The US Army Space Missile Defense Command

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      I ran across this article from the US Army SMDC about the effects of alcohol on personnel and it’s relevance to security issues. There is a lot of very interesting information in this document concerning alcoholism and substance abuse that I found fascinating and informative. I hope you do too. (FYI, the links have been disabled)     

Relevance to Security

Alcohol affects the central nervous system and how the brain functions. It affects perception, thinking, and coordination. It impairs judgment, reduces inhibitions, and increases aggression. Those who abuse alcohol are more likely than others to engage in high risk, thoughtless, or violent behaviors.

There is much statistical evidence to document a relationship between alcohol use and fatal automobile accidents, other forms of accidental death and injury, spousal abuse, crime, and suicide. For more information, see Evidence of Effect on Behavior.

Recurrent use of alcohol to the point of intoxication may affect an individual’s ability to exercise the care, judgment and discretion necessary to protect classified information. Although statistical evidence is not available for the impact of alcohol abuse on national security, there have been many cases in which excessive drinking has increased the risk of accidental, careless or even deliberate disclosure of classified information.

Evidence from past espionage cases indicates that alcohol problems are more prevalent among convicted spies than in the population as a whole. For more information, see Alcohol Use by Convicted Spies.

Alcohol abuse may be part of a pattern of impulsive, immature, sensation-seeking, hostile, or antisocial behavior that raises serious concern about a subject’s reliability, trustworthiness, or judgment. Although the alcohol issue alone may not be sufficient to cause disqualification, the broader pattern of undesirable behavior may be. Refer to the discussion of Personal Conduct guideline, Pattern of Dishonest, Unreliable, or Rule-Breaking Behavior. An alcohol problem that is part of a pattern of undesirable behavior is more serious than an alcohol problem that exists in isolation. It may indicate an underlying personality defect that will cause future problems and resist treatment. For more information, see Alcohol and Emotional/Mental Issues and DWI/DUI May Indicate Other Security Issues.

Evidence of Effect on Behavior

The risk of fatal automobile injury has been found to be 11.1 times greater for drivers with a blood alcohol level of .05 to .09 than for drivers who have not consumed any alcohol. The risk increases exponentially with the amount of alcohol consumed. Drivers with a blood alcohol level between .1 and .15 are 48 times more likely to have a fatal accident, while those with a level over .15 are 385 times more likely to be killed in an auto accident. Ref 1

Drivers not using seat belts are three times more likely to have been drinking than drivers using seat belts. Intoxicated motorcyclists have been found to wear helmets only one-third as often as motorcyclists who are not intoxicated. Of drivers who have accidents while driving with suspended, revoked, or no licenses, about 83% have been drinking. Ref 2

Alcoholics are 10 times more likely than non-alcoholics to become fire or burn victims, and 16 times more likely to die in falls. Blood alcohol levels as low as .04 have been found to significantly affect radio communication by pilots. Studies suggest that alcohol is associated with 47% to 65% of adult drownings. Ref 3

Research at Fort Bliss supports studies of civilian populations that show alcoholism and alcohol abuse are related to 50% to 75% of spouse abuse incidents. Surprisingly, the spousal violence generally does not occur during or immediately after the drinking; as a result, the drunkenness is often not reported in police reports on spouse abuse. However, so many spouse abusers have alcohol problems that spouse abuse may be regarded as a possible indicator of alcohol problems. The Fort Bliss study recommends that within a military community, all spouse abusers be referred for alcohol evaluation. Ref 4

Alcohol Use by Convicted Spies

Among 24 convicted American spies who were interviewed and tested after their imprisonment, 20 had been drinkers. Eleven had been heavy drinkers. Nine reported that their alcohol consumption increased when they started to engage in espionage; the remainder reported no change in their habits. Seven had been arrested and convicted at least once for an alcohol-related vehicular offense (driving while under the influence). Sixteen of the 24 reported that during their developmental years, one or both parents had an alcohol-related problem. Psychological disorders, attempted suicide, and physical abuse were common among the families of these subjects. Ref 5

CIA operations officer Aldrich Ames, who was arrested for espionage in 1994, had a reputation for drinking too much. There are several specific instances in which his drinking led directly to actions that endangered security. Ames became seriously inebriated while playing in a CIA-FBI softball game. He had to be driven home that night and left behind at the field a jacket with his CIA badge, a wallet that included alias documentation, and cryptic notes on a classified meeting. On another occasion, at a meeting at CIA Headquarters with foreign officials, Ames became so intoxicated that he made inappropriate remarks about CIA operations and then passed out at the table. Ref 6 For additional information on Ames’ drinking problem, see Ames Example.

