• Military cracks down on alcohol abuse amid age-old bingeing habit

    By Bill Briggs, NBC News contributor

    Officials within the U.S. military are actively targeting over-boozing troops at home and abroad, but addiction specialists and service members say binge drinking remains as rampant as ever inside the armed services.

    Among the new initiatives to stem the problem: The Marines, starting next year, will give random breathalyzer tests to Corps members; the Air Force and Army curbed some overnight liquor sales for U.S. military personnel in Germany; and American service members in Japan were barred from leaving their residences after consuming more than one adult beverage.


    The restrictions seem to have been independently created by brass within each branch — for example, the new rules for service members in Japan follow the October sexual assault of an Okinawa woman allegedly carried out by two U.S. sailors. Still, the fresh regulations arise three months after a study commissioned by the Department of Defense found that binge drinking by active-duty troops now constitutes "a public health crisis," noting as well that drunken soldiers were cited as a problem as far back as the Revolutionary War.

    "But we can do better," said Dr. Charles P. O’Brien, chairman of the panel that authored the report and director of the Center for Studies of Addiction at the University of Pennsylvania. "We have a lot of research, a lot of medication, and a lot of techniques that have been developed over the years. We don’t have to be stuck in the old ways of handling things.

    "We found, though, that in the whole Army, there’s only one doctor who's trained in addiction medicine. This is a specialty where we need more people and they're not there. So, most people are not getting treated with evidence-based medicine," O'Brien told NBC News. The study was issued by the Washington, D.C.-based Institute for Medicine.

    Worse, O'Brien said he has learned — from emails he received in recent days from active-duty personnel — that one of the study's most simple suggestions has not been implemented: that the military's health system, TRICARE, alter its rules and allow substance-abusing service members to be treated with anti-addiction medications like Suboxone.  

    "We met a general who is on Suboxone but they (military doctors) are not letting other people have it," O'Brien said. "It's ridiculous ... When we briefed (military leaders in September), they expressed interest in following our recommendations. But, so far, I don't have any concrete evidence that anything has happened." 

    NBC News asked the Department of Defense to list which, if any, of the panel's recommendations have been installed to date. 

    "The Department of Defense appreciates the hard work of the Institute of Medicine in assessing substance abuse programs and policies in the Military Health System," Cynthia O. Smith, a DoD spokeswoman, responded in an email. "We are in the process of analyzing their findings and recommendations, but most importantly, we want to do the right thing for the Service member. If there are areas in need of improvement, then we will work to improve those areas. The health and well-being of our Service members is paramount."

    Click here for more military-related coverage from NBC News.

    The agency has a stated policy to "prevent and eliminate drug and alcohol abuse and dependence from the Department of Defense." The U.S. military, therefore, screens for problem drinking, provides treatment for those identified with alcohol or drug problems, and is working to "change attitudes toward binge drinking," Smith said, adding that "such abuse and dependence are incompatible with readiness, the maintenance of high standards of performance, and military discipline."

    Indeed, in its analysis of boozing on military bases, the Institute of Medicine found that 47 percent of active-duty personnel engaged in binge drinking during 2008 (the most recent year for which data was available), and the authors concluded the use of alcohol and other drugs are "currently at unacceptably high levels," making it "detrimental to readiness and total force fitness." 

    Military members like Marine Sgt. Thomas Brennan, who joined in 2004 and who later served in Iraq and Afghanistan, describe drinking as a staple of life in uniform. He knows of several recent drunken-driving arrests involving his Marine buddies or his former unit members, he said.  

    "With the amount of recreational drinking that goes on, it’s like peer pressure times 10," said Brennan, 27. "Everybody’s drinking. The Marine Corps is a brotherhood. You want to be part of that brotherhood, and your brothers are doing it. Nobody forces you to do it but the inclination to do it is pretty strong.”

