Drugs and Alcohol

Alcohol and Substance Abuse

Substance abuse is defined as the wrongful use of a controlled substance, prescription medication, over-the-counter medication, or intoxicating substance to the extent that it has an adverse effect on performance, conduct, discipline, or mission effectiveness. This also includes the intentional inhalation of fumes or gasses of intoxicating substances, with the intent of achieving an intoxicating effect on the user's mental or physical state, and steroid usage other than that specifically prescribed by a physician.

Alcohol Abuse
Alcoholism is a disease that can have serious effects on a person's physical and emotional health as well as on their personal and professional relationships. If you or someone you know has an alcohol abuse problem, it's vital to get help as soon as possible.

Substance Abuse v. Drug and Alcohol Dependence
Drug and alcohol dependence refer to the psychological or physiological (physical) reliance on alcohol, a chemical substance, or pharmacological agent. Substance abuse is the wrongful use of a substance that could lead to dependence. Both can result in adverse personal, professional, physical, and social effects. Both are clinical diagnoses determined from an assessment by a qualified mental health professional or physician. Individuals experiencing either substance abuse or dependence can benefit from treatment intervention. However, drug dependence requires treatment as well as possible medical monitoring for physical withdrawal.

Risk Factors
Any service member, regardless of rank or specialty, can be at risk. Often, alcohol and other illicit drug use are associated with significant stressors linked to military life, such as combat, deployment, field duty, and frequent moves or separations from family.

Persons who use alcohol or other drugs as a preferred way to socialize, to "relax," or to cope with life stressors are most vulnerable to becoming regular users and potentially dependent on alcohol or drugs. It is also not uncommon for service members to use alcohol or other drugs to alleviate their distress or to try to escape from depression, post-traumatic stress, or anxiety. However, using alcohol or drugs as a means of coping will only make the original problem worse and will likely cause additional complications.

Warning Signs
Dependence on alcohol or other drugs might occur gradually over time (months or years) or with a quick onset over the course of only a few weeks. The following are some of the potential indicators of substance abuse or dependence:

  • Physical - decreased physical capabilities, less energy, decreased appetite, nutritional deficiencies, increased injuries and falls, symptoms of alcohol or drug withdrawal (e.g., tremors [hands shaking], sweating, vomiting, hallucinations). Increased tolerance for alcohol or drugs (needing more of the substance to achieve the desired effect).
  • Psychological - denial of the problem, irritability, agitation, mood swings, anxiety, depression, difficulty concentrating, memory lapses, black outs, or efforts to stop using drugs or drinking.
  • Financial - difficulties with budgeting or with debts, inability to pay bills due to money spent on alcohol or drugs, borrowing money before pay day to buy alcohol or other drugs, or borrowing money to pay late bills.
  • Legal - encounters with law enforcement or the courts for drug-related offenses (e.g., driving under the influence, public intoxication, underage drinking, possession of drugs, assault, sexual assault, domestic violence, child abuse, or child neglect).
  • Work Performance - low motivation, poor morale, loss of interest, increased errors, faulty judgments, tardiness, increased sick days, and avoidance of others.
  • Relationships - strained, conflicted relationships or reports of physical abuse, domestic violence, separation, or divorce can be indicators of a substance abuse problem. Some substance abusers become isolated or withdrawn, whereas others become more social when under the influence of alcohol or other drugs, wanting to be the center of attention.
  • Behavioral Changes - changes in appearance (less attention to grooming or dress), excessive use of eye drops or breath mints, increased difficulties on the job and with relationships, and becoming more aloof or secretive.
  • Social Changes - efforts to seek out activities that involve alcohol or drugs.

Note: These indicators can also be the result of other issues and may not necessarily be substance-abuse related. However, a combination of several of these indicators warrants further inquiry or assessment.

Effects of substance abuse
If untreated, substance abuse can lead to serious medical problems like cirrhosis of the liver, increased cancer risk, heart disease, and damage to the brain. Substance abuse can also lead to serious family conflicts, loss of friendship, problems at work, and mental health problems such as depression, loss of self-esteem, and chronic feelings of guilt.