Alcohol and Emotional/Mental Issues

One study found that within the general population, nearly half of all those diagnosed as alcohol abusers or alcohol dependent also had some form of psychiatric disorder. The percentage was greater for females than males. Although the diagnosis of alcohol dependence was five times more prevalent among men than among women, the association of alcoholism with other psychiatric diagnoses was stronger in women; 65% of female alcoholics had a second diagnosis, compared with 44% of male alcoholics. Ref 7

A different study that examined only those in treatment for both alcohol and other drug problems found that 65% had a current mental disorder and 78% had a history of some mental disorder during their lifetime. The patients in treatment for alcoholism had lifetime prevalence rates of 42% for antisocial personality disorder, 31% for phobias, 30% for psychosexual dysfunction, 23% for major depression, 13% for dysthymia (a depressive disorder), 9% for panic disorder, and 8% for schizophrenia. Obviously, many patients had more than one disorder. The diagnostic methods used may have led to overestimation in some categories, but the findings are significant nonetheless. Ref 8

Potentially Disqualifying Conditions

The five potentially disqualifying conditions listed in the Adjudicative Guidelines fall into two distinct categories: alcohol-related behavior either at work or away from work and medical diagnosis of alcohol abuse or dependence.

This supplemental discussion of disqualifying conditions is divided into:

  • Behavioral Evaluation: This looks at how the subject behaves while under the influence of alcohol. Do subject’s actions indicate poor judgment, unreliability, untrustworthiness, or carelessness? How imminent is the security risk? The behavioral evaluation is done by the adjudicator.
  • Medical Evaluation: This looks at alcohol abuse or dependence as an illness. Does subject meet the criteria for a diagnosis of alcohol abuse or dependence? Is subject’s drinking likely to continue or get worse? Is counseling or treatment likely to be effective? Medical evaluation is done by a credentialed medical professional.

To judge an individual’s quantity of alcohol use, it may be useful to have a better understanding of alcohol consumption patterns. For more information on this, see Categorizing Light, Moderate, and Heavy Drinkers.

Behavioral Evaluation

The key question about alcohol use is how it affects subject’s judgment and ability to control his/her behavior. How subject behaves under the influence of alcohol is more important than how much or how often subject drinks and whether or not subject is diagnosed as an alcoholic.

This discussion of behavioral problems related to alcohol use is divided into the following sections:

People differ greatly in their reaction to alcohol. Some daily drinkers are quiet drunks who cause no trouble. Some infrequent drinkers go on occasional binges and totally lose control. Some individuals who have engaged in flagrant misconduct or poor judgment while under the influence of alcohol do not receive an adverse medical diagnosis.

An adverse adjudication decision based on an individual’s behavior does not need to be supported by a medical diagnosis of alcohol abuse or dependence. Such a diagnosis may not be available even when subject’s behavior provides clear evidence of security risk.

Medical diagnosis of alcohol abuse or dependence is heavily dependent upon information provided by the subject. This makes diagnosis difficult, as alcoholics are typically in denial. Moreover, an employee whose security clearance may be at stake has a strong incentive to deny symptoms of an alcohol problem when talking with a medical professional. See Ames Example.

Work, Legal, Social, Financial,
or Health Problems

Drinking habits that cause or exacerbate any of the following types of problems are a security concern. If excessive use of alcohol causes any one of these problems, it raises the possibility that poor judgment or loss of control while intoxicated could also contribute to the unauthorized disclosure of classified information.

  • Work problems such as absences, reduced productivity, unreliability, carelessness, or unsafe habits;
  • Legal problems such as driving while intoxicated, public drunkenness or disorderly conduct;
  • Social problems such as family conflict, spouse abuse, loss of friends, interpersonal conflicts, abusiveness, or belligerency;
  • Financial problems such as neglect of bills or overspending;
  • Health problems such as liver damage or making an ulcer worse.

Work-Related Incidents

Incidents at work are generally more serious than if the same type of behavior occurs away from work. If subject allows alcohol use to affect one aspect of work performance, it may affect other aspects including control over classified information. If subject’s supervisor or a coworker has reported alcohol on subject’s breath at work, absenteeism, or that subject’s performance has been adversely affected by hangover or by drinking during lunch, this is more serious than alcohol use that affects only one’s personal life.

Incidents that do or could relate directly to the protection of classified information are the most serious.

  • Excessive Talkativeness: An individual who becomes excessively talkative while intoxicated may say things that are regretted or not remembered later. Such a person may be unable to exercise the care and discretion needed to protect classified information. The risk is greatest for personnel whose job requires meeting and discussing sensitive topics with others, often over lunch, without making inappropriate revelations. This includes many intelligence officers, liaison officers, negotiators, purchasing agents, and senior officials.
  • Loss of Physical Control: An individual who occasionally becomes intoxicated to the point of passing out may lose physical control over sensitive materials. This is a particular concern among personnel who must carry classified materials outside of a secure area. Anyone who carries a badge for access to a controlled area risks losing that badge if they become seriously impaired by alcohol use.

