Active-duty personnel and military veterans are exposed to a range of shocking and horrifying experiences as a regular part of what they do. For a generation, this was considered par for the course, as was using drugs and alcohol to “get over it.” Now, we understand much more about what trauma and alcohol abuse do to both the mind and the brain, and how important treatment is for the next generation of American soldiers.
PTSD and Combat Tours
The rate of mental health problems for active-duty personnel and military veterans is epidemically high. The American Journal of Public Health notes that across both genders and a range of age groups, post-traumatic stress disorder (PTSD) “was the most frequently diagnosed mental health condition” for soldiers who had served between 2001 and 2014 (covering Iraqi Freedom, Enduring Freedom, and New Dawn operations of the Iraq War). It is the most common mental health diagnosis issued for almost 1 million soldiers who did at least one tour of duty in Iraq and Afghanistan between 2001 and 2013; 19 percent of the personnel who served on those tours developed PTSD within one year of coming back home.
Personnel between the ages of 18 and 29 years of age showed the highest incidence rates for any mental health conditions related to their combat experiences. Female service members had a higher rate of incident-related bipolar disorder and major depressive disorder, while their male counterparts showed a greater risk for incident-related schizophrenia and substance use disorders. Older Hispanic and African American service members had higher rates of mental health conditions and substance use disorders than their younger, white American counterparts.
In 2007, researchers writing in the JAMA journal conducted the largest study of what military combat does to the mental health functioning of members of the armed forces. Soldiers who participated answered questions relating to combat stress and drinking habits. Over 88,000 personnel completed the survey 3-6 months after being redeployed to combat service in Iraq; of them, over 70 percent reported experiencing combat situations they described as “traumatic,” and about 50 percent said they had actively feared for their lives during their deployment. Among respondents who were active duty at the time of the survey, 9 percent of them met three of the four criteria for a positive PTSD diagnosis; 14 percent of US Army Reserve and National Guard soldiers scored the same. The research survey further found that 12 percent of active-duty personnel, and 15 percent of reservists, met the basic criteria for drinking problems, but only 0.4 percent of the same reported being sent to a substance abuse treatment program.
In 2008, the US Air Force conducted a community assessment survey that showed a connection between the total number of deployments and total time deployed, with the risk that a member of the US Air Force would become a problem drinker. Statistically, the results suggested that one additional year of deployment increased the likelihood of the development of an alcohol use disorder by 23 percent, and each further deployment period increased that risk by 14 percent.
The Psychiatric Services journal noted that “soldiers exposed to more intense combat were also more likely to score positive [for] alcohol misuse,” which researchers found after screening soldiers 3-4 months after they returned from Iraq. Other research has connected deployments involving combat exposure to “post-deployment heavy weekly drinking,” as well as binge drinking and drinking-related problems among active-duty and reserve personnel.
Drinking in the Military
As more attention has been given to the issue of mental health problems in the armed services, the extent of the problem – and the roadblocks posed – has come to light. In 2009, almost 9,200 soldiers officially requested help for their alcohol abuse, which ABC News says is a 56 percent increase since the Iraq War started eight years prior. Additionally, 11,892 soldiers had to undergo an “alcohol education course,” a program meant for soldiers who received disciplinary action for alcohol-related misbehavior (but where the soldiers did not meet the criteria for problematic drinking).
Drinking has long been part of military culture. Tom Tarantino, who is the legislative director for the Iraq and Afghanistan Veterans Association, told ABC News that the “work-hard, play-hard ethos to the military” often (and easily) crosses the line from recreational drinking to problematic drinking. In 2013, the Substance Use & Misuse journal reported that across the US Armed Forces, at least one-third of personnel reported past-month binge drinking (five drinks for men in a single sitting; four drinks for women in a single sitting).
In 2012, Stars and Stripes, the official newspaper of the US Armed Forces, wrote of how the “alcohol-soaked culture” among soldiers was taking its toll, quoting a report by the Institute of Medicine that said that the rate of substance abuse among troops constituted a “public health crisis.” A report issued by the US Army in January 2012 found that 43 percent of active-duty personnel engaged in binge drinking in the month before taking the survey; 67 percent of the binge drinkers were under the age of 25, some as young as 17.
