FACTORS DISCOURAGING ALCOHOLISM Military discipline and standards We were advised that alcoholism and problem drinking would ruin a serviceman's career if, as a result, he could not perform his duties or meet other military standards and that the high degree of human reliability required in certain occupations, such as aircraft pilot and nuclear technician, militated against the development of alcoholism. Also the military services are considered to have a lesser problem because the military population, compared with the civilian population, is highly controlled and supervised and because the military services are continually screening military personnel for security clearances, reenlistments, and so forth. Lower age of military personnel Since alcoholism is generally considered to be more prevalent among the middle-aged, the younger age of personnel in the services and early retirements tend to lower the incidence of alcoholism. Heavy drinking, however, often starts among younger servicemen and could develop progressively into a more serious problem. CHAPTER 4 POLICIES, PRACTICES, AND ATTITUDES AFFECTING THE MILITAI ALCOHOLIC Military regulations and certain statutes deal punitively with t intemperate in the use of alcohol. Section 972 of title 10 of the Ur States Code provides that an enlisted member of the Armed Fo who is unable to perform his duties for more than 1 day becaus the intemperate use of drugs or alcoholic liquor must make up time, which is categorized as bad time. Section 802 of title 37 of United States Code adds that a serviceman absent from duty f continuous period of more than 1 day because of disease tha directly caused by the intemperate use of alcohol or drugs is not titled to pay for that period of absence. The official stated policy of DOD and the military service alcoholic consumption by military personnel is "to encourage stinence, enforce moderation, and punish overindulgence." Military regulations generally provide that injuries directly proximately resulting from the intemperate use of alcohol are du misconduct and are not considered to be in the line of duty and result in the loss of certain entitlements to the serviceman, altho illnesses which are the secondary result of the intemperate us alcohol usually are considered to be in line of duty. The Unif Code of Military Justice cites being drunk on duty, being drunk disorderly, and drunken and reckless driving as punishable offer Military regulations provide also that the alcoholic or problem dri may be considered ineligible for a security clearance or may separated from the service. Although the regulations generally vide for an opportunity to overcome the problem through couns and rehabilitation prior to any adverse action, rehabilitative meas are not delineated and the lack of adequate treatment prog further negates the stated compassionate intent of such provis We have been informed that, because the military services deal punitively with alcoholism, there is a tendency to cover up problem throughout the chain of command and there is little incer for an individual to come forward openly and seek help. The pro is hidden and covered up as long as possible by the man himself family, or a sympathetic commanding officer so as not to jeopar the serviceman's career. Doctors have told us that some of their leagues are reluctant to diagnose patients as alcoholics and often related illnesses. Consequently medical, personnel, legal, and administrative records are poor indicators of the incidence of holism among military personnel. This situation is similar to that which existed many years ag venereal disease until regulations were modified so that it wa longer considered misconduct. This modification of regulations avoided driving the problem underground and provided for early detection and treatment. DOD's handling of alcoholism is in contrast with its handling of the drug problem where amnesty and rehabilitation programs have been started and widely publicized. Little has been done by the military establishment to deal with the problem of alcoholism unless an individual has become at least partially ineffective in his duties or has committed one or more punishable offenses, such as being absent without leave, drunk and disorderly, or involved in some traffic mishap while intoxicated. Some individuals stated their belief that a man should be allowed to drink until he gets into trouble. Most of the bases that we visited had no regulations on how to handle an alcoholic or a problem drinker. We have been told that commanders are allowed a great deal of discretion and may take any one or more of the following approaches. ì. Leave him alone: The alcoholic may be carried along by sympathetic commanding officers until he retires either because he elects to or because he is encouraged to. 2. Transfer him: The problem drinker may merely be passed from one command to another. 3. Counseling or treatment: The individual is counseled by his commanding officer or the chaplain or is sent to the hospital or counseling, medical or psychiatric treatment, or referral to Alcoholics Anon ymous. 