Revised April 2011
Scope of the problem
The ongoing operations in Iraq (Operation Iraqi Freedom) and Afghanistan (Operation Enduring Freedom) continue to strain military personnel, returning veterans, and their families. Some have experienced long and multiple deployments, combat exposure, and physical injuries, as well as post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI).
Although less common, substance abuse is also a key concern. While the 2008 Department of Defense Health Behavior Survey reveals general reductions over time in tobacco use and illicit drug use, it reported increases in other areas, such as prescription drug abuse and heavy alcohol use. In fact, prescription drug abuse doubled among U.S. military personnel from 2002 to 2005 and almost tripled between 2005 and 2008.
Alcohol abuse is the most prevalent problem and one which poses a significant health risk. A study of Army soldiers screened 3 to 4 months after returning from deployment to Iraq showed that 27 percent met criteria for alcohol abuse and were at increased risk for related harmful behaviors (e.g., drinking and driving, using illicit drugs). And although soldiers frequently report alcohol concerns, few are referred to alcohol treatment. Research findings highlight the need to improve screening and access to care for alcohol-related problems among service members returning from combat deployments.
Mental illness among military personnel is also a major concern. In another study of returning soldiers, clinicians identified 20 percent of active and 42 percent of reserve component soldiers as requiring mental health treatment. Drug or alcohol use frequently accompanies mental health problems and was involved in 30 percent of the Army's suicide deaths from 2003 to 2009 and in more than 45 percent of non-fatal suicide attempts from 2005 to 2009.
Drug Abuse Research and Military Personnel
To gain a fuller understanding of these issues, the Millennium Cohort Study—the largest prospective study in military history—is following a representative sample of U.S. military personnel from 2001 to 2022. Findings from this study suggest that Reserve and National Guard personnel and younger service members who deploy with reported combat exposures are at increased risk of new-onset heavy weekly drinking, binge drinking, and other alcohol-related problems. Results also suggest an increase in smoking initiation and relapse among those deployed, highlighting the importance of prevention strategies before, during, and after deployment. To meet this need, a host of government agencies, researchers, public health entities, and others are working together to adapt and test proven prevention and treatment interventions for potential use with military and veteran populations and their families.
To address the social problems both caused by and contributing to drug use, NIDA-supported researchers are developing and testing novel treatment approaches with veterans. In one project, researchers are using smart phones and wearable wireless sensors to record real-time responses to stress among veterans suffering from addiction and trauma. The data will be compiled and analyzed to detect patterns of responding that predict relapse. Included on the research team are psychologists working to create interventions that can be delivered by smart phones to help deter patient drug use as a response to stress.
NIDA-supported research is also working to improve veterans' access to drug treatment, including adapting currently available Internet-based interventions and studying the use of drug courts. Drug courts have demonstrated effectiveness in addressing nonviolent crimes committed by drug abusers, ushering them into needed treatment instead of prison. Because the criminal justice system is a frequent treatment referral source for veterans, specialized drug courts for this population may give them the opportunity to access services and support they may not otherwise receive. While New York pioneered the concept of a court devoted exclusively to handling nonviolent crimes committed by veterans, this concept has spread quickly, with 65 courts now in 20 states.
Advancing the Research
Along with the studies mentioned above, NIDA—in collaboration with the U.S. Department of Veterans Affairs and other Institutes within the National Institutes of Health—awarded $6 million in 2010 federal funding to 14 principal investigators to support research on substance abuse and associated problems among U.S. military personnel, veterans, and their families.
The purpose of the initiative was to enhance and accelerate research on the epidemiology/etiology, identification, prevention, and treatment of alcohol, tobacco, and other drug use and abuse, including illicit and prescription drugs, and associated mental health problems among active-duty or recently separated military troops and their families. Most of the research funded under this initiative is focused on substance abuse and related conditions experienced by veterans returning from wars in Iraq and Afghanistan.
These 14 projects will explore a range of topics, including the following:
- therapies for co-occurring disorders, such as depression and substance abuse;
- the effectiveness of early interventions for recently returning soldiers;
- the high rates of smoking among returning military personnel; and
- the impact of a youth substance abuse prevention intervention designed for parents returning from deployment.
By supporting research initiatives like those mentioned here and collaborating with other stakeholders, NIDA intends to contribute to the design and implementation of effective prevention and treatment interventions that can help safeguard the health and well-being of those who protect and serve our Nation.