Prevention
Strategies to decrease substance abuse issues:

  • Be knowledgeable of the symptoms of substance abuse and dependence.
  • Implement healthy coping strategies in lieu of using alcohol or drugs to cope with stress or to relax.
  • Create and implement a proactive plan to address physical, psychological, social, and work-related stressors.
  • If needed, seek consultation from a supervisor or a mental health professional.
  • Tips for leaders in preventing substance abuse include:
  • Be proactive and don't wait until there is a significant problem within the unit.
  • Keep an open dialogue with junior service members about substance use, abuse, and dependence.
  • Promote healthy alternatives to coping with stress and an open, non-judgmental environment that encourages service members to get help when they need it before problems become unmanageable.

Recognizing a Problem
If you recognize symptoms of substance abuse or dependence in yourself or find that your use of alcohol or other drugs is interfering with work and personal relationships, it is time to seek professional help. This is not to suggest that you have failed in any way. In fact, getting help can be the key to getting better and being able to return more fully and more effectively to leadership and work roles.

Treatment for substance abuse
Most people who abuse alcohol and/or drugs need long-term support and professional help. There are many kinds of help, including self-help programs like Alcoholics Anonymous, detox programs, outpatient or inpatient (residential) programs, and halfway houses. Other programs offer support to the friends and families of substance abusers, such as Al-Anon and Alateen. You can learn more by calling the National Clearinghouse for Alcohol and Drug Information hotline at (800) 729-6686.

The first step in getting treatment is getting a formal assessment of the problem. This should be done in person with a trained substance abuse professional. Ask your doctor for a referral. Your employee assistance program (EAP) may have additional information. Remember that the program that provided this publication also has many resources on substance abuse.

Recovering From Dependence on Drugs or Alcohol
The use of alcohol or drugs can get out of control for some people. While no one intends to become physically dependent on a substance, it can sneak up and begin to damage a person's life in many different ways. It usually starts with social using or drinking and then becomes a way to relieve stress or numb emotional pain. As time passes, it becomes more difficult to go without the substance, and larger and larger amounts are needed just to feel good. It's an addiction when people continue to seek and consume a substance despite harming themselves and the people around them.

If you think you might have a problem with drugs or alcohol, or know you have a problem, change is possible. It usually takes treatment, support from others, plus commitment and hard work.  But you can get your life back. Treatment and support are available to service members through the substance abuse program of their service branch. For military family members struggling with addiction, treatment services are covered under TRICARE. Eligible veterans can also access substance abuse programs through the Department of Veterans Affairs.

Making the decision to change
After recognizing drug or alcohol abuse and the possibility of addiction, the first step toward recovery is making the decision to get sober. This decision is never easy because it involves much more than just getting clean.  A person actually recovers from addiction by changing familiar behaviors and creating a new lifestyle. If you want to get free of a substance that controls your life, you must also:

Give up people, places and things that trigger cravings. Try to avoid people who you have been drinking or using with or who encourage your abuse, either directly or indirectly. Stay away from places where you bought or used drugs or alcohol. And get rid of things that make you think about drinking or using, such as drug paraphernalia or alcohol and bar equipment in your home. You may not be able to steer clear of all situations that trigger cravings, but being more aware of them will help you avoid being caught off guard.

Become totally honest with yourself and others. Lying is a normal part of an addict's life. Addicts lie about every aspect of their substance abuse in an effort to hide their addiction. Lying becomes so routine that addicts lie to themselves as much as to others, and telling the truth no longer comes naturally. Recovery requires complete honesty. It may take some time and practice telling the truth before it begins to feel right.  

Learn how to deal with stress in new and healthier ways. For many people, addiction began as a way to manage stress or cope with painful feelings through the use of drugs or alcohol. Using a substance may seem like the only remedy for anxiety, loneliness, anger or sadness, but it's not. These emotions are part of life, and to recover from addiction, you'll need to have new and better ways to get through difficult times. Learning new skills and techniques to manage stress is an important part of treatment.

Getting treatment
Once you've decided to confront your addiction, you'll need to get treatment. Because addiction changes the way the brain functions, going it alone doesn't work. Treatment helps you rebuild the brain's connections that have been altered by addiction. However, there's not a single treatment approach that fits everyone's needs.