Spouse Abuse

Research at Fort Bliss supports studies of civilian populations that show alcoholism and alcohol abuse are related to 50% to 75% of spouse abuse incidents. Surprisingly, the spousal violence generally does not occur during or immediately after the drinking; as a result, the drunkenness is often not reported in police reports on spouse abuse. However, so many spouse abusers have alcohol problems that spouse abuse may be regarded as a possible indicator of alcohol problems. The Fort Bliss study recommends that within a military community, all spouse abusers be referred for alcohol evaluation. Ref 9

Driving While Intoxicated

Frequent driving or engaging in other physically hazardous activity while intoxicated, e.g., boating, skiing, or operating machinery, is a concern. If this happens during duty hours, it is a serious concern.

A single arrest for driving while intoxicated is a serious concern, as two studies have shown that 90% of those arrested for a single DWI/DUI have an alcohol problem serious enough to merit treatment. For information on these studies, see Research on Driving While Intoxicated.

This finding has significant implications for investigators and adjudicators. A single recent DWI arrest suggests that investigators should intensify their search for other indications of alcohol-related problems or other behavioral problems. Depending upon recency of the DWI/DUI, adjudicators may wish to consider an alcohol evaluation before approving eligibility for access.

Two or more DWI/DUI arrests may indicate the presence of other security concerns such as criminal behavior or a tendency toward reckless or sensation-seeking behavior. For more information, see DWI/DUI May Indicate Other Security Issues.

For background information on blood alcohol levels, see Blood Alcohol Concentration.

Research on Driving While Intoxicated

Many responsible citizens occasionally drive with a blood alcohol level above the legal limit. In a 1987 U.S. national survey, 6.1% of adults responded positively when asked if they had driven during the past month “when you’ve had perhaps too much to drink.” Ref 10 In a 1983 Gallup Poll, 80% of mid-level executives of large companies answered yes when asked if they had ever driven while drunk; this compared with only 33% of the general public who reported they had ever driven while drunk. Ref 11

Despite the prevalence of drinking and driving, a single arrest for driving while intoxicated (DWI or DUI) is an important indicator of alcohol abuse. Most of those who are arrested are not average citizens who just happen to have been caught during an unusual lapse in judgment or through an unfortunate piece of bad luck.

People who get so drunk that their driving attracts attention and results in arrest are usually problem drinkers. Since problem drinkers tend to drive under the influence repeatedly, they are the ones who push the odds to the point of getting caught.

A systematic study of 1,600 military personnel arrested for DWI, and who subsequently completed a five-day alcohol evaluation and education program at Beaumont Army Medical Center, Ft. Bliss, Texas, showed that fully 90% of DWI offenders had a serious alcohol problem. Ref 12 Of this group, which represents all military personnel arrested for DWI either on or off post in the Ft. Bliss area from January 1985 to September 1989, 45% were diagnosed as alcohol dependent (alcoholic), 45% as alcohol abusers, and only 10% revealed no pattern of alcohol abuse.

A civilian study of 1,208 persons convicted of driving under the influence in Indiana in 1985 reported almost identical findings — 91.2% were diagnosed as alcohol abusers or alcohol dependent. Ref 13 This percentage is higher than most earlier studies of DWI offenders conducted in the 1960s and 1970s which generally found that 60% to 70% were alcohol dependent or alcohol abusers. The date of the studies may be a factor, as public attitudes toward drinking and driving changed after those earlier studies were done. Persons willing to drink and drive in the face of increased social consciousness of its risks and punishments may be more likely to have a serious drinking problem than was the case in earlier years. The percentage may also depend upon the thoroughness of the post-arrest evaluation program. The depth of evaluation provided by the Ft. Bliss program, for example, was substantially greater than most other programs.

DWI/DUI May Indicate Other Security Issues

Some researchers have suggested that driving while impaired is often part of a more general behavioral syndrome typified by high-risk behaviors and irresponsible attitudes. Ref 14 Individuals with alcohol-related offenses (such as DWI/DUI or disturbing the peace) often have derogatory information in other areas as well. This might include, for example, misdemeanor theft, spouse abuse, rule violations or other problems at work, financial problems, or withholding of information on the personnel security questionnaire.

Although each derogatory item may be minor by itself, the information as a whole may add up to a pattern of impulsive, irresponsible, or antisocial behavior. Such cases may be adjudicated under the Personal Conduct guideline. The adjudicator makes a whole-person judgment on whether the individual has the “strength of character, trustworthiness, honesty, reliability, discretion, and sound judgment” required by Section 3.1.(b) of Executive Order 12968.

Studies at Fort Bliss showed a strong relationship between DWI offenses and criminal activity. Military personnel with one DWI offense were two to three times as likely to have some other criminal offense as compared with personnel who had no DWI record. Personnel with two or more DWI offenses were 1.5 to 2.5 times as likely to engage in some other criminal offense as those with only one DWI. Ref 15

One study of 1,406 randomly selected DUI offenders in Massachusetts found that half had previously been arraigned for some criminal offense unrelated to driving. Ref 16 Another study found that impaired drivers arrested after an accident or moving violation scored significantly higher on tests of hostility, sensation-seeking, psychopathic deviance, and mania than impaired drivers caught in roadblocks or impaired drivers who have never been caught. Ref 17

Blood Alcohol Concentration

Blood alcohol concentration, often abbreviated as BAC, refers to the number of grams of pure alcohol present in 100 milliliters of blood. State laws often define two types of minimum blood alcohol concentrations that constitute evidence of intoxication — “illegal per se” and “presumptive” levels. Presumptive levels of intoxication are generally lower than illegal per se levels and require a greater burden of proof to convict an individual of drunk driving.

