Members of the armed forces are not immune to the substance use problems that affect the rest of society. Although illicit drug use is lower among U.S. military personnel than among civilians, heavy alcohol and tobacco use, and especially prescription drug abuse, are much more prevalent and are on the rise.

The stresses of deployment during wartime and the unique culture of the military account for some of these differences. Zero-tolerance policies and stigma pose difficulties in identifying and treating substance use problems in military personnel, as does lack of confidentiality that deters many who need treatment from seeking it.

Those with multiple deployments and combat exposure are at greatest risk of developing substance use problems. They are more apt to engage in new-onset heavy weekly drinking and binge drinking, to suffer alcohol- and other drug-related problems, and to have greater prescribed use of behavioral health medications. They are also more likely to start smoking or relapse to smoking.

Illicit and Prescription Drugs

According to the 2008 Department of Defense (DoD) Survey of Health Related Behaviors among Active Duty Military Personnel, just 2.3 percent of military personnel were past-month users of an illicit drug, compared with 12 percent of civilians. Among those age 18­–25 (who are most likely to use drugs), the rate among military personnel was 3.9 percent, compared with 17.2 percent among civilians.

A policy of zero tolerance for drug use among DoD personnel is likely one reason why illicit drug use has remained at a low level in the military for 2 decades. The policy was instituted in 1982 and is currently enforced by frequent random drug testing; service members face dishonorable discharge and even criminal prosecution for a positive drug test.

However, in spite of the low level of illicit drug use, abuse of prescription drugs is higher among service members than among civilians and is on the increase. In 2008, 11 percent of service members reported misusing prescription drugs, up from 2 percent in 2002 and 4 percent in 2005. Most of the prescription drugs misused by service members are opioid pain medications.

Mental Health Problems in Returning Veterans Service members may carry the psychological and physical wounds of their military experience with them into subsequent civilian life. In one study, one in four veterans returning from Iraq and Afghanistan reported symptoms of a mental or cognitive disorder; one in six reported symp-toms of post-traumatic stress disor-der (PTSD). These disorders are strongly associated with substance abuse and dependence, as are other problems experienced by returning military personnel, including sleep disturbances, traumatic brain injury, and violence in relationships. Young adult veterans are particularly likely to have substance use or other mental health problems. According to a report of veterans in 2004-2006, a quarter of 18- to 25-year-old veterans met criteria for a past-year substance use disorder, which is more than double the rate of veterans aged 26-54 and five times the rate of veterans 55 or older.

The greater availability of these medications and increases in prescriptions for them may contribute to their growing misuse by service members. Pain reliever prescriptions written by military physicians quadrupled between 2001 and 2009—to almost 3.8 million. Combat-related injuries and the strains from carrying heavy equipment during multiple deployments likely play a role in this trend.

Drinking and Smoking

Alcohol use is also higher among men and women in military service than among civilians. Almost half of active duty service members (47 percent) reported binge drinking in 2008—up from 35 percent in 1998. In 2008, 20 percent of military personnel reported binge drinking every week in the past month; the rate was considerably higher—27 percent—among those with high combat exposure.

In 2008, 30 percent of all service members were current cigarette smokers—comparable to the rate for civilians (29 percent). However, as with alcohol use, smoking rates are significantly higher among personnel who have been exposed to combat.

Suicides and Substance Use

Suicide rates in the military were traditionally lower than among civilians in the same age range, but in 2004 the suicide rate in the U.S. Army began to climb, surpassing the civilian rate in 2008. Substance use is involved in many of these suicides. The 2010 report of the Army Suicide Prevention Task Force found that 29 percent of active duty Army suicides from fiscal year (FY) 2005 to FY 2009 involved alcohol or drug use; and in 2009, prescription drugs were involved in almost one third of them.

Addressing the Problem

A 2012 report prepared for the DoD by the Institute of Medicine (IOM Report) recommended ways of addressing the problem of substance use in the military, including increasing the use of evidence-based prevention and treatment interventions and expanding access to care. The report recommends broadening insurance coverage to include effective outpatient treatments and better equipping healthcare providers to recognize and screen for substance use problems so they can refer patients to appropriate, evidence-based treatment when needed. It also recommends measures like limiting access to alcohol on