August 17, 2018
Substance Abuse Prevention, Treatment, and Research Efforts
in the Military
Congress has taken an interest in understanding federal
efforts and identifying options to address substance abuse,
particularly in the context of the opioid crisis. On October
26, 2017, President Trump declared the drug demand for,
and use of, opioids as a “national public health emergency”
and directed all executive agencies to “use every
appropriate emergency authority to fight the opioid crisis.”
The Department of Defense (DOD) has, for many years,
operated substance abuse programs focused on prevention,
treatment, and research of alcohol, illicit drug use, and non-
medical use and abuse of prescription drugs.
What are the substance abuse trends in the
military?
From 2009-2016, the number of new alcohol or substance
abuse diagnoses per year has been on a declining trend for
active duty service members. According to the 2015 DOD
Health-Related Behaviors Survey, active duty service
members reported using or misusing the following
substances within the past year: illicit drugs (0.7%),
prescription drugs (4.1%), and alcohol binge drinking
(30%). Other than binge drinking, the prevalence of
substance abuse is lower than in the general U.S.
population. DOD attributes these trends to the education,
prevention, and treatment programs it has developed over
the past decade.
Figure 1. Incidence Rates of Alcohol and Substance
Abuse in Active Duty Service Members, 2007-2016
Source: Shauna Stahlman and Alexis Oetting, “Mental Health
Disorders and Mental Health Problems, Active Component, U.S.
Armed Forces, 2007-2016,” Medical Surveillance Monthly Report, vol.
25, no. 3 (March 2018), pg. 5.
Note: “Person-year” is a measure of the time at risk for a defined
population.
DOD recently reported that opioid medications are
prescribed at a higher rate for service members than the
general U.S. population. This higher prescription rate may
be attributable to deployment-related effects such as combat
exposure and injuries. However, the incidence rate for
dependence or abuse among service members has declined
by 38% between 2012 and 2016. When adjusted for
demographics, the opioid death rate among service
members is significantly lower than the U.S. population at
2.7 per 100,000 and 10.4 per 100,000, respectively.
How does substance abuse impact military training
and operations?
Service members seeking substance abuse treatment or
rehabilitation may require extended leave from duty. Those
with problematic substance use can be administratively
separated from the military. Administrative separations
occur when a service member refuses to participate in, or
fails to successfully complete, a rehabilitation program; or
if there is a lack of potential for continued military service.
Extended absences or unplanned attrition can impact a
unit’s mission by creating staffing and capability gaps,
disrupt unit cohesion, reduce morale, or perpetuate mental
health stigma. In 2011, DOD quantified the amount of lost
duty days resulting from service member illnesses and
injuries. Substance abuse ranked as the second-highest
cause with at least 7.0 lost duty days per patient. While this
rate is lower than the U.S. civilian employer average of
14.8 days, reduced productivity and absenteeism can
negatively impact military training and operations.
What are the main elements of DOD’s substance
abuse prevention, compliance, and disciplinary
policies?
Table 1 lists selected aspects of DOD’s substance abuse
policies, which are implemented by various DOD
components and each military service. In general, they
focus on administrative and medical approaches to
prevention, screening, treatment, compliance, and
retention/separation.
Table 1. Aspects of DOD Substance Abuse Policies