In the various states, illegal per se BAC levels cluster around .10, but several states define it as low as .08 and others as high as .15. There is a very significant difference in amount of drinking and degree of intoxication between .08 and .15

Presumptive levels for DWI or DUI conviction range from .05 and up but also cluster at the .10 level. The President’s Commission on Drunk Driving recommended in 1983 that a BAC of .08 be enacted by state legislatures as presumptive evidence of intoxication. The National Institute on Alcohol Abuse and Alcoholism describes a BAC of .05 as “driving while impaired.”

BAC levels are influenced by several variables other that just amount of alcohol consumed. They are influenced by body weight; owing to lower average body weight, it takes less drinking for the average woman to reach a given BAC than for the average man. BAC is reduced by food consumption, and it is reduced by time elapsed between drinking and testing. BAC declines by about .015 per hour. Ref 18

DWI vs. DUI — What’s the Difference

State laws differ on the use of the terms DWI and DUI. These terms are most often used interchangeably, although some states do attribute a specialized meaning to one of them.

DUI stands for driving while under the influence, and it usually refers to the influence of either alcohol or drugs. DWI usually stands for driving while intoxicated, and may refer only to alcohol. However, DWI may also stand for driving while impaired, in which case it may refer to either drugs or alcohol or may refer to a specific degree of alcoholic impairment distinct from intoxication.

Other Indicators of Serious Problem

Recognition that One Has a Problem: Recognition that one has an alcohol problem is the first step toward recovery. Refusal or failure to accept counseling or to follow medical advice relating to alcohol abuse or dependence is a serious concern. Refusal or failure to comply with a supervisor’s advice to significantly decrease alcohol consumption or to change life style and habits which contributed to past alcohol related problems is a serious concern. Failure to cooperate in or to complete successfully a prescribed alcohol rehabilitation program is a very serious concern.

Part of Broader Pattern of Behavior: An alcohol problem that is part of a broader pattern of undesirable behavior is more serious and more likely to cause trouble than an alcohol problem that exists in isolation. When alcohol problems appear together with any other issue, the combination adds up to more than the sum or its parts. See Personal Conduct, Pattern of Dishonest, Unreliable, or Rule-Breaking Behavior.

History of Alcohol Use: If recent evidence of a drinking problem is present, medical professionals will need subject’s entire history of alcohol use back to childhood in order to assess the seriousness of this issue. On the other hand, remission of drinking problems without treatment is common as younger drinkers mature or as the lifestyle, stress, or other circumstances that prompted the drinking change. Therefore, incidents more than three to five years old may no longer be relevant if there are no more recent indications of an alcohol problem.

Ames Example

The case of Aldrich Ames holds a number of lessons related to alcohol abuse. Ames is the CIA officer arrested in 1994 after nine years of espionage during which he compromised many CIA operations in the former Soviet Union.

When Ames was reassigned from Mexico City to Washington in 1983, his supervisor recommended that he be counseled for alcohol abuse due to several incidents that occurred during his Mexico City assignment. The counseling he received amounted to one conversation with a counselor who, according to Ames, told him that his case was not serious when compared to many others. The fallacy here was that the counselor depended on what Ames told him, and we can assume that Ames almost certainly did not give him the full story.

The following is a list of alcohol abuse incidents involving Aldrich Ames. It is significant not so much for what it tells about Ames’ alcohol use, as for what it tells about Ames as a person — his irresponsibility and lack of self-control. This record indicates that Ames lacked the “strength of character, trustworthiness, honesty, reliability, discretion, and sound judgment” required by Section 1.3.(b) of Executive Order 12968. Whether a doctor who interviews Ames’ finds that his alcohol use meets the formal medical definition of abuse or dependence is essentially irrelevant under these circumstances.

In his entrance-on-duty polygraph examination in March 1962, Ames admitted that in November 1961 he and a friend, while inebriated, had “borrowed” a delivery bicycle from a local liquor store, were picked up by the police, and subsequently released with a reprimand. In April 1962, he was arrested for intoxication in the District of Columbia. He was arrested for speeding in 1963 and for reckless driving in 1965; Ames later stated that at least one of these incidents was alcohol-related.

At a Christmas party at CIA Headquarters in 1973, Ames became so drunk that he had to be helped to his home by employees from the Office of Security. At an office Christmas party in 1974, he became intoxicated and was discovered by an Agency security officer in a compromising position with a female CIA employee.

