But a new report says substance use and misuse among troops and their families has become a "public health crisis" and says Pentagon methods for dealing with it are out of date.
In a study requested by the Defense Department, the Institute of Medicine report Monday said:
-- About 20 percent of active-duty service members reported they engaged in heavy drinking in 2008, the latest year for which data was available. (Heavy drinking was defined as five or more drinks a day as a regular practice.)
-- Binge drinking increased from 35 percent in 1998 to 47 percent in 2008. (That's five or more drinks at a sitting for men, four or more for women, but done perhaps just once or twice a month as opposed to each week.)
-- While rates of both illicit and prescription drug abuse are low, the rate of medication misuse is rising. Just 2 percent of active-duty personnel reported misusing prescription drugs in 2002 compared with 11 percent in 2008.
-- The armed forces' programs and policies have not evolved to effectively address medication misuse and abuse.
"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," said Charles P. O'Brien of the University of Pennsylvania's Center for Studies of Addiction, the chairman of the study committee.
Defense Department spokeswoman Cynthia Smith said Monday that officials were analyzing the report.
"We want to do the right thing for the service member," Smith said. "If there are areas in need of improvement, then we will work to improve those areas."
Substance abuse has "long been a concern for the U.S. population and for its military in particular," the report noted. "Dating as far back as the Revolutionary War, Dr. Benjamin Rush detailed the effects of alcohol on the troops. During the Civil War, addiction to opium prescribed for pain became known as the `soldier's disease."'
Today, the military's approach to treating substance abuse "tends to be old-fashioned," O'Brien said, noting the example of the military's reluctance to use medications that can combat cravings and in other ways help treat addiction, he said.
"Modern treatment of substance abuse does involve medications. There are FDA-approved, effective medications that could be used and should be used much more than they are," he said.
Another problem is an overreliance on hospitalization and in-patient rehabilitation facilities, rather than the outpatient care that characterizes most civilian addiction treatment.
"Addiction tends to be chronic," O'Brien explained. "The basic pathology of the addiction has a memory. It doesn't go away that quickly."
Military counselors also need better training.
"We reviewed the training materials the U.S. Navy uses for counselor training. Those materials are based on guidelines originally written in 1984. They haven't updated them," said Dr. Dennis McCarty, a professor of public health and preventive medicine at the Oregon Health and Science University. "We think there's a substantial opportunity to enhance the training for the counselors" who work with active-duty military personnel.
To reduce the stigma attached to getting help -- and thus drawing more troops into its programs -- the military should integrate prevention and treatment efforts more into primary health care and do more to preserve confidentiality for those seeking help, the report said.