4. Punishment: This could be a reprimand, extra duties, reduction in rank, loss of security clearance, bar reenlistment, or separation from the service. Alcoholism was designated a disease by the World Health Organization in 1951 and by the American Medical Association in 1956. The hospital commander at one base believed that chronic alcoholism. and problem drinking represented moral and spiritual deficiencies. He said that alcohol was not an addictive drug and that he found it difficult to accept the premise that alcoholism was a disease. According to a chaplain at the base, hospital personnel were reluctant to treat alcoholics and they referred them to facilities in the civilian community for treatment. At two bases where there were alcoholism treatment programs, the base commanders did not permit the existence of the programs to be publicized. A study by a Navy doctor revealed some antipathy among the doctors at one naval hospital toward the treatment of alcoholics. This seemed to confirm a view expressed by other professional medical personnel that there was a reluctance among some doctors to treat alcoholics. A base commander we interviewed believed that a hardline disciplinary approach of separation from the service should be taken toward the alcoholic. At another activity, several officials stated that the general Army policy was not to tolerate alcoholics. In their view there was no place in the Army for an alcoholic or a problem drinker, except that special efforts were made to retain men close to retire ment. The Chief of the Navy's Bureau of Medicine and Surgery sta in 1966 that: “*** it would thus appear that current policies tend to l the illness and thus interfere with early detection, managem by leadership, nonmedical counseling, medical and psychia treatment and disposition, when appropriate. All too the individual, whether Regular or Reserve, officer, or enlis is protected by his superiors because, if separated or discharg he will lose all his earned' equity in retirement benefits cumulated over his years of active service. Since the N Establishment does not consider alcoholism a disease, a mem is not compensated for the 'earned' equity if he is separs from service due to chronic alcoholism." A recent DOD fact sheet on alcoholism reiterated these vi and recognized that alcoholism control in DOD had not been adequ that current DOD practices dealt punitively with alcoholics, that DOD did not consider alcoholism as a disease. The fact sh also called for the removal of the stimga attached to alcohol and recovered alcoholics. CHAPTER 5 CURRENT ALCHOLISM PROGRAMS REHABILITATION At the time of our review, no DOD-wide alcoholism rehabilitation. program existed, nor were there any guidelines specifying procedures to be followed in treating alcoholics. As a result the treatment given to the military alcoholic depended on the attitudes and interests of the local commanders and medical officers. At many of the installations that we visited, treatment was limited, compared with that provided under formally established alcoholism rehabilitation programs at the Long Beach Naval Station, California; Fort Benning, Georgia; and Wright-Patterson Air Force Base, Ohio. The pilot programs at these three installations received top-level support, and the local personnel involved with the programs were concerned with alcoholism on a full-time basis. The treatment approach is multidisciplinary, drawing on the knowledge and techniques of psychiatry, psychology, and medicine, with the core of treatment centered around participation in Alcoholics Anonymous and other forms of individual and group therapy. Fom the beginning of the Long Beach program in February 1965, over 500 enlisted men and 37 officers have been treated; the overall recovery rate was 50 to 60 percent. The clinic accommodates from 30 to 35 resident patients for treatment for 30 to 90 days. A 12-bed hospital ward is utilized for detoxification when necessary. Military personnel outside the Long Beach area have been sent to the clinic for treatment. About 200 officers and enlisted men have received alcoholism treatment at Wright-Patterson since 1966. According to the director of that program, "almost 90 percent of the patients have made satisfactory military and personal readjustment following return to duty." The Surgeon General of the Air Force recently has established additional clinics at Lackland Air Force Base, Texas, and Eglin Air Force Base, Florida. These clinics are available to eligible personnel throughout the Air Force. From March 1970 through January 1971, about 190 individuals received treatment under the Army's Fort Benning program, including 41 who participated in the resident portion of the program. The residents perform their normal military duties during the day and return to a "halfway" house in the evening. We estimated that the annual operating cost for this clinic was about $150,000, with an initial investment of $75,000. A few other installations had attempted to provide in varying degrees some of the same services made available by the clinics. The existence of some alcoholism rehabilitation efforts was dependent on |