For example, many, but not all, substance abusers require detoxification at the beginning of treatment. Medication may be an important part of treatment for some people but not others. And inpatient care, residential rehabilitation and outpatient services are possible treatment options depending on a person's age, history of substance abuse and other physical or behavioral health conditions.

As you explore options with a professional care provider, remember that there's no quick and easy treatment for addiction. Intensive treatment for weeks or months, followed by long-term follow-up and support, is often necessary for recovery. Your ongoing commitment to the recovery process is also crucial.

An effective treatment program will address more than just your substance abuse. At a minimum, you can expect your treatment program to provide:

Education and therapy sessions on addiction, getting sober and preventing relapse. Before you can successfully resist your addictive substance, you'll need to understand how it affects your brain and your body, and how to manage triggers leading to relapse. Your participation in these sessions may be as an individual or in a group.

Counseling to help you develop new coping skills. You might work with a behavioral health or substance abuse counselor, individually or with your family, to develop effective ways to handle feelings like anger, anxiety and the hurts that are part of life. Counseling will also help you deal with underlying problems such as depression or conflicts in your family or workplace. And it can help you learn specific strategies you can use to relax and get through difficult times without using drugs or alcohol.

Self-help groups for drug and alcohol addiction
Joining a support group can be a very important aspect of recovery. Meetings of self-help groups like Alcoholics Anonymous and Narcotics Anonymous are widely available on military installations and in civilian communities. They offer a safe place where you can connect with others who know what you're going through and are an effective way to discuss and receive support for the challenges of maintaining sobriety. Recovering addicts are typically encouraged to start attending a self-help group during treatment and continue for as long as they find meetings helpful. They're also urged to return to their meeting as soon as possible after a relapse. Some recovered addicts stay involved in a self-help group for years. They become group leaders and sponsors and freely share personal experiences with addiction and offer their insights to help new members.

Most but not all recovery support groups follow the 12-step model developed by Alcoholics Anonymous. Twelve-step programs typically have a spiritual emphasis and the goal of total abstinence. Although the specific steps differ slightly between organizations, they generally treat recovery as a process that involves:

  • Admitting that you cannot control your addiction or compulsion
  • Recognizing a higher power (as you understand it) that can give strength
  • Examining past mistakes with the help of a sponsor (experienced member)
  • Making amends for these mistakes
  • Learning to live a new life free from old, unhealthy habits and ways of behaving
  • Helping others who suffer from the same addictions or compulsions

The Substance Abuse and Mental Health Administration's fact sheet on mutual support groups provides additional information on 12-step programs as well as other organized self-help groups. Use the list of support group websites to find a meeting in your area that fits your needs.

Maintaining sobriety
Having family and friend's support, getting involved in new activities like a hobby or volunteering, and taking care of yourself by exercising, eating right and getting enough sleep are all things that will help you maintain sobriety. But remember, relapse is a common part of the recovery process. Instead of seeing it as failure (if it happens), get sober again as quickly as you can. Try to evaluate the causes of your setback and what you might have done differently. A relapse can be turned into an opportunity to learn from mistakes and strengthen your commitment to sobriety.

If you think you may be abusing or addicted to drugs or alcohol, a Military OneSource consultant (800-342-9647) can help you identify the resources or support programs that will be right for you. If you're an active duty service member and have voluntarily sought help, you can receive confidential treatment through your service's substance abuse program. If your command is aware of your problem or you were ordered into treatment, military leaders are expected to support good faith efforts to recover from substance abuse or addiction and welcome clean and sober service members back into their units.

Drug Testing Policy:
Department of Defense (DoD) policy requires all Service branches to conduct random urinalysis testing to detect and deter drug use among all military personnel. If a service member has a positive drug test, the commander should refer him or her for further assessment. Anyone who is directed by the commander to take a urinalysis test must comply, including those DoD civilians that serve in Department of Health and Human Services approved Testing Designated Positions. If a service member refuses to submit a urinalysis sample, it is considered a failure to obey a lawful order and he or she can be referred for disciplinary action.

