Uncle Clonazepam’s Army

This week’s Time magazine has a cover article on ‘America’s Medicated Army’, discussing the widespread use of antidepressant and anxiety-reducing drugs in US Army troops in Iraq and Afghanistan.

The saying goes that ‘military psychiatry is to psychiatry what military music is to music’, and, certainly, military mental health clinicians have quite different objectives to their civilian counterparts.

Treating someone who has been traumatised by a war zone with the priority of returning them to combat is an unusual way of working from a civilian perspective.

While military psychiatry has traditionally relied on rest from combat operations using the ‘PIE‘ principle of minimal withdrawal from the theatre of war, for the first time, the American military are now allowing deployed troops to be prescribed psychiatric medication, principally to treat depression and anxiety.

The article is an interesting angle on the sorts of intense stresses that soliders endure, but it’s probably worth remembering that having soldiers medicated against the traumas of war is not particularly new.

Traditionally, however, soldiers have medicated themselves with whatever substances were to hand.

Drug use by US troops in the the Vietnam War has been widely portrayed in Hollywood films but it is based on hard medical evidence. Contemporary medical studies reported that approximately 1 in 5 soldiers was addicted to heroin, with marijuana and alcohol use even more widespread.

I looked and couldn’t find any data on illicit drug use in troops in Iraq, but a recent report notes that 11% of US soldiers in Iraq who sought mental health care had ‘severe misuse of alcohol’, rising to 18% if ‘moderate’ cases are included.

These figures are hard to compare directly, but that’s 18% of soldiers referred to military psychiatrists, not 18% of the total troop population, which makes me think there’s probably less self-medication occurring during this war than the Vietnam war at least, and possibly others.

Even if this rather rough estimate turns out to be true, it’s impossible to say whether the availability of prescribed medication is reducing drug and alcohol misuse, or whether it is being used to shore up the troops in an geographical area where recreational substances are just harder to come by.

The history of military psychiatry has told us that the single best way of preventing mental illness (and death, injury and civilian causalities) is to not deploy troops into combat.

Unfortunately, history has also told us that the blindingly obvious has never been particularly popular with political leaders, and until that time, the military may simply be trying to avoid widespread illicit self-drugging by making army approved medication available to its depressed and anxious soldiers.

Link to Time article ‘America’s Medicated Army’.

2 thoughts on “Uncle Clonazepam’s Army”

  1. Based on my experience (not in combat which
    might not count) SSRI’s are necessary but will
    increase the need for street drugs and alcohol
    though they don’t mix. I never drank so much as
    when I was stupid enough to believe my p-doc
    and try the whole line of SSRI’s. They will
    work for a minority they will not for the many. For me they made me want to drink
    gave me erectial dysfunction, which made me
    want to drink more, add extreme combat on to
    that, and you know the figures out of Iraq are completely off including the suicide stats
    and the numbers taking SSRI’s. The original
    article in Time is a joke.

  2. They’re not really medicating for trauma, they’re medicating for depression, anxiety, and demoralization — thus enabling troops to serve for longer tours of duty.
    By enabling longer and more numerous tours of duty, military psychiatry also likely increases the already high number of veterans returning with PTSD. It’s been demonstrated that soldiers with multiple tours of duty have much higher rates of PTSD.

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