription Drugs

To best represent the struggles that go along with substance abuse problems, Robins Public Affairs photographer Tommie Horton asked Angela Woolen, Rev-Up reporter, to model for the photo illustration used on the front page of the base newspaper. Although prescription drugs were used for the illustration, all substance abuse problems are serious, and help is available. (U.S. Air Force photo illustration by Tommie Horton)

Sometimes it's hard to tell the difference between a developing drug problem and a real need for increased doses to manage a medical problem. It's important to openly discuss medication dosage and risks with your health care provider.(U.S. Air Force photo illustration by Tommie Horton)

PATRICK AIR FORCE BASE, Fla. -- Just 2.3 percent of military personnel were past-month users of an illicit drug, compared with 12 percent of civilians, according to the 2008 Department of Defense (DoD) Survey of Health Related Behaviors among active duty military personnel. Among those age 18¬-25, who are most likely to use drugs, the rate of military personnel was 3.9 percent, compared to 17.2 percent among civilians.

A zero tolerance policy for drug use among DoD personnel is the likely reason why illicit drug use has remained at a low level in the military for two decades. The policy was instituted in 1982 and is currently enforced by frequent random drug testing; service members face dishonorable discharge and even criminal prosecution for a positive drug test.

However, in spite of the low level of illicit drug use, abuse of prescription drugs is higher among service members than among civilians and is on the increase. In 2008, 11 percent of service members reported misusing prescription drugs, up from 2 percent in 2002 and 4 percent in 2005. Most of the prescription drugs misused by service members are opioid pain medications.

Mental Health Problems in Returning Veterans
Service members may carry the psychological and physical wounds of their military experience with them into subsequent civilian life.

In a study, one in four veterans returning from Iraq and Afghanistan reported symptoms of a mental or cognitive disorder; one in six reported symptoms of post-traumatic stress disorder (PTSD). These disorders are strongly associated with substance abuse and dependence, as are other problems experienced by returning military personnel, including sleep disturbances, traumatic brain injury, and violence in relationships.

Young adult veterans in particular are likely to have substance use or other mental health problems. According to a report of veterans in 2004-2006, a quarter of 18 to 25-year-old veterans met the criteria for a past-year substance use disorder, which is more than double the rate of veterans aged 26-54 and five times the rate of veterans 55 or older.

The greater availability of these medications, and increases in prescriptions for them, may contribute to their growing misuse by service members. Pain reliever prescriptions written by military physicians quadrupled between 2001 and 2009--to almost 3.8 million.

Combat-related injuries and the strains from carrying heavy equipment during multiple deployments play a likely role in this trend.

Addressing the Problem
A 2012 report prepared for the DoD by the Institute of Medicine (IOM Report) recommended ways of addressing the problem of substance use in the military. These included increasing the use of evidence-based prevention, treatment interventions and expanding access to care.

The report also recommends broadening insurance coverage to include effective outpatient treatments and better equipping healthcare providers to recognize and screen for substance use problems so that they can refer patients to appropriate, evidence-based treatment when needed. The report recommends measures like limiting access to alcohol on bases.

The IOM Report also notes that addressing substance use in the military will require increasing confidentiality and shifting the cultural climate where drug problems are stigmatized and evoke fear in people suffering from them.

Branches of the military have already taken steps to curb prescription drug abuse. The Army has implemented changes that include limiting the duration of prescriptions for opioid pain relievers to six months and pharmacist monitoring of a soldier's medications when multiple prescriptions are being used.

NIDA and other government agencies are currently funding research to better understand the causes of drug abuse and other mental health problems among military personnel, veterans, and their families and how best to prevent and treat them.

DoD and Air Force policy states that members who do not self-refer for treatment or rehabilitation and subsequently test positive for using controlled substances inappropriately may be considered in violation of the Uniform Code of Military Justice (UCMJ). Taking prescription drugs without a prescription, in excess of the prescribed amount, when not used for their prescribed purpose, beyond their expiration date, or consuming someone else's prescription drugs are all considered abuse of a controlled substance. The policy reminds Airmen and commanders to closely read Air Force Instruction 44-121 on the Alcohol and Drug Abuse Prevention and Treatment (ADAPT) Program, especially section 3.7 which outlines the conditions, limitations and methods of self-reporting.

Under AFI 44-121 any member who voluntarily discloses personal drug use or possession specifically to the unit commander, first sergeant, military medical personnel or a substance abuse evaluator with the intent of entering drug treatment will be granted limited protection under the UCMJ. However, members cannot self-identify any time after having been ordered to provide a sample, including after a sample has been returned with a positive result.

ADAPT - Who we are and how we can help
Most Airmen associate the ADAPT with punitive measures. This misperception is the main barrier that prevents people from seeking help. The truth is, ADAPT is patient-focused and dedicated to helping eligible beneficiaries receive the treatment they need when they are in their darkest hours. Struggling with drug addiction will divide families, harm service members, and detract from the ability of the Air Force to achieve air dominance. Our goal is to help you get well and enable you to achieve something that seems to foreign at times: sobriety.

ADAPT staff are highly trained and expertly skilled in treating all forms of addiction. Your chance to get well is only a phone call away. 321-494-8234

Military response to prescription drug abuse
In 2012, the DoD expanded drug testing requirements for service members to include some of the most abused prescription drugs containing hydrocodone and benzodiazepine. It also limited the length of time for a valid prescription for commonly abused drugs to six months. Service members with prescriptions for these drugs are not subject to disciplinary action when they're taken within the prescribed dosage and time limits.

Military health care providers and pharmacists have also become more alert to the signs of abuse by service members and military family members. These signs include asking for increased doses of medication or more frequent refills, false or altered prescription forms and multiple prescriptions for the same drug from different doctors.

Getting help for prescription drug abuse
Addiction to a prescription drug can sneak up on you if you take more than prescribed. Sometimes it's hard to tell the difference between a developing drug problem and a real need for increased doses to manage a medical problem. It's important to openly discuss medication dosage and risks with your health care provider.

If you're an active-duty service member, a military family member or a veteran, and think you may have a problem with prescription drugs, help is available. Military Treatment Facilities, installation substance abuse programs, the Department of Veterans Affairs and TRICARE offer treatment services for prescription drug addiction. Likewise, a Military OneSource consultant can work with you to assess your problem, review options for getting help, and provide appropriate referrals. A consultant can be reached by calling 800-342-9647.