    In a New York Times blog published in October, Brennan wrote that the "golden rule" among Marine officers and non-commissioned officers seems to be: "If you’re going to partake, do so behind closed doors and keep your mouth shut about it. I have heard many leaders tell under-age Marines that if they were going to drink that they should keep their doors locked and be smart about it. Only when they were caught were they told not to do it."

    “I couldn’t tell you how many times I’ve heard that over the years," Brennan told NBC News on Monday. "I wasn’t perfect either. I let it go on.”

    The September study on alcohol abuse within the military also chastised the armed services for allowing "ready access to relatively inexpensive alcohol on military bases." 

    At Camp Lejeune, where Brennan was stationed, convenience stores contain large refrigerators stocked with domestic and imported beers, sold tax free. A six-pack of Stroh's, for example, costs about $4, he said.

    On base, Marines also can purchase "Military Special" liquors, a cut-rate brand of liquor, including vodka and whiskey, that goes for about $6.50 per liter. At AR15.com, a firearms website popular with military members, one commenter described Military Special booze as: "No good for sipping, but for shots it works;" another said: "I am not sure I would clean battery terminals with that crap." 

    One combat-related factor exacerbating the overindulgence of alcohol is Post-Traumatic Stress Disorder. In September, the Institute of Medicine reported that Iraq and Afghanistan veterans diagnosed with PTSD have alcohol-abuse rates that are twice as high as those found among civilian young adult males.

    Brennan was diagnosed with PTSD and said that self-medicating with alcohol caused him to suffer a "short-lived drinking problem" after he returned from Iraq.  

    "You’re already depressed because of the PTSD. Alcohol’s a depressant. A lot of guys with PTSD just got angry (when they drank) and did dumb stuff, like fighting," Brennan said in a phone interview. "We had one guy throw his refrigerator off the third deck one night when he was drinking. But I don’t know if that was PTSD, or just him being a crazy drunk."

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  • Military should better address growing alcohol and drug abuse, report says

    By Vignesh Ramachandran

    Binge drinking and prescription drug abuse among the nation's military has grown and top military leadership should address this "crisis," according to a new report released Monday.


    The study, by the national Institute of Medicine, called its findings of alcohol and other drug use in the armed forces "a public health crisis" and characterized the level of use as "unacceptably high." The institute is part of the National Academy of Sciences.

    The report found that 47 percent of active duty service members engaged in binge drinking in 2008, up from 35 percent a decade earlier. Heavy drinking was reported in 20 percent of active duty service members in 2008, up from 15 percent in 1998.

    The number of prescriptions military physicians wrote for pain medication quadrupled since 2001 to almost 3.8 million prescriptions in 2009, according to the report. However, some attribute this growth to combat-related injuries and strains from carrying heavy gear.

    Current approaches to preventing and treating substance abuse are outdated, the report said.

    "We commend the steps that the Department of Defense and individual service branches have recently taken to improve prevention and care for substance use disorders, but the armed forces face many ongoing challenges," said University of Pennsylvania professor Charles P. O'Brien, who chaired the committee that wrote the report.

    "Better care for service members and their families is hampered by inadequate prevention strategies, staffing shortages, lack of coverage for services that are proved to work and stigma associated with these disorders."

    Related: US Army investigated soldiers over suspected drug abuse in Afghanistan, data show

    The Institute of Medicine wants military leadership to acknowledge these facts and to attack "substance use problems before they begin by limiting access to certain medications and alcohol." Among the committee's recommendations are to curb easy access to inexpensive alcohol on military bases, reduce the number of outlets that sell alcohol, restrict their hours of operation and reduce the type and amount of alcohol purchased.

    Barriers for military members to get help for substance abuse is also an issue, the committee wrote. Fear of negative consequences, gaps in insurance coverage, lack of confidential services and stigma are among the obstacles, the report listed.

    The Associated Press contributed to this report.

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  • US health care: It's officially a mess, institute says

    By Maggie Fox, Senior Writer, NBC News

    If banking were like health care, it would take days to get money out of an ATM because the records would be lost. If airlines were like health care, pilots would decide on their own which safety checks to make, if any. If shopping were like health care -- well, you get the picture.

    It’s a mess, the Institute of Medicine says in a report released on Thursday. The U.S. health care system wasted $750 billion in 2009, about 30 percent of all health spending, on unnecessary services, excessive administrative costs, fraud, and other problems. As many as 75,000 people who died in 2005 would have lived if they got the kind of care provided in the states with the best medical systems, the Institute found.

    The report, issued just as candidates for Congress and for president make health care reform a central part of the national debate, doesn’t pull any punches. The panel of experts assembled by the Institute, an independent body that is supposed to provide a non-partisan last word on important issues, leaves no doubt that U.S. health care now is anything but the best in the world.

    "The threats to Americans' health and economic security are clear and compelling, and it's time to get all hands on deck," says Mark Smith, president and CEO of the California HealthCare Foundation in Oakland and chairman of the panel.

    "Our health care system lags in its ability to adapt, affordably meet patients' needs, and consistently achieve better outcomes."

    But there's hope. "We have the know-how and technology to make substantial improvement on costs and quality. Our report offers the vision and road map to create a learning health care system that will provide higher quality and greater value," Smith says.

    “What I am seeing around the country is that people are absolutely committed to reform,” says James Conway of the Harvard School of Public Health and the Institute for Healthcare Improvement in Massachusetts, who served on the panel.

    “Whether you look at the Republican platform or the Democratic platform, you find in pretty strong language the importance of developing a high quality health care system.”

    One of the biggest problems is that health insurers, hospitals and health systems don’t learn from their mistakes, the report says. Half of all health care professionals still neglect to wash their hands properly before seeing patients, even though it’s one of the main causes of infections that kill tens of thousands of patients every year.

    An organized system that finds out what went wrong and where, and then provides for the health system to correct those mistakes right away would save money and lives. It’s possible in a computerized world, but it’s not happening on a systematic basis. Hospitals that report every single infection and ruthlessly track down where it came from have found they can cut infection rates to zero, for instance.

    Yet just this week the Centers for Disease Control and Prevention reported that a third of Americans have high blood pressure and only half of them have it under control. There are dozens of drugs to treat it, not to mention diet and exercise methods. It took 13 years for one of those drug types, the beta-blockers, to become the standard of care even after they had been clearly demonstrated to work, the report says.

    What’s missing, the report says, is coordination. “What I see is people doing a little bit of this and a little bit of that. Everyone has their little initiative. And back at the ranch, the doctor, the individual provider, is drowning in the sea of initiatives,” Conway says. “What is missing is a much more systemic and collective response.”

    The report points to two main problems. “One is the increasingly unmanageable complexity of the science of health care. During the past half-century, there has been an explosion of biomedical and clinical knowledge, with even more dazzling clinical capabilities just over the horizon,” the report says. But the current system doesn’t help providers learn this material and it doesn’t give them any incentive to apply it.

    “Second is the ever-escalating cost of care, which is widely acknowledged to be wasteful and unsustainable. Unless ways are found to provide more efficient, lower-cost health care, more and more Americans will lose coverage of and access to care.”

    Conway praises the Massachusetts health care system, which he says is organized with the patient in mind. The report also says government initiatives, such as the Patient-Centered Outcomes Research Institute (PCORI) and the Center for Medicare & Medicaid Services Innovation Center are good ways to test and apply proven treatments and methods for paying for health care.

    “Until we organize the health care system around the people we are privileged to serve, we aren’t going to figure it out,” Conway said.  “I don’t think we have done that before -- we haven’t organized it around the person with cancer. That would be a remarkable change.”

    Some ways to get there? Let people see what various treatments cost up front. Employers, who cover the health care costs of 55 percent of Americans, can help, too, the report says. They can use their buying power to demand high-quality, high-value health care, and get their employees involved in wellness programs.

    So what would happen if shopping were like U.S. health care? "Product prices would not be posted, and the price charged would vary widely within the same store, depending on the source of payment,” the report says.

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