Defense Department Eyes Substance Abuse Trends

By Lisa Daniel
American Forces Press Service

WASHINGTON, Oct. 1, 2010 - October 25 starts Red Ribbon Week for drug awareness, and this year Defense Department officials hope to shed light on what may be a disturbing new trend in substance abuse by servicemembers, according to the department's director of health promotion and preventative services policy.

While illegal drug use has held static for several years, according to the department's annual Survey of Health Related Behaviors Among Active Duty Personnel, the misuse of prescription drugs and legal substances is growing. In 2005, the survey showed an uptick in servicemembers' misuse of legal substances such as prescription drugs, inhalants, and compounds known as "designer drugs" marketed on the Internet often as herbal remedies, Lynn Pahland said in a Sept. 28 interview with American Forces Press Service.

Unsure whether the increased reporting reflected real use or was a misinterpretation of questions, the department refined the questions for the 2008 survey, but the uptick remained, Pahland said, and closely aligned with a major civilian drug use survey by the U.S. Centers for Disease Control.

Pahland's team at Military Health Affairs immediately commissioned a research project to find out the motivation behind the answers. The results are expected later this month, she said.

"It's a huge concern, it's a national concern," Pahland said. "Any kind of drug use or health choice that leads to the impairment of a military person leads to the degradation of readiness."

Underscoring that national concern, Gil Kerlikowske, the Obama administration's drug control policy director, yesterday called prescription drug abuse "America's fastest-growing drug problem." He issued the statement after Congress passed the Secure and Responsible Drug Disposal Act, a law designed to curb misuse of prescriptions through better disposal of unused or expired prescriptions.

"Prescription drug abuse is America's fastest-growing drug problem, and one largely fed by an unlikely source -- Americans' medicine cabinets," Kerlikowske said in the statement. The new drug disposal law "will save lives by providing patients with safe, environmentally sound ways to dispose of unused or expired prescription drugs."

The military study will closely examine trends among servicemembers and try to pinpoint causes and possible prevention programs, Pahland said. "The military absolutely comes from the U.S. population, but there also is a very specific type of individual who comes into the military," she said.

Military Health Affairs' health promotion and preventative services office works closely with other federal agencies to identify emerging drug trends and develop policies and prevention tactics, Pahland said. "We populate each other's work groups and committees, and share data with others," she said. "Our primary focus is to use every resource with our colleagues in other agencies and in academia to identify, study and track drug use."

The health-related behaviors survey, which asks active-duty servicemembers to report their behaviors anonymously, "really gives us a good snapshot of people's attitudes and behaviors, so we can react to the data and improve our programs," she said.

The military has hundreds of drug awareness and prevention programs at all levels, from the Office of the Secretary of Defense to the command level and below, Pahland said. One of those programs is the Military Health System's participation in the National Family Partnership's Red Ribbon Week, held the last week of October each year to highlight drug prevention efforts. The nonprofit partnership was created in 1980 to curb a rising tide of drug use by young people.

Under the theme, "I Am Drug Free," Military Health Affairs will host an Oct. 22 ceremony in the Pentagon's Hall of Heroes that will recognize six military programs deemed the best for drug awareness.

As with its drug prevention programs, the military has numerous regulations and policies against drug abuse, including legal substances, covered in the Uniformed Code of Military Justice, Defense Department personnel policies, as well as those of the services, Pahland said. In some cases, installation commanders issue rules against certain legal substances, and work with local officials to curb the use of 'herbal' compounds, she said.

Regardless of the duplication and various sources, it is clear that even the misuse of legal substances is banned for all servicemembers. As one example, DoD Directive 1010-3.4 includes in its definition of drug abuse, "The wrongful use, possession, distribution, or introduction onto a military installation of a controlled substance, prescription medication, over-the-counter medication, or intoxicating substance (other than alcohol)."

The policy goes on to say that "wrongful" means: "without legal justification or excuse, and includes use contrary to the directions of the manufacturer or prescribing health-care provider, and use of any intoxicating substance not intended for human ingestion."

But military leaders and department officials know servicemembers are abusing legal substances, sometimes with disastrous consequences. Officials with the Armed Forces Medical Examiner's office report instances in the past year of servicemembers dying from sniffing, or "huffing," inhalants.

Military members have sniffed glue, paint thinner, and gases such as Freon, butane, propane, and helium, all of which are known to cause disorientation, euphoria and other symptoms, Navy Lt. Cdr. Sean Swiackowski, deputy medical examiner, said in a recent interview with The Pentagon Channel. "We've seen in the past year or two just how prevalent it has become," he said.

Designer drugs such as synthetic marijuana, marketed as "spice," or "K-2," and salvia divinorum, a variation of the sage plant known as "salvia," also have caught on in recent years, according to Defense officials. The compounds are legal in most states, inexpensive, and have not shown up on random drug tests, although that may soon change as tests are improved, Pahland said.

But they also can be dangerous. "A lot of these products are made in garages and homes, so you don't have quality control," Army Col. Timothy Lyons, chief of toxicology in the medical examiner's office, said. "Each package, even under the same name, has different levels of compounds. So you really just don't know what you're getting."

Pahland, Swiackowski, and Lyons agree that ignorance of the dangers of such substances is a big problem. Many are marketed as herbal remedies and compared to products like St. John's Wart, poppy seeds, and chamomile tea, and servicemembers often buy them thinking it will be a safe way to relax, Pahland said.

"I've talked to quite a few people who said they did not know this was something harmful," she said.

Too many servicemembers still are reluctant to seek medical attention for problems like depression and anxiety, and may be self-medicating, Pahland said.

"Especially in the military, we have people who are used to being self-sufficient who might interpret depression as a weakness," she said. "But we certainly do not."

Health Affairs is looking at various policy options to prevent substance abuse, Pahland said, including the different methodologies used in dispensing prescriptions and tracking the movement of those prescriptions.

"One of the most important things is that the entire Department of Defense has as a focus on the well-being of our forces," she said. "So there many, many areas in DOD that are looking to better protect our personnel.

"The main thing, from my perspective, is: don't take a drug you're not prescribed, or that you know nothing about," she said. "These things seem routine, but they're so very important."

Related Sites: Military Health System Red Ribbon Week