Overmedicating in the Military: A Case Study into How Holistic Care and Preventive Practices Can Address the Problem of Substance Abuse among Overmedicated Troops Abstract

This case study examines the problem of overmedication in the military. It discusses why this is a problem, based on the statistics and increasing awareness among various stakeholders. The study itself examines the cases of three soldiers in the military who were interviewed to describe how they were overmedicated and what impact it had on their lives. They also described how they were able to beat their addictions and turn their lives around in a positive direction using some form of positive psychology as an intervention instead of relying on pharmacological interventions. The study concludes with recommendations for what the military can do to address this problem, namely, implementing resiliency training among soldiers to help empower them to overcome their issues instead of attempting to distract them with drugs.

Keywords: overmedication military, drugs military ptsd, positive psychology military

Introduction

All one need do is a simple Google search using the keywords “overmedication military” to see that overmedicating in the military is an issue that needs addressing. The headlines leap from the screen: one from CNN, 2011—“After Decade of War, Concerns About Over-Medicated Military” (Keyes, 2011); one from MilitaryTimes (2013)—“Medicating the Military—Use of Psychiatric Drugs Has Spiked”; another from 2013 and CBSNews—“Veterans Dying from Overmedication” (Axelrod, 2013); from 2014 and the U.S. Department of Health and Human Services—“Overmedication: Problems and Solutions: (Director’s Testimony to Senate Committee on Veterans’ Affairs, 4/30/14)” (Briggs, 2014); and finally from Congress itself—S.788, the Veteran Overmedication Prevention Act of 2017 (Billings, 2017), currently sitting in committee in the U.S. Senate. One can go back to 2007, when Veterans for America counselors and investigators charged that the military was overmedicating troops (Mehan & Schneider, 2007)—but no matter where one looks, the stories all appear to be the same: soldiers and veterans are not getting the help they need; instead they are just getting prescription drugs which exacerbate their problems.

What sparked our interest in this topic were headlines just like these and stories that have been growing over the years. We have all heard the tales of soldiers and veterans becoming addicted to pain killers or opioids. We have seen the opioid epidemic washing over America and noted how it has coincided with the American military’s presence in the Middle East (Schoomaker & Buckenmaier, 2018; Snow & Wynn, 2018). As Schoomaker & Buckenmaier (2018) point out, “prescription opioid deaths are approaching 20,000 a year; in 2016, combined prescription and illicit drug deaths—many of which can be attributed to gateway use of prescription opioids—topped 64,000” (p. 9). This crisis is well-known in general terms (see Barglow (2013) and Huntley (2014) in the Appendix). What is required is a more detailed, in-depth understanding of it is real, specific terms—in academic terms that allow human faces and experiences to be understood from the standpoint of scholarly rigor.

This case study was designed to shed light on a problem that persists in the U.S. military—the problem of overmedicating soldiers as a quick-fix solution to mental health problems that run much deeper. Unfortunately there has been little scholarly attention paid to this issue: it has all been done by investigative journalists, watchdog organizations, independent physicians and counselors, and Congressmen at the federal level. With the Veteran Overmedication Prevention Act in committee in the U.S. Senate, there is a need for scholarly attention on this issue to help frame the discourse in an academic light. This case study aims to provide that perspective by giving an in-depth perspective of the problem of overmedication in the military using the case study design.

Literature Review

Giordano et al. (2016), Hines et al. (2014), and Kang et al. (2015) show that military soldiers and veterans are suffering in increasing numbers from mental health issues, post-traumatic stress disorder (PTSD) and are at risk of suicide as a result of failing to receive adequate care. Studies have shown that holistic approaches to care are most effective in treating the whole person, from mental health to physical dependencies and so on (Newhouse & Spring, 2010).

One way to provide holistic care to patients has been shown to be through positive psychology. Sheldon and King (2001) state that...

216). In other words, it is the science how people can live well and be strong. For that reason, positive psychology serves as the core of Master Resiliency Training (MRT) in the U.S. Army. Just as positive psychology focuses on identifying the elements that enable individuals to flourish (Fredrickson, 2001), MRT enables leaders in the Army to demonstrate and teach the skills that soldiers need to overcome obstacles and face challenges with determination, commitment and the ability to succeed. As Casey (2011) puts it, “the Army is leveraging the science of psychology in order to improve our force’s resilience” (p. 1). Positive psychology focuses on what motivates people to succeed. It looks at the sources of inspiration that make individuals want to reach up toward the light and hold onto the good. Positive psychology is the essence of the concept of “chicken soup for the soul”—it is the idea that people need to surround themselves with positive inputs to resist the negative distractions and oppressive feedback that can stymie their potential. It is the approach of basic psychology, in so far as psychology focuses on how to help human beings be happy and at peace (Sheldon & King, 2001).
The way to achieve the happiness and peace afforded by positive psychology is through the cultivation of positive emotions (Fredrickson, 2001). And the way to cultivate positive emotions is through the development and cultivation of resources that people can use to ward off anxiety, stress, depression, anger—anything that can come along to hold one back. The resources most commonly utilized to assist in this process are mental toughness, which comes by way of conditioning; commitment to an ideal, which can be fostered through habit and virtue; and mindfulness, which can come by way of meditation (Fredrickson, Cohn, Coffey, Pek & Finkel, 2008). The military can thus help soldiers develop their mental toughness, commit to an ideal, and strengthen their mindfulness by implementing MRT.

Through MRT the military can teach the skills and methods needed to train their soldiers in how to be resilient. The life of an ordinary civilian is difficult enough; the life of a soldier is doubly demanding. The soldier is not only responsible for tending to himself and making sure his life is in order; he is also responsible for tending to his unit and making sure he is supporting his brothers in arms at all times. The soldier in the Army is the member of a family that is tasked with defending the homeland at great risk to one’s own personal safety. The soldier is expected to live up to the demands of this task and serve honorably in the capacity that is allotted to him.

Leaders in the military, however, are often confronted with the baggage that many soldiers bring with them into the military or that they collect along the way of their service. Leaders have to know how to help soldiers deal effectively with this baggage so that it does not weigh them down mentally and lead them into collapse. Too many soldiers suffer from PTSD because they lacked resilience. The military leaders who have gone through MRT are better equipped to help their soldiers obtain that resilience so that they can in turn deal with whatever issues are impacting them, whether it is depression, anxiety or fear (Reivitch, Seligman & McBride, 2011). MRT provides the framework for developing a successful and positive approach to life.

One of the biggest challenges that a leader in the military will face is a unit of soldiers who lack mental and emotional toughness. Grit and determination are some of the fundamental qualities that every soldier must possess. If soldiers do not already possess them coming into the unit, how can they acquire them? The leader has to know the answer to this question—otherwise his soldiers will be like sitting ducks waiting to be picked off by the least disruption to the moods, minds and emotions. The leader has to know how to inspire toughness. MRT teaches that the leader has to know what does not inspire resilience—and that is the first key lesson taught in MRT: misconceptions about resilience are identified and true concepts of resilience are discussed by focusing on six key areas: Self-awareness, Self-regulation, Optimism, Mental agility, Character strengths, and Relationship connections. The first key area is crucial: unless one is aware of one’s own “thoughts, emotions, and behaviors, and patterns in each that are counterproductive,” one is going to be blocked at the gate (Reivich et al., 2011, p. 27). Awareness is necessary for the second key—self-regulation, which involves both monitoring and regulation emotions and thoughts…