In Mexico City during 1981-1983, Ames had a reputation of regularly having too much to drink during long lunches. Upon returning to the office, his speech was often slurred and he was unable to do much work. On one occasion when Ames was involved in a traffic accident in Mexico City, he was so drunk that he could not answer police questions nor recognize the US Embassy officer sent to help him. At a diplomatic reception where he drank too much, he became involved in a loud and boisterous argument with a Cuban official. This alarmed his supervisors and prompted the message to CIA Headquarters recommending that he be counseled for alcohol abuse when he returned to the United States. (Routine periodic background investigation in 1983 noted only that Ames was inclined to become a bit enthusiastic when he overindulged in alcohol. It failed to find a serious alcohol problem.)

In Washington in 1984 or 1985, after consuming several drinks at a meeting with an approved Soviet contact, Ames continued to drink at a CIA-FBI softball game until he became seriously inebriated. He had to be driven home that night and left behind at the field his CIA badge, cryptic notes, a wallet which included alias identification documents, and his jacket.

One of Ames’ supervisors recalled that he was drunk about three times a week during his tour in Rome from 1986 to 1989. He would go out for long lunches and return to the office too drunk to work. On one occasion in particular, he returned from a meeting with an agent too drunk to write a cable to Washington as directed by his supervisors. At an embassy reception in 1987, he got into a loud argument with a guest, left the reception, passed out on the street, and woke up the next day in a local hospital. One colleague said Ames began to drink more heavily in 1987 after he failed to get promoted. The station security officer brought Ames’ drinking habits to the attention of the Chief of Station. After Ames’ arrest, his wife told FBI debriefers that alcohol was partly to blame for their marriage falling to pieces during their Rome tour, and for their having numerous fights.

While assigned to CIA Headquarters during 1990 to 1994, Ames was noted for his proclivity to sleep at his desk after a long lunch. In 1992, Ames became so intoxicated during a liaison meeting with foreign officials that he made inappropriate remarks about CIA operations and personnel and then passed out at the table. Ref 19

Of course, all of this information was never pulled together in one place until after Ames’ arrest.

Medical Evaluation

A medical diagnosis of alcohol abuse or dependence by a credentialed medical professional may be a basis for adverse adjudicative action. Medical evaluation may also assist the adjudicator in determining the seriousness of an alcohol problem, whether it is likely to persist or get worse in the future, and the prospects for successful treatment.

Accurate medical evaluation is difficult when a subject conceals information from the medical professional. Alcoholics typically deny they have a problem. Medical evaluation is likely to be useful only if the medical professional is provided with all relevant information concerning a subject’s background and behavior. Adjudicators may make a negative decision based solely on a subject’s behavior while under the influence of alcohol, without a supporting medical evaluation of abuse or dependence. See Ames Example.

For further information, see:

Definition of Alcohol Abuse and Dependence

Alcoholism is a lay descriptive term. Health professionals refer to alcohol abuse or dependence.

Alcohol abusers are not physically addicted to alcohol, but develop problems as a result of their alcohol consumption and poor judgment, failure to understand the risks, or lack of concern about damage to themselves or others. Alcohol abusers who are not addicted remain in control of their behavior and can change their drinking patterns in response to explanations and warnings. An alcohol abuser either:

  • Persists in habitual drinking or occasional binge drinking that causes or exacerbates a persistent or recurrent social, work, financial, legal, or health problem;
  • Or uses alcohol repeatedly under circumstances which are physically dangerous, such as driving while intoxicated.

Some alcohol abusers also become physically dependent upon alcohol. Alcohol dependence is an illness with four main features:

  • Physiological tolerance, so that more and more alcohol is needed to produce the desired effects;
  • Difficulty in controlling how much alcohol is consumed once drinking has begun;
  • Physical dependence, with a characteristic withdrawal syndrome that is relieved by more alcohol (e.g., morning drinking) or other drugs;
  • A craving for alcohol that can lead to relapse if one tries to abstain.

For additional detail, see Medical Criteria for Diagnosis of Abuse or Dependence as described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

Indicators of Current or Potential
Future Abuse or Dependence

Some elements of past behavior can serve as particularly useful guides to what one might expect in the future. The presence of any of the following indicators suggests that an individual may already have a serious alcohol problem or be at high risk for developing one. Any one indicator is not conclusive evidence of a serious alcohol problem, but it is relevant circumstantial evidence and should be reported.

