Substance Use Disorders in the U.S. Armed Forces

2015 Military medicine  
Preface Substance abuse has long been an issue of concern for the U.S. population and for its military in particular. Dating as far back as the Revolutionary War, Dr. Benjamin Rush detailed the effects of alcohol on the troops. During the Civil War, addiction to opium prescribed for pain became known as the "soldier's disease." Drug problems in both the military and civilian sectors have intensified throughout the 20th century as the types and formulations of substances being used have
more » ... . Since the 1970s, the Institute of Medicine (IOM) has been called upon numerous times to advise the government on both medical and legal solutions to the problem of substance abuse. Experts from various fields, ranging from mathematics and epidemiology to pharmacology and law, have spent many hours on about a dozen different committees struggling with this thorny problem, which affects our country on societal, economic, personal, and public health levels. While the popular substances of abuse may shift from decade to decade, the overarching problem continues. In the 21st century, prescription opioid abuse has arisen as a major area of concern while problems of alcohol, nicotine, and stimulants have persisted as well. Research has demonstrated that stress and availability are important background factors for causing the initiation and abuse of drugs. As the United States approaches the end of the longest continuous period of war in our history, the stresses faced by our military population are apparent. Our all-volunteer military has endured long periods of deployment and redeployment in highly taxing and demanding environments. Consequently, posttraumatic stress, traumatic brain injury, substance abuse, and suicide are at very high levels. Press reports of substance abuse among the military stimulated congressional interest and a call for action. The Department of Defense requested that the IOM take a fresh look at the policies and programs of each of the branches of the military and evaluate the adequacy and appropriateness of their prevention, screening, diagnosis, and treatment of substance use disorders. The committee approached this task by holding public meetings to gather information from representatives of each of the military branches and TRICARE (the military's purchased care health plan), as well as from academic researchers and interested members of the public. The committee also conducted visits to military bases and met with a variety of care providers, including those working in substance abuse specialty programs and those in primary care, behavioral health, and pain management. The committee requested information from each branch of the military and from TRICARE Management Activity regarding program descriptions, access, utilization, and evaluation results. We also requested data on the providers in the substance abuse programs. We extend our appreciation for the exceptional cooperation from all of those who presented at our meetings, hosted our visits to military bases, and assisted with our information gathering efforts. In addition, the committee wishes to express our appreciation to the study director, Dr. Maryjo Oster, and to the IOM staff, Ms. Acknowledgements The committee thanks the Department of Defense, the individual service branches, and TRICARE Management Activity for the opportunity to review and comment upon the organization and content of their substance used disorders prevention and treatment services. We appreciate their assistance and collaboration in the review.
doi:10.7205/milmed-d-14-00517 pmid:25735012 fatcat:la7zxthyrzfrtfq5ouwvvjl3pq