A Rise in Substance Abuse in the United States Armed Forces – an Examination

BY GRETCHEN COTHRON — Recently, The New York Times published an article discussing the failure of the armed forces to effectively treat military personnel with substance abuse problems. The article referenced a report by the Institute of Medicine that gives an in-depth look into substance abuse problems in the armed forces.

In the ten-year span from 1998 to 2008, approximately 20 percent of military personnel on active duty reported heavy drinking, with a 12-point increase in admitted binge drinking.[1] A reported 11 percent of active personnel admitted to medication abuse, a nine-point increase since 2002.[2]

The report recommended that the armed forces focus on outpatient care programs that are better suited for the long struggle from addiction to recovery.[3] The article cites a lack of funding to increase treatment and understaffing of treatment specialists due to underfunding as reasons for why the recommended best practices have yet to be implemented.

A Westlaw Next search under Military Law Cases using the terms “alcohol abuse AND PTSD” yields 9,968 cases, most of them addressing denials of disability claims for treatment related to substance abuse and Post-traumatic Stress Disorder (“PTSD”)[4]. Of these cases, 648 are civil cases concerning pension and retirement benefits. Many of the cases deal with Vietnam Veterans who have PTSD and who are unable to receive benefits or treatment due to their alcohol abuse.  The United States Department of Veteran Affairs (“VA”) acknowledges that alcohol abuse and PTSD are often related.[5] This begs the question, “Why is the government denying benefits and treatment for PTSD when the disorder is oftentimes accompanied by alcohol abuse?” The VA acknowledges that sixty-to-eighty percent of Vietnam Veterans seeking treatment for PTSD have reported drinking problems.[6] Yet, countless veterans with PTSD are being denied treatment or benefits due to alcohol abuse.

The VA states “without treatment, PTSD can result in marital problems, behavioral problems in children, depression, outbursts of anger, physical violence, substance abuse and sometimes thoughts of hurting oneself.”[7]

Why is the government allowing persons who served in the armed forces and suffered severe trauma to return home to the above listed problems and be refused treatment or assistance due to substance abuse? Not properly or fully treating members of the armed forces for substance abuse can lead to a high number of future unemployed vets, costing taxpayers just as much, if not more, than treatment would cost.

The legal implications of not treating veterans with PTSD-related substance abuse problems could be far-reaching. Incidents involving alcohol while in active duty can result in a less than honorable discharge. Combing through the criminal cases retrieved by searching Westlaw Next for “PTSD AND Alcohol” in the Army Court of Criminal Appeals cases, one will discover one hundred cases relating to incidents involving alcohol by personnel with PTSD. When these veterans likely receive less than honorable discharges, their medical treatment for both PTSD and alcohol abuse stops, as the armed forces are no longer required to provide benefits to personnel with less than honorable discharges.

The Institute of Medicine report explains that:

Contemporary substance abuse treatment systems include frequent screening, brief counseling, brief interventions in primary care settings, a focus on client-centered motivational interviewing, multiple entry points to treatment, pharmacotherapies that reduce cravings and maintain functioning, outpatient counseling, intensive outpatient programs, residential treatment when needed, and continuous contact with counseling professionals after an intense period of treatment. Modalities of care utilize evidence-based environmental, psychosocial, and medication interventions. The standard of practice in modern SUD treatment no longer relies on inpatient hospital services except for the most medically complex patients.[8]

While non-profit agencies such as Legal Services of Greater Miami offer assistance to veterans who are attempting to raise their discharge status to honorable so that they may receive treatment, more can be done to address the legal implications of not properly treating armed forces personnel prior to discharge.

Treating armed forces’ personnel to prevent post-discharge problems associated with substance abuse is necessary. The Times article includes a statement regarding the needed changes to the treatment of substance abuse by Cynthia O. Smith, a spokeswoman for the Department of Defense. “If there are areas in need of improvement, then we will work to improve those areas,” Ms. Smith said. “The health and well-being of our service members is paramount.”[9]