Will We Pay Our Debt to Our Vets?

By Katie Drummond 05/22/12

Soldiers are coming home from our two wars with a staggering rate of invisible brain injuries—and the addictions that go with them. With treatment estimated to cost $1 trillion, will America really meet their dire needs?

Army Staff Sergeant Robert Bales photo via

Robert LeHeup will be the first to admit that he's an alcoholic. “I drink so that I don't go to shit,” says LeHeup, a 30-year-old bartender living in Columbus, South Carolina. “I drink because I have to.”

LeHeup is a former Marine sergeant, who served two grueling tours in Afghanistan during the US invasion and early occupation. He drinks to dull memories of the everyday chaos and carnage. He drinks to tolerate his disgust at the raucous bar-goers who have no idea how easy life is in America, compared to the casual violence and grinding poverty of Afghanistan. He drinks because, in the Marines, that is just what everybody does.

“There was this drive to prove to each other that we can handle our liquor,” recalls LeHeup, who increasingly channels much of his distress more productively into his burgeoning writing career. “In the Marines, when I was stateside, I drank a fifth before I went out drinking, you know what I mean?” 

LeHeup, in his ongoing struggle with alcoholism, is anything but an outlier among this generation of military service-members. In fact, more than a decade after the start of the wars in Afghanistan and Iraq, an unprecedented number of men and women in the US military are currently in the throes of addiction.

In addition to the incalculable personal tragedies, the long-term socioeconomic costs range from healthcare to lost productivity, and could eventually rival even the estimated total costs of waging the two decadelong wars: $3 to $4 trillion dollars. (As sold to the American people by the Bush administration, the price tag of each war was said to be under $100 billion.) Recent estimates are lacking, but a 1997 report from the Office of the Inspector General warned that in a single year, the single problem of alcohol abuse among soldiers and veterans cost the country nearly $1 billion dollars, widely viewed as a conservative count.

Among veterans who’ve sought treatment for PTSD, between 50% and 80% also suffer from addiction.

There is no shortage of studies and statistics on the extent of the problem. Consider these: Between 24% and 38% of service-members between the ages of 18 and 25 (depending on their branch) qualified as “heavy drinkers” in a 2006 study, compared to 15% of the civilian population. 

total of 11,200 active-duty soldiers were busted for using illicit drugs in 2011, up from 9,400 in 2010.

And 17% of active-duty personnel admitted to “misusing” prescription drugs—primarily opiate painkillers—in a 2008 survey by the Department of Defense. By comparison, a 2010 survey of civilians found that 6% reported “nonmedical use” of prescription meds.

Of course, the consumption of alcohol or illicit drugs by soldiers is hardly a new phenomenon. Indeed, warriors have been imbibing for thousands of years. In the words of retired Army Brigadier General Stephen Xenakis, they drink “to celebrate, to forget and to fortify themselves for the next day's battle.”

The phenomenon continues to this day. According to a 2004 study, young recruits report that they drink because alcohol is viewed as “a necessary ingredient of successful group socializing,” because it is inexpensive and ubiquitous, and because it is “the only thing there is to do during off hours.” 

Where official military policy is concerned, alcohol use is strictly prohibited during deployment. On installation, imbibing—regardless of one's age—was once a mainstay of military culture. More recently, leaders have frowned upon such consumption. “Alcohol use is greater than anything else,” Major General Anthony Cucolo said in 2009. “We are most concerned about alcohol use and abuse [among soldiers].”

If addiction isn't new for the military, it’s much more complicated than media reports tend to convey. For example, there’s a widespread notion that many Vietnam Vets are the walking wounded, addicted to heroin and homeless.

But while thousands of soldiers experimented with the plentiful heroin in Vietnam during combat, the vast majority actually cleaned up and reintegrated into society successfully in the first few years after they came home. Rates of addiction among those veterans are in fact lower than rates among nonveterans from the same generation.

Yet one group of Vietnam Vets didn’t share in this relatively positive outcome: those who also suffered from a mental health ailment incurred by combat. Among veterans who’ve sought treatment for post-traumatic stress disorder (PTSD) in the years following their military service, between 50% and 80% also suffer from addiction. For decades, veterans groups have charged that these and other veterans' health needs have been inadequately met.

PTSD has likely been around for as long as war itself. Called “soldier’s heart” during the Civil War, “shellshock” in World War I, and “combat fatigue” in World War II, PTSD was made an official diagnosis only with its inclusion in the DSM in 1980, due to the high incidence of psychological distress in Vietnam Vets. 

This link between addiction and mental health is precisely what makes the situation of today’s soldiers so dire. More men and women who have seen combat in the wars in Afghanistan and Iraq are suffering from brain-based damage—primarily, PTSD and traumatic brain injury (TBI)—that frequently precipitates addiction. And, crucially, these soldiers have received grossly inadequate care from the military’s medical system.

As the two wars wind down, the price paid in veterans’ mental and physical illnesses will become only more glaring. Two factors stand out as fateful: First, that our military, unlike in generations past, is entirely comprised of volunteer fighters; second, that these two wars were two of the longest in our history. As a result, soldiers have been redeployed to an unprecedented extent. Three, four, even five tours of duty are now par for the course.

More than half of vets with PTSD will be diagnosed with alcohol abuse, a third with drug abuse.

They’re also suffering from devastating rates of PTSD, often described as “the invisible wound” of this generation’s wars. The condition, estimated to afflict at least 25% of returning service-members who saw combat, is characterized by a bevy of symptoms, including rage, insomnia and anxiety—that can often be soothed with alcohol or drugs.

Myriad studies have long found a distinct connection between PTSD and substance abuse. A comprehensive 2006 analysis by Veterans Affairs sums them up: An estimated 52% of those afflicted with PTSD will be diagnosed with alcohol abuse or dependence, and 34.5% with dependence on drugs. According to the report, PTSD doubles one's odds of an alcohol-use disorder, and a drug-use disorder triples the risk.

Thanks to technological breakthroughs in better body armor and battlefield medicine, more soldiers are also coming home alive: With injury survival rates that exceed 90%, more members of our military than ever before are living with brain damage, physical disability or chronic discomfort caused by injuries that, in previous wars, would have killed them.

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Katie Drummond is a is the deputy editor of Medium. She has been a reporter for Forbes magazine, a contributing editor at The Daily, and a freelance writer for outlets including Wired.com, New York magazine and Prevention. You can find her on Linkedin and Twitter.