  • Subject’s drinking is causing or exacerbating a persistent or recurring social, work, financial, legal, or health problem. This is the heart of the alcohol issue.
  • Subject has tried unsuccessfully to cut down the extent of alcohol use. Or, once subject starts drinking, he/she sometimes loses control over the amount drunk. Both are indicators of alcohol dependence.
  • Subject commonly drinks while alone. Regular solitary drinking, as compared with social drinking, indicates potential current or future alcohol dependence.
  • Subject drinks prior to social events (to relax), as compared with using alcohol at social events. Drinking prior to social events indicates potential current or future alcohol problems.
  • Subject drinks first thing in the morning as an “eye-opener” or to get rid of a hangover. This is a strong indicator of dependence.
  • Subject claims a high tolerance for alcohol, e.g., makes statements such as: “I can drink a lot without its having any effect on me, so I don’t have to worry.” High tolerance is an indicator of alcohol dependence — it takes more and more to have the same effect on the body.
  • Subject uses alcohol as a means of coping with life’s problems. This indicates possible psychological or emotional problems and greatly increases the likelihood that alcohol already is or will become a problem. On the other hand, if motivation is experimentation, peer pressure, or adolescent rebelliousness, this does not necessarily predict future abuse.
  • There has been a recent increase in subject’s drinking. A change for the worse in subject’s drinking pattern may signal the existence of other relevant issues.
  • There is a family history (parents or siblings) of alcohol abuse. The child of an alcoholic is 2 to 5 times more likely to become an alcoholic than an individual with no family history of alcoholism. On the other hand, some children react to parental alcoholism by carefully avoiding alcohol themselves. The chances the child will follow in the parent’s footsteps depend, in part, upon which parent is the alcoholic and the nature of the relationship with that parent. Children of alcoholic mothers are at far greater risk than children of alcoholic fathers. Sons of alcoholic fathers are almost twice as likely to become alcoholics if the mother expressed high esteem for her alcoholic husband than if she did not convey to her children a high regard for their father. Ref 20

Categorizing Light, Moderate,
And Heavy Drinking

Drinkers have been categorized as abstainers, light drinkers, moderate drinkers, and heavier drinkers. The categories are based on average alcohol intake per day. Moderate drinkers consume 0.22 to 0.99 ounces of alcohol per day, which is equivalent to about 4 to 13 drinks per week. Heavier drinkers consume 1 or more ounces of alcohol per day, which is 2 or more drinks per day or 14 or more drinks per week. According to a major study in 1988, 17% to 29% of males were in the heavier drinker category. The percentage varied according to age and demographic group. The percentage of heavier drinkers was higher among those age 45-64, with less than a high school education, unemployed or in the lower income brackets, and those who were divorced, separated or widowed. Among females, 6% to 10% were in the heavier drinker category, with the highest percentages in the same demographic groups as for males. Ref 21 Heavier drinkers are not necessarily problem drinkers, although most problem drinkers would fall into this category. Some who have a problem with occasional binge drinking would not fall into the heavier drinker category as defined by this study.

Frequency of Problems Caused by Drinking

Drinking is a problem only if it leads to adverse consequences. Older drinkers are more likely to be heavier drinkers than younger drinkers, according to the 1988 study referenced in the previous topic, but a major national survey conducted in 1984 showed that older heavy drinkers are less likely than younger heavy drinkers to have problems as a consequence of their drinking. This survey found:

“that 7% of all drinkers had experienced moderate levels of dependence symptoms during the preceding year (i.e., they reported 3 or more of 13 indicators of dependence, such as impairment of control, morning drinking, and increased tolerance). Ten percent had experienced moderate levels of drinking-related consequences (i.e., they reported 4 or more of 32 consequences related to problems with spouse, job, police, or health). As would be expected, many drinkers reported both [dependence symptoms and adverse consequences], and thus the categories are not mutually exclusive.

Problem levels were higher among men than among women. Among male drinkers, the proportion reporting at least a moderate level of problems was highest in the 18-to-29 age category for both dependence symptoms (14%) and drinking-related consequences (20%). The proportions dropped with increasing age, reaching respective lows of 5% and 7% among men aged 60 and older.

Among female drinkers, the proportion reporting at least a moderate level of dependence symptoms remained stable at 5% to 6% from age 18 to age 49 and then dropped to 1%. For drinking-related consequences, however, the proportion reporting at least a moderate level of problems was relatively high in the 18-to-29 age group (12%) but dropped to 6% for women in their thirties and forties and was negligible for women aged 60 and older.” Ref 22

Frequency of Heavy Drinking
By High School & College Students

Every year since 1975, the Institute for Social Research at the University of Michigan has conducted a nationwide survey of about 17,000 high school seniors on drug and alcohol use and related questions. This survey includes annual follow-up questionnaires mailed to a sample of previous participants from each high school graduating class since 1976. This survey confirms significant reductions in frequency and amount of alcohol consumption by high school students since the mid 1980s, but the level remains very high. The figures on binge drinking are particularly significant.

In 1992, 51% of high school seniors were current drinkers, meaning they consumed alcohol during the previous thirty days. 36% of males and 20% of females engaged in occasional heavy drinking, which is defined as five or more drinks at one sitting during the previous two weeks. More than one-half of high school seniors did not perceive a “great risk” in having five or more drinks at a time once or twice each weekend. 29% reported that most or all of their friends got drunk at least once a week.

