NATIONAL HARBOR, MD—Tobacco, alcohol and prescription drug misuses, and illicit drug use cost the US Department of Defense (DoD) billions in direct health care expenditures and have additional impact as they inhibit force readiness, according to researchers from the Defense Health Agency. To date the DoD has struggled to understand the scope of the problems, although in most cases the researchers believe it is less than that of the general population.
Tobacco use and its related health problems have been linked to higher drop-out rates in basic training, poorer visual acuity, and a higher rate of absenteeism. Financially, tobacco use also extracts a significant cost: an estimated $1.7 billion in additional medical costs to the DoD, including $1 billion for prime beneficiaries and up to $700 million for standard beneficiaries. About $80 million is the result of secondhand smoke, and $5 million is derived from smokeless forms of tobacco. Also the DoD estimated that the cost in loss of productivity and fire injuries for service members is about $63 million.
Alcohol misuse also represents a significant challenge to military health and readiness, costing the DoD $1.3 billion in a 2014 estimate that included $73 million in loss of productivity. In the case of alcohol, the social impact was likely even higher. In fiscal year 2017, the DoD estimated that alcohol was a factor in one-third of attempted suicides. According to the DoD’s 2018 Workforce and Gender Relations survey of active-duty service members, alcohol also was a factor in 62% sexual assaults of women and 49% of sexual assaults of men.
Prescription drug misuse and Illicit drug use are less common, with lower rates than those found in the general population. Cocaine and marijuana are the most common drugs, while pain relievers are the most common prescription drugs being misused.
Service members face a number of risk factors for substance use disorders (SUDs), including service-related injuries, demands of active duty, poor relationships with commanders, separation from family members, psychiatric distress, and boredom. A particular challenge for the Military Health System is getting service members to seek help for SUDs. Many service members may be concerned over actual and perceived consequences for seeking treatment for a SUD, the stigma associated with SUDs, and negative associations with seeking treatment.
In response, the DHA has developed online health education campaigns to complement ongoing service-level programs and policy initiatives. Both You Can Quit 2 for tobacco and Own Your Limits for alcohol include live chats, educational materials, quizzes, and other interactive elements and allow service members to access the resources anonymously. The DoD plans to study their effectiveness.