Pill Popping in Combat

One major sign of the Vietnam War's deleterious effect on the U.S. military was the widespread abuse of alcohol and illicit drugs by troops in Vietnam. Such usage occurred among rear-area troops and combat troops, with bad consequences for both. Drug use went hand-in-hand with other aspects of disciplinary breakdown -- falsified reports, orders disobeyed, fragging, racial tensions, and so on. Those were the dark days of the military.

In Time magazine this week, Mark Thompson reports that drug use has become a major issue for troops in Iraq and Afghanistan, as well. Except there's a major difference this time. Instead of getting high on illicit substances, these troops are taking prescription medications doled out by military medical personnel in order to stay in the fight. Thompson reports:

...For the first time in history, a sizable and growing number of U.S. combat troops are taking daily doses of antidepressants to calm nerves strained by repeated and lengthy tours in Iraq and Afghanistan. The medicines are intended not only to help troops keep their cool but also to enable the already strapped Army to preserve its most precious resource: soldiers on the front lines. Data contained in the Army's fifth Mental Health Advisory Team report indicate that, according to an anonymous survey of U.S. troops taken last fall, about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help them cope. Escalating violence in Afghanistan and the more isolated mission have driven troops to rely more on medication there than in Iraq, military officials say.

At a Pentagon that keeps statistics on just about everything, there is no central clearinghouse for this kind of data, and the Army hasn't consistently asked about prescription-drug use, which makes it difficult to track. Given the traditional stigma associated with soldiers seeking mental help, the survey, released in March, probably underestimates antidepressant use. But if the Army numbers reflect those of other services -- the Army has by far the most troops deployed to the war zones -- about 20,000 troops in Afghanistan and Iraq were on such medications last fall. The Army estimates that authorized drug use splits roughly fifty-fifty between troops taking antidepressants -- largely the class of drugs that includes Prozac and Zoloft -- and those taking prescription sleeping pills like Ambien.

By Phillip Carter |  June 6, 2008; 9:33 AM ET
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The Pentagon keeps statistics but whether you have a high enough security clearance is the question, when you run into obfustication and denial you know you are onto something important.

Posted by: elgunjduts | June 6, 2008 1:46 PM

Remember, this is the first teetotaling war. Back in the 90's, they made the rule that deployed troops were not allowed to drink. This led to some hysterical scenerios (I know you have a TS-SCI... but I can't trust you with a beer!)
Drinking is not for everyone, and can be problematic. But it is better to have a controlled situation (like the old club system) where an adult can choose to get a beer and a break in the stress.
Along with the irregular nature of this war, the lack of a front line of battle and repeated tours,denying the troops the dignity of being treated like adults may be contributing to the mental stress.

Posted by: rmarigny | June 6, 2008 3:53 PM

Something about this article is not quite right. For starters, Army doctors and pharmacies prefer Celexa to the older drugs, Prozac and Zoloft. What else did you get wrong?

Posted by: Xixi | June 6, 2008 5:36 PM

The article said "The class of drugs that includes Prozac and Zoloft ". I take this to be a simple way of saying SSRI's, or selective seratonin re-uptake inhibitors. Celexa is an SSRI.

No one got anything wrong, they just used layman's terms. So take a chill pill. OK Xixi?

Posted by: Josh Jasper | June 6, 2008 9:06 PM

One thing that seems to be seldom reported except by Michael Yon is the durg use by the enemy. Many of the suicide bombers spend their last days stoned on herion and opiates. Their handlers make sure they have plenty of junk.

Posted by: Buck Smith | June 6, 2008 11:21 PM

This is real crazy. One only has to read the side effects from these drugs to know that they actually could reduce the alertness of a soldier that needs to be alert. Is the military just like the VA pushing drugs for the drug companies.

Posted by: ghostcommander | June 7, 2008 1:16 AM

One could say that, in a general sense, some soldiers are relying on prescription medications to stay in action. Sleep aids and antidepressants, though, are very different kinds of medications.

Sleep aids like Ambien might be useful for soldiers (and airmen) required to operate at night and sleep during daylight hours. A light sleeper might use a sleep aid to keep from having sleep interrupted by distant explosions. Sleep aids are, of course, used by many people outside combat areas to treat the symptoms of insomnia. Finally, sleep aids could be abused, taken by soldiers to hold things together while under stress; it may be worth noting that in comparison with earlier American wars the drug of popular choice for this purpose -- alcohol -- is less easily available in Iraq and Afghanistan.

These uses are not mutually exclusive, but it seems to me that more evidence is needed to determine that sleep aids are being inappropriately used by large numbers of soldiers. Antidepressants are another story, for a couple of reasons. One is that they aren't an immediate substitute for alcohol. Another is that even newer generation antidepressants like Celexa make some people drowsy when they don't want to be; these side effects are not always predictable and would be undesirable in a combat environment.

On the other hand it is true that even in civilian life, antidepressants are often prescribed as an alternative to much more expensive and timeconsuming psychotherapy. If there were strong pressure to keep soldiers in service and in theatre, I imagine this could lead to a spike in prescriptions of these medications. This could be a response to a spike in incidences of major depression among personnel stationed in Iraq and Afghanistan -- and healthwise, major depression is a pretty big deal, to which no medication by itself is an entirely reliable answer. However, reliance on medications could also be a response to inadequacies in the Army's counseling services. Not every emotional distress is depression, and one might suspect that if antidepressants are being overprescribed it may be because the Army lacks the capacity to address its soldiers emotional issues in other ways.

Posted by: Zathras | June 8, 2008 11:51 PM

I am an active duty Army Nurse who has deployed to both Iraq and Afghanistan. It is true that the use of prescription antidepressants and sleeping aids by Soldiers occurs while deployed in support of current conflicts. However, this is not the only way in which Soldiers deal with the stress associated with combat. I can attest that the Army has made great strides in addressing the psychological needs of Soldiers. In Afghanistan in 2006 Combat Stress Teams deployed far forward as a resource to Soldiers who experienced combat. These teams are only one example of how the Army is working to meet the needs of Soldiers. Training is also being conducted across the Army to educate all personnel (military and civilians alike) on recognizing a Soldier in need of help.

To compare illicit drugs to prescription anti-depressants and sleep aids works against what the Army is trying to achieve. The Army is working to eliminate the stigma associated with seeking help for psychological problems. Soldiers prescribed these medications at least have sought help. The goal is to identify problems before it is too late.

Being deployed to a combat zone is an awesome experience that I will never forget. I gained some life long friends and came to an even greater realization as to why it is great to be an American. However, the emotional traumas are very real. The things you see on a daily basis affect you on a very deep level. To need an anti-depressant to deal with that stress, along with the mental health counselors is not surprising. If there is a story to be told it is to look at what improvements that have been made not a focus on individual soldiers.

"The views expressed in this response are those of the author and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government"

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