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Army's Approach to Drug Treatment Criticized
January 23, 2009

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News Summary

While more returning U.S. soldiers struggle with addiction to painkillers prescribed by Army doctors to treat their combat injuries, the U.S. Army's approach to treating addicted soldiers is drawing increasing criticism, the Associated Press reported Jan. 21.

In the six years since the start of the war in Iraq, use of legal painkillers like Percocet, Vicodin, and OxyContin by injured troops has increased nearly 70 percent. Surveys reveal that more soldiers are struggling with prescription drug addiction and are seeking help from Army doctors and counselors.

But some critics say that the military system that historically relies on discipline as well as treatment is mishandling their charge. Barbara McDonald, a civilian social worker and Army drug abuse counselor, described the Army's handling of the recent surge in prescription drug abuse as "a terrible problem," calling the military's approach a broken system, as likely to punish or denigrate troops as to treat their addictions.

A recent court martial and subsequent imprisonment of a soldier in Fort Leonard Wood, Missouri, for illegally buying prescription drugs and selling the pills to eight other soldiers, along with allegations of misconduct and staffing shortages in the Army Substance Abuse Program (ASAP), induced Sen. Claire McCaskill, (D-Mo.) to ask the Secretary of the Army to investigate.

"Clearly, at Fort Leonard Wood and potentially across the military, they have not prioritized this as a health issue," McCaskill said. "The culture has traditionally looked at this as a discipline issue."

Army officials have defended their treatment approach, even while acknowledging treatment staffing shortages nationally; ASAP is 90 counselors short of required employment levels.

Chuck Ashbrook, who oversees ASAP prevention and education efforts at Fort Leonard Wood, said counselors pay close attention to links between substance abuse, post-traumatic stress disorder and combat injuries, noting that medical advances have allowed soldiers who might have returned from previous conflicts as casualties to survive with injuries that require stronger pain management.

Ashbrook also cited historical increases in drug dependency among soldiers during wartime. "We've always seen these kinds of problems," Ashbrook said. "This is not unique."

COMMENTS ON THIS ARTICLE:

Posted by boogie on 26 Jan 09 11:17 AM EST
At least someone's got it right! This is a "self dicipline problem". Hooray for the Army, maybe we need to send everyone who thinks they are a so called "Addict or Alcoholic" to them instead of letting them whimp out on society and cost us billions of dollars in these do nothing "step programs" which clearly don't work.

Posted by Jason Blanchette on 26 Jan 09 11:37 AM EST
The army certainly has some tweaking to do with their handling of addictions but any soldier who profits from selling drugs should be court martialed. This is the most effecient military in the world, and it's not by accident.

Posted by Gyrine68 on 26 Jan 09 12:34 PM EST
I take umbrage to the above remarks; nowhere does it say that the soldier at Ft. Leonard Wood was selling the drugs for profit or personal gain. This wouldn't be the first time a soldier utilized a collective approach to supply and demand As a Marine Vietnam Veteran with anecdotal experience I can tell you with a certainty that there is a tendency to over-medicate on the part of both the military and the VA. Furthermore, there exists a significant body of literature linking PTSD and substance abuse. My guess is that you probably have PTSD as a moral or adjustment issue as well.

Posted by David on 26 Jan 09 02:11 PM EST
The research on treatment effectiveness is very, very clear IT WORKS! Not that some providers can't mess it up, they do. Defining problems with alcohol & drugs as something so one dimensional as "self discipline problems" is no more helpful than trying to get us to believe that all problems with alcohol & drugs is due to some sort of disease process. We need to take a very broad view of what people do in their lives and try to understand things from various perspectives. Empathy and accountability are not mutually exclusive. The desired outcome has to reign over process. There is no one answer to this very serious and complex problem. Treatment does not work for person and every situation nor does punishment, fear and guilt. If we are interested in solutions then finding fault has to be done not with predjudice and emotionalism but with the sincere desire to help bring about positive changes, in the person and the system. Both need help!

Posted by Judy Lynne Cole on 26 Jan 09 04:43 PM EST
The Army could choose to add PDR listed nutritional SON Formula to their formulary and thus be able to provide the 8 essential amino acids as the building blocks for recovery from addictive behaviors, PTSD, wounds, etc.

Posted by Bob Melson on 26 Jan 09 08:25 PM EST
Since the Civil War we have been dealing with drug addiction created, caused by, exacerbated by injuries combat stress etc. We have research based approaches to deal with pain medication abuse and addiction. Methadone has been shown effective for over 30 years. We want reseach when we like what is says. I would encourage all to read "Tommy" by Kipling, it tells the story of how we actually hold veterans in our society.

Posted by Bob Melson on 26 Jan 09 08:32 PM EST
We have been dealing with the problem of drug use created by, casued by exacerbated by injuries and the stress of combat since at least the civil war. We have research which documents treatments that do work. We really like to quote research when we agree with the result. We have researched Methadone for over 30 years it works. I suggest "Tommy by Kipling as an example of how we really deal with and feel about veterans.

Posted by PathwayBob on 26 Jan 09 08:53 PM EST
I worked as the Substance Use Disorder specialist in the only OIF/OEF residential PTSD program in the country. (VA does this type of work,but doesn't narrow it to our current wars. The people (active & veteran) we see are very raw and very wounded. Chronic pain IS a huge issue for many of them. Current techniques are saving more of gravely injured than over before. Synthetic opiates are heavily prescribed by the military. Our vets & active duty are becoming dependent of these meds for their pain mgmt. The thing most people don't know about these meds is their serontonergic effect. It's not easy to explain; research is just now looking at this but there is a mood enhancing effect with them. They are harder to "kick". I am saddened by some of the posts;maybe they don't know anyone who has PTSD where any noise makes them jump out of their skin,they feel such rage they are afraid they will strangle their wife,etc. Then put chronic pain on top of this. Addiction is a killer especially for someone who already thinks they've no real reason to live or thinks they're already dead. Recovery is not a matter of discipline. Yes no one ever has the right to profit from another's pain. Peace.

Posted by Pam on 26 Jan 09 11:16 PM EST
If you want to learn more about how the Army's substance abuse treatment program works, look online for "AR 600-85," the 14 January 2009 version. This is the regulation governing the program. Eye opening read, it is available publicly.

Posted by Bonnie on 06 Feb 09 08:56 AM EST
boogie - your ignorance of addiction is blatant when you describe addicts as simply having a self-discipline problem. Educate yourself, and you will learn how addiction affects the brain and "will power" and "discipline" have NOTHING to do with actual drug addiction. The 12-step program does not work for everyone, which is why I would like to see more alternative support groups out there. People need more choices than just AA or NA. But treatment - whether through self-help, medical intervention, or rehab - does work - and helps lot of people suffering from addiction. We just need to make it better, and more readily available to the ones who want it. Unfortunately, it's your kind of judgmental thinking that encourages the stigma and discrimination associated with addiction to flourish - shame on you!

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