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Substance abuse among U.S. military declared a public health crisis

Rising rates of alcohol and prescription drug use among the nation’s armed forces have become a public health crisis that could negatively affect service members’ abilities to perform their duties, said an Institute of Medicine report issued Sept. 17.

In 2008, 47% of active duty personnel reported binge drinking at least once in the previous month, up from 35% in 1998. Between 2002 and 2008, misuse of prescription medication in the past 30 days increased from 2% to 11% of active service members, the IOM report said.

Contributing to the problem are outdated military policies on preventing and treating substance use disorders, according to the IOM. “Many of these policies had been drafted more than 10 years previously and had not been revised to reflect emerging knowledge,” the report said.

Other challenges include patients avoiding care for substance-use disorders due, in part, to concerns about being penalized, and limited training in addiction and psychiatry among physicians who care for patients with substance abuse problems.

To help overcome those obstacles the IOM issued a series of recommendations for the Dept. of Defense and individual branches of the military, including:

Improve training for health professionals who manage substance-use disorders.

Provide confidential substance abuse treatment for service members.

Integrate efforts to prevent and treat substance use disorders into primary care.

The report calls on physicians who care for service members to screen them at least once a year for unhealthy alcohol use and talk to those whose behaviors seem indicative of substance-use disorder about the risks of excessive alcohol consumption. Doctors who feel they are unable to treat a patient’s substance abuse problem should refer the individual to a specialist.

The IOM also recommends that physicians check local prescription drug monitoring programs before prescribing service members medications with high abuse potential, such as opioids, to help reduce abuse and misuse of pain drugs in the armed forces.

“The [IOM] committee views physicians as playing an increasing role” in remedying this problem, said Dennis McCarty, PhD, a member of the IOM committee that wrote the report.

“Many of the active-duty service members returning [from deployment] have pain problems, emotional problems [related to] post-traumatic stress disorder, and often drug and alcohol problems. Someone has to look at the whole patient. The person best positioned to do that is the primary care physician,” said McCarty, a professor in the Dept. of Public Health and Preventive Medicine at Oregon Health and Science University.

The IOM report was spurred by congressional concerns about drug use in the armed services and the Dept. of Defense’s request that the IOM assess protocols pertaining to substance use disorders that are implemented across the Defense Dept. and the different military branches.

Between March 2011 and June 2012, the 14-person IOM committee, which included experts in addiction and public health, evaluated the armed services’ procedures for prevention, screening and diagnosis, and treatment of substance use disorders. It found that despite the Defense Dept.’s high standards for performance and discipline, alcohol and drug use remain “unacceptably high” in the military.

The IOM said changing the environment of military bases could help reduce unhealthy use of alcohol and other drugs. Such changes could include consistently enforcing underage drinking regulations, paring down the number of stores that sell alcohol on military bases and reducing the hours the businesses are open.

In the armed forces, “there’s a culture of heavy drinking and a culture where it’s career limiting to identify yourself as having alcohol-use disorder,” McCarty said.

Among the goals of the IOM report is to help prevent substance abuse among service members and to make treatment for such problems more acceptable when it’s needed, he said.

The full and original article can be found at: http://www.ama-assn.org/amednews/2012/09/24/hlsb0928.htm

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