Substance Abuse

Substance Abuse. The Department of Defense (DoD) defines substance abuse as the use of tobacco, illicit drugs, or excessive amounts of alcohol. Responsibility for controlling substance abuse has oscillated between the command structures and the medical departments of the services.

Political interest in regulating alcohol consumption in the United States emerged in the mid‐nineteenth century, when eighteen states passed prohibition laws. Temperance organizations subsequently made drinking a national issue. In 1862, the traditional rum ration for naval personnel was discontinued, and in 1914, drinking by officers aboard navy ships was prohibited. The Prohibition Amendment was ratified in 1919. After Prohibition was repealed in 1933, drinking in the armed services became an almost obligatory social ritual. Command‐sponsored club happy hours, airborne forces' “Prop Blast” parties, and naval aviators' Tailhook Conventions were organized around heavy drinking.

In 1970, PL 91‐616, the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act, defined alcoholism as a disease and mandated that military alcohol abusers receive treatment in a nondiscriminatory and confidential context. The following year, Title V of the Selective Service Act, PL 92‐129, required DoD to identify, treat, and rehabilitate alcoholics to prevent the loss of experienced personnel. The medical departments treated physiological and psychiatric conditions associated with drinking, and command conducted rehabilitation programs.

In 1980, DoD announced that alcohol abuse was incompatible with military discipline, performance, and readiness. Commanders were to deglamorize drinking, educate service members on its harmful effects, punish drunken driving severely, and deemphasize alcohol at social functions. The 1986 DoD Health Promotion Program, designed to improve the quality of service members' lives and to enhance readiness, included programs to reduce the use of alcohol, tobacco, and drugs. By 1987, the services were operating the world's largest integrated occupational health program, with 47,000 enrollees. But alcoholic service members, suspecting that their careers would be compromised, were reluctant to ask for rehabilitation.

The DoD‐sponsored Worldwide Survey of Substance Abuse and Health Behaviors Among Military Personnel began in 1980. Between 1980 and 1992, the proportion of drinkers among service members declined from 86.5 percent to 79.6 percent, and heavy drinkers declined from 20.8 percent to 14.5 percent. In contrast, 9.5 percent of civilians in 1991 were heavy drinkers.

Cigarettes became a ritual of relaxation during World War II. In 1964, Surgeon General Luther Terry made public the deleterious effects of smoking on health. In 1982, DoD began to track smoking on its Worldwide Surveys. As part of the 1986 Health Promotion Program, DoD limited smoking in workplaces; in 1994, it banned smoking indoors. Between 1980 and 1992, the proportion of military smokers declined from 51 percent of the force to 35 percent. During the same period, civilian smoking declined from 30 percent to 25 percent.

Use of illegal drugs and abuse of medicinal drugs became a problem in the armed forces in the late 1960s as a consequence of expanding drug use in the civil sector and easy availability of drugs in Vietnam. During the Vietnam War, drug users were classified as addicts and evacuated through medical channels. In 1971, treatment and rehabilitation of drug as well as alcohol abusers was mandated.

The Boys in the Barracks, a landmark study of drug use in the U.S. Army in 1973–74 by L. H. Ingraham and F. J. Manning, revealed the psychological purposes served by drug abuse. Soldiers in dysfunctional units used drugs as a basis for establishing trust among themselves and bonding against authority. These findings led to initiatives to enhance cohesion around military values and to train leaders to care for and empower their subordinates. The first Worldwide Survey (1980) indicated that drug abuse was volitional rather than addictive behavior, and a 1980 DoD directive made commanders rather than the medical departments responsible for its control.

In 1984, random urinalysis made it difficult for drug users to escape detection, and in 1986 the Health Promotion Program introduced zero tolerance for drug use. Officers and noncommissioned officers caught using drugs were eliminated from the service. Commanders had discretion to give junior enlisted personnel a second chance by authorizing rehabilitation. Drug use fell from 27.6 percent of military personnel in 1980 to 3.4 percent in 1992. The latter figure compares favorably with 10 percent use in 1991 in the general population.

Since the mid‐1980s, substance abuse has declined as commanders, supported by the medical departments, have assumed responsibility for promoting healthy behavior. Emphasis on cohesion, focus on wartime missions, and improved leadership have reduced the psychosocial needs for drugs, alcohol, and tobacco. The military population has become older and better educated, and more members are married—demographic characteristics negatively correlated with substance abuse. Drug abuse has been almost eliminated. But both drinking and smoking—which military traditions define as characteristics of a fighting man—persist, particularly among the young, unmarried, and poorly educated.

Bibliography

Marvin R. Burt , et al., Worldwide Survey of Nonmedical Drug Use and Alcohol Use Among Military Personnel: 1980, 1982.
Robert M. Bray , et al., 1982 (1985, 1988, 1992) Worldwide Survey of Substance Abuse and Health Behaviors Among Military Personnel, titles vary; 1983, 1986, 1989, 1992.
Larry H. Ingraham and and Frederick J. Manning , The Boys in the Barracks, 1984.
U.S. Department of the Army , Alcohol and Drug Abuse Prevention and Control Program, Army Regulation 600–85, 1988.
Henry J. Watanabe,, Paul T. Harig,, Nicholas J. Rock,, and and Ronald J. Koshes , Alcohol and Drug Abuse and Dependence in Franklin D. Jones, et al., eds., Textbook of Military Medicine, Part I, Vol. 7: Military Psychiatry—Preparing in Peace for War, 1994.
Robert M. Bray,, Larry A. Kroutil,, and and Mary Ellen Marsden , Trends in Alcohol, Illicit Drug, and Cigarette Use Among U.S. Military Personnel: 1980–1992, Armed Forces and Society, 21 (Winter 1995), pp. 271–93.

Faris R. Kirkland