Drinking in the army is nothing new, says ABC News, but with more attention being paid to the psychological toll of long deployments and battlefield horrors, alcohol abuse is seen less as a rite of passage, and more as a potential red flag for self-medicating post-traumatic stress disorder or major depressive disorder. Such behavior is seen in both active-duty service members and veterans. According to army officials, as many as 85 percent of the soldiers who get substance abuse treatment do so because of problems they have with their alcohol consumption. This has required the army to engage in a “nationwide search for additional counselors,” because currently, there is only one counselor for every 2,000 soldiers, and a soldier looking for help has to wait for days before they can be seen.
Information on Other Professions
Pain and Silence
Some in the military fear that the overtures toward treatment have come too late. ABC News spoke to Brian, a three-tour soldier who requested anonymity because of his criticisms that the army does not pay enough attention to the problem of alcoholism among active-duty and retired personnel. For many soldiers, they are the ones who have to initiate the conversation, and they do so only after something goes wrong. In Brian’s case, he “started drinking heavily to mask the pain” of four separate bomb attacks on a single tour, as well as traumatic brain injury and other extensive medical problems related to his combat experiences. The only thing that finally convinced him to get help for his drinking was the realization that no civilian job would let him drink the way the military did.
Part of the problem is that the no one in the army would have any respect for a soldier “who whined about his pain and took sick leave.” There is a culture of silence in the military, which covers everything from reporting sexual abuse, reporting illegal behavior by a fellow soldier (even hurting or killing innocent civilians), admitting mental health struggles, to requesting help for a drinking problem.
Tom Tarantino, who is also a retired army captain in addition to being legislative director for the Iraq and Afghanistan Veterans Association, told ABC News that alcohol abuse in the army is a symptom of a larger, multifaceted problem; one of those facets is that for so long, combat-related mental health issues were not taken seriously by military leadership. The upper echelons of army administration have repeatedly stated that the treatment for mental health problems will not negatively affect a soldier’s career and advancement prospects, but a majority of active-duty personnel are still reluctant to come forward with their concerns. Tarantino said that after years of strong indoctrination of soldiers being “taught to be strong and macho,” capable of lifting the world on their shoulders, the idea of admitting to a mental health struggle or a losing battle with alcoholism is seen as a weakness and source of shame for unit cohesiveness.
Most of the soldiers who ask for help with their alcohol problems are between 18 and 25 years old, and an army spokesman told ABC News that the challenge is to reach younger personnel earlier. For many, he says, their time with the army is their first time away from home. Much like college students, this is a time they “experiment with life,” usually by partaking in copious amounts of alcohol consumption. Younger brains do not fully develop their executive functions, a point borne out by extensive research that documents that even healthy human brains are still in the process of maturation in the early 20s. This, coupled with traumatic combat experiences, often means that younger service members are most at risk for developing serious mental health and (related) drinking problems.
At Fort Riley in Kansas, Gary Klozenbucher, the clinical director of the Army Substance Abuse Program, said that the soldiers he sees for alcohol abuse treatment are a mix. Some, with a referral from their commanding officer looming over their heads, are scared; others are combative and insist that they don’t have a drinking problem, or that they can control it. Klozenbucher said that a majority of the soldiers who come into his office have had a history of alcohol and drug abuse before their deployment, which is exacerbated by the loneliness of deployment and the trauma of combat experiences. Upon returning home, many of these soldiers struggle with legal, financial, and domestic issues.
Moving Treatment in the Right Direction
Today, there is general acceptance that alcohol is a (potential) problem for many new and old recruits, a marked contrast from the days when hard drinking was a required (and even encouraged) bonding experience. An army veteran joked that “back in the 1970s and 1980s, we assumed drinking was mandatory,” where even commanders told their troops to limit their alcohol consumption to two on-duty drinks at lunch. The difference now is that more people recognize problematic drinking for what it is, and the army is “moving in the right direction” to address that problem.
In 2016, the Alcohol Research: Current Reviews journal wrote that a variety of psychological treatments, medications, and combinations thereof have been successfully tested in how well they address the severity of co-occurring alcohol use disorders and post-traumatic stress disorders among veterans and active-duty personnel. Researchers concluded that when a soldier suffering from PTSD abuses alcohol as a form of self-medication, the conditions should be address simultaneously. This is a departure from previous approaches, which sought to focus on the substance abuse before moving to the mental health issue of PTSD. However, current clinical experimentation and research suggest combining both conditions under a single integrated treatment plan.