Among college students surveyed in 1992, 51% of males and 33% of females reported having five or more drinks at a time at least once during the previous two weeks. This type of heavy drinking at one sitting peaks among 21-22 year-olds. It diminishes from 40% of 21-22 year-olds (males and females combined) to 24% of 31-32 year-olds. Ref 23

Among high school seniors surveyed in 1996, 30.2% reported having consumed five or more drinks in a row at least once during the previous two weeks. Ref 24

Of particular significance for the security clearance process is that an individual’s pattern of drinking in high school does not necessarily remain constant as the individual becomes older. One study tracked a group of young men over a 15-year period from age 16 to 31. It found that “half of the heavier drinkers at age 18 remained at that level at age 31, and 7% had become abstainers. Half of the 18-year-old abstainers became moderate drinkers, one-third became heavier drinkers, and only 15% remained abstinent. Nearly half of the moderate drinkers became heavier drinkers; most of the other half remained at the same level, except for 4% who became abstainers.” Ref 25

Mitigating Conditions

Conditions that may mitigate security concerns are listed below. In case of uncertainty whether alcohol incidents have been mitigated, the adjudicator should make a “whole person” judgment. The adjudicator should ask: Does subject’s behavior demonstrate reliability, trustworthiness, good judgment, and discretion? If subject meets that test, access is “clearly consistent with the interests of national security.” If not, access may be denied.

Problem Is Not Serious Enough
For Adverse Action

After considering the nature and sources of all available information, the adjudicator may determine that subject’s drinking is not serious enough to warrant recommending disapproval or revocation of clearance. It may be appropriate to recommend approval with a warning that future incidents involving alcohol will cause a review of access eligibility. The adjudicator may also recommend approval under condition that subject agrees to evaluation by a credentialed medical professional and complies with recommendations regarding treatment or counseling.

In making this determination, the adjudicator considers subject’s behavior while intoxicated and medical evaluation of subject’s dependence upon alcohol and the likelihood that subject’s condition may worsen. The adjudicator also makes a whole-person determination that subject probably will or will not keep future drinking under control to ensure that it does not present a security risk. In making this judgment, the adjudicator considers everything that is known about subject’s maturity, sense of responsibility, self-control, honesty, willingness to follow the rules, and commitment to the organization. See the Whole Person Concept in the Introduction and Pattern of Dishonest, Unreliable, or Rule-Breaking Behavior under Personal Conduct.

Problem Is Not Recent

If the drinking problem occurred a number of years ago and there is no evidence of a recent problem, alcohol may no longer be an issue even if the subject received no counseling or treatment. Remission of alcohol problems without treatment or counseling is not unusual; it is usually related to a change in personal circumstances or lifestyle.

The amount of time which must elapse since the last report of alcohol abuse is a judgment call. Typically, two to five years may be required, depending upon the seriousness of past alcohol incidents, changes in subject’s personal circumstances or lifestyle, the degree to which investigation finds improved drinking habits since the last incident, the whole person evaluation, and medical evaluation. If there is strong, positive evidence of abstinence or other significant change in life style, or if the subject has successfully completed a treatment program and stayed with the aftercare program, as little as one year may be sufficient.

Remission Without Treatment or Counseling

Remission of drinking problems without treatment is common as young drinkers mature and the lifestyle, stress, or other circumstances that prompted the drinking change. The likelihood of spontaneous remission without treatment is relatively high among young men in their 20s, but relatively low among men in their 40s or older. Controlling one’s own drinking problem without treatment is far more common in women than among men.

One survey rechecked the same respondents nine years later. It found that of those reporting drinking problems during the first questioning, fewer than half reported still having problems at the time of the follow-up questioning. Ref 26

Positive Changes in Behavior

Positive changes in lifestyle or drinking habits for at least six months after subject has been warned, counseled, or completed an alcohol awareness program may mitigate one or two recent alcohol incidents. Persuasive evidence that subject recognizes his/her problem and is strongly motivated to overcome it is an important consideration. On the other hand, denial or grudging recognition of the problem indicates the problem is likely to persist.

Positive changes in lifestyle may be associated with moving from school into the work force, marriage, or having children. A positive change in lifestyle may also be a decision to avoid certain friends, or to avoid situations that create a sudden impulse to drink, e.g., changing one’s route home to avoid going by a neighborhood bar.

Self-Referral to Alcohol Awareness
or Rehabilitation Program

Cleared personnel are encouraged to seek treatment if they develop alcohol-related problems. If an individual’s problem surfaces solely as a result of self-referral to counseling or a treatment program, there were no major precipitating factors such as alcohol-related arrests, and subject is making satisfactory progress, the case should normally be handled as a medical problem. Administrative action concerning security clearance can be deferred pending satisfactory outcome of treatment.

Successful Completion
Of Rehabilitation Program

Alcohol abuse or dependence is a treatable illness, although relapse is not unusual. Completion of inpatient or outpatient treatment along with an aftercare program mitigates security concerns if subject has abstained from alcohol or greatly reduced alcohol consumption for a period of at least 12 months after treatment and has received a favorable prognosis by a credentialed medical professional.