There are a number of options for urinalysis testing of service members:

  • Random urinalysis testing involves drug testing of service members with random selection by a DoD-certified computer program.
  • Voluntary consent testing is used prior to a probable cause or command-directed urinalysis test. Commanders should coordinate this test with the Staff Judge Advocate (SJA) office.
  • Probable cause testing occurs when a commander has probable cause to believe that the service member has used illegal drugs. Commanders should coordinate this test with the SJA office.
  • Commander-directed testing is used when the commander suspects drug use but does not have a sufficient basis for probable cause. Commanders should coordinate this test with the SJA office. This test is appropriate if the service member has exhibited drug-related unlawful or atypical behaviors of concern to the commander.
  • Self-identification testing is appropriate when a service member comes to his or her commander and self-identifies as being a drug user prior to being selected to participate in urinalysis testing.
  • Rehabilitation testing is directed by the commander on an unannounced basis for persons who are in rehabilitation (including aftercare) to ensure adherence to sobriety. Unit commanders may discontinue this testing if a court-martial or separation action is initiated on a member in rehabilitation.
  • Other testing options include urinalysis testing as part of unit inspection (all or part of a unit), during the aftermath of a safety mishap, as part of a command-directed assessment for fitness for duty or the need for treatment, or as part of a medical intervention.
  • New members of the military may also be required to submit to testing.

Intervention Services
Service members who abuse alcohol or other drugs may be identified and provided with intervention services in several different ways:

  • Assessment and treatment services are available for service members who seek help with alcohol or drug abuse or dependency. Service members may still be subject to potential disciplinary action, when appropriate, and the limits of confidentiality remain in effect (e.g., the commander's "need-to-know" in terms of the service member's treatment progress with regard to fitness for duty and mission readiness).
  • A health care provider must refer a service member for an assessment if substance abuse or dependence is suspected.
  • Commanding officers who suspect problem drinking or illicit drug use must refer service members for further assessment.
  • A service member could be identified as having substance abuse or dependency issues after an alcohol- or drug-related incident, such as driving while intoxicated, underage drinking, or disorderly conduct, if law enforcement or another disciplinary authority is involved. In such instances, commanders are notified and are responsible for making a substance abuse assessment referral.

Assessments
An assessment is often the initial step toward gaining a better understanding of the extent and nature of the service member's substance use, abuse, or dependence. Professionals who have experience diagnosing substance abuse disorders conduct assessments. An assessment involves a comprehensive bio-psychosocial and substance use history. Upon completion of the assessment, a diagnosis and recommendations are given which may include: no further action, outpatient counseling, intensive substance abuse/dependence treatment, or inpatient medical treatment for substance dependence and possible physical withdrawal.

Confidentiality
If a service member voluntarily seeks treatment, confidentiality is a part of the treatment process. Confidentiality refers to the protection of the personal and private information shared during a counseling session by the service member with a mental health or substance abuse counselor. However, there are exceptions to confidentiality in counseling, which include the service member's involvement with suspected child abuse, threats of potential harm to self or others (suicidal or homicidal), subpoena under court order, and the commander's need to know. In addition, many treatment programs require spouse involvement in the treatment and support of the service member.

If a service member is ordered for treatment, the command has a right and need to know the progress and outcome of the treatment. Commanders can request information about the service member due to their need to know about the service member's fitness for duty; to assure the safety of the service member, of the command, and the unit; and to protect the integrity of the mission. This includes service members who voluntarily receive treatment at a military facility. Therefore, treatment in a military facility is not likely to remain confidential.

Service members and dependents can seek treatment from a civilian facility at their own expense or through a support group without directly notifying command. It is possible that a military treatment facility (MTF) might learn of the treatment through the filing of insurance claims and requests for retroactive referrals. If MTF staff learned that a member was seeking treatment through a civilian program, they would notify command if the member was receiving inpatient care or if the member was addicted to drugs or alcohol.
It is important to note, however, that command involvement in treatment and aftercare can be supportive and beneficial. In fact, successful transition from treatment often depends on the support of others. Therefore, if command is aware of the service member's treatment needs, the commander may be able to help support the service member's efforts to maintain sobriety.

Counseling Services and Resources
Counseling services available through the installation are free to service members and DoD civilian personnel designated as Civilian Expeditionary Workforce and their family members. More information on substance abuse treatment and prevention programs within each Service is available online on their respective websites: