Larson investigates military substance abuse
Heller scientist contributes to report on methods to halt dependence
Drug and alcohol abuse has been a serious issue in the U.S. military for decades, and a surge in abuse was reported in connection with the recent wars in Iraq and Afghanistan. That prompted Congress to ask the Department of Defense (DOD) to investigate; in turn, the DOD asked the Institute of Medicine (IOM) to assess protocols currently in place regarding the prevention, screening and diagnosis, and treatment of substance abuse.
Mary Jo Larson Ph.D. ’92, a senior scientist at the Heller School for Social Policy and Management, was one of 14 committee members who took part in a year's worth of researching and writing. The resulting report, Substance Use Disorders in the U.S. Armed Forces, was released recently and called for an emphasis on preventative measures through targeted education and early medical intervention.
Larson, who is in Heller’s Institute for Behavioral Health, is also the Principal Investigator of a grant from the National Institute on Drug Abuse. She was recruited to the committee in part due to her expertise in both the military health system and in treatment of substance use disorders. The committee included prevention, treatment, pharmacology, and health services experts from the private sector, medical schools, universities, and public policy research organizations.
“While each of us had some knowledge of specific DOD programs or how the Veterans Administration programs worked, we had to conduct substantial research on its policies and programs because the DOD does not run a transparent military health system,” said Larson. “Its programs are siloed with no single entity accountable for all substance abuse programs.”
Larson says the military needs to tackle alcohol problems at the prevention side. While commanders of the armed forces are not tolerant of incidents such as alcohol related altercations or driving under the influence, Larson says they’re not taking a public health approach.
“Commanders need to change the drinking environment, to identify personnel with elevated risk, to educate personnel about how heavy drinking impairs adjustment after combat deployments, and to offer confidential, medically-based interventions,” said Larson.
According to the IOM report, about 20 percent of active duty personnel reported having engaged in heavy drinking in 2008, the latest year for which data are available, and monthly binge drinking increased to 47 percent in 2008 from 35 percent in 1998. While rates of both illicit and prescription drug abuse are low, the rate of medication misuse is rising. Eleven percent of active duty personnel reported misusing prescription drugs in 2008 compared with two percent in 2002. The armed forces' programs and policies have not evolved to effectively address medication misuse and abuse, the committee noted.
It was at New England Research Institutes (NERI), where Larson worked as a research scientist for ten years, that she developed her interest in services for military members.
“It started with a study on training programs— how to deliver effective training on evidence based treatments to counselors inside the Veteran’s Administration,” said Larson. “The VA is treating both post traumatic stress disorder (PTSD) and substance abuse disorders and wanted to upgrade its training so more counselors were using cognitive behavioral therapy approaches.”
Larson also has a Master in Public Administration from Harvard’s Kennedy School of Government. Before going to the NERI, she worked at Brandeis for eight years as a senior research associate and returned to campus in 2009 as a senior scientist.
Heller's Institute for Behavioral Health has sponsored a military health working group comprised of members who receive support to conduct research on various topics involving active duty military and their families. Topics have included deployment problems and combat operational stress, post-deployment screening and emergence of substance abuse problems post-deployment, and complementary and alternative interventions for PTSD.
“We hope the IOM report will lead to DOD changes,” said Larson. “The normative behavior is to drink more than the average college student, including during the work week, with great consequence for armed force readiness and fitness. This puts the average service member at great risk for developing problems, especially when they come under psychological stress or trauma from deployment or other reasons.”
The military has a dual role, Larson says. They need to have ready, fit personnel to deploy, and they must also take preventative measures against drug and alcohol abuse through targeted education and early medical intervention.