Studies of U.S. military treatment programs show that completion of the aftercare program is the strongest predictor of treatment success. Other predictors of treatment success are pay grade and completion of the treatment program itself. Ref 27

Since most alcohol abusers deny they have a problem, motivation is a key to successful treatment. All three of the predictors noted above are related to motivation to overcome one’s problem. The higher one’s pay grade, the more one has invested in his or her career. Within the military, this is a strong motivator, as success in achieving sobriety is often a condition for continued employment. Completion of the treatment regimen and the aftercare program are tangible demonstrations of motivation.

Success of military treatment programs is measured by subsequent job performance as well as by subsequent abstinence. Studies of these programs have found that at least two-thirds of those who completed a program were abstinent or virtually abstinent one year later. Another 19% were drinking occasionally but had substantially reduced their alcohol consumption. Nearly 83% had received a satisfactory or highly satisfactory performance rating. Ref 28

Military alcohol treatment programs tend to be more successful than civilian programs for several reasons. One is that the military’s “zero tolerance” policy causes military personnel to be referred for treatment earlier than their civilian counterparts. In other words, the problem is less serious at the start of treatment. Another reason is that successful treatment is often a requirement for continued military service, and this enhances motivation for overcoming drinking problems.

Most experts on alcoholism believe that continued sobriety after treatment for alcohol abuse or dependence requires total abstinence. This conventional requirement for total abstinence is now being challenged by a growing number of treatment programs that teach moderation rather than abstinence. Proponents of “moderation management” acknowledge that this approach is not appropriate for chronic drinkers who are severely dependent on alcohol. They argue that moderation is possible, however, for “problem drinkers” whose bouts with alcohol have lasted five years or less and who do not suffer physical withdrawal when they abstain. Long term success rates for moderation programs are not yet known. The National Institute on Alcohol Abuse and Alcoholism says that “moderate drinking may be an acceptable goal” for some drinkers with a “relatively mild” problem. Ref 29

Relapse Rates

For the adjudicator evaluating the significance of alcoholism treatment as a mitigating factor, the most significant indicators that an individual will remain abstinent are successful completion of the treatment program, strict adherence to the full aftercare program, and any other evidence that the individual recognizes his or her problem and is highly motivated to overcome it.

Relapse is a common occurrence after all addiction treatment programs, but the risk of relapse diminishes as time passes. In alcohol as well as drug and smoking addiction programs, the first relapse occurs most commonly during the first three months after completion of treatment

One interesting study of treatment outcomes for military personnel was conducted by the Tri-Service Alcoholism Recovery Department (TRISARD) at the Bethesda Naval Hospital. Ref 30 It showed that if one gets through the first three months without relapse, the chances for long-term abstinence improve dramatically, and the chance of a relapse that affects work performance is small. It is noteworthy that failure to achieve complete abstinence did not, in most cases, lead to objectionable behavior or affect work performance. In fact, this study showed that when a patient who completed the program got through three months without a relapse, the chance that any subsequent relapse from abstinence would affect job performance was almost negligible for at least 24 months.

A recent, broadly publicized study of civilians found that five years of abstinence was necessary before relapse is unlikely. Ref 31 However, this was a study of abstainers, not of treatment effectiveness. The study did not distinguish between alcohol abusers who tried to abstain on their own from those who successfully completed a treatment and aftercare program. Obviously, those who complete both treatment and an aftercare program are far more likely to be successful. Those whose security clearance and/or job depends upon achieving sobriety are also far more likely to be motivated to be successful.

Inpatient vs. Outpatient Care

There is great variety in the length and types of treatments used in civilian alcoholism treatment programs, and the length of aftercare programs varies from one to three months up to two years. The scientific evidence of the effectiveness of many treatments is questionable, but all programs have many graduates who report successful outcomes. The evidence indicates that expensive, inpatient treatment programs offer no advantages in overall effectiveness as compared with outpatient treatment. Ref 32 The effectiveness of treatment may be determined more by the motivation of the participant to break the habit than by the specifics of the treatment program.

Aftercare Program

Aftercare refers to the period after treatment during which the patient remains in contact with an alcohol counselor. It may last as little as three months, but one year of aftercare is preferable. Aftercare usually includes regular attendance at Alcoholics Anonymous meetings.

Reference Materials

Army, Navy, Air Force Terminology
For Alcohol Evaluation

Army, Navy and Air Force all use different terminology for describing substance abuse treatment programs. The terminology defined below was in effect in 1996. All three services are in the process of revising their substance abuse program regulations. The Army will probably drop its track terminology while leaving its treatment programs essentially unchanged.

Army

The Army Alcohol and Drug Abuse Prevention and Control Program (ADAPCP) as prescribed in Army Regulation 600-85 provides for three tracks.

Track I is awareness education and outpatient group counseling, as needed. Enrollment in Track I will not normally exceed 30 days.

Track II provides outpatient rehabilitation. This includes intensive individual or group counseling, and awareness education as needed. Enrollment in Track II is for at least of 30 days. With aftercare, it may extend for up to one year.

Track III provides inpatient treatment for 6 to 8 weeks at a residential treatment facility, with outpatient follow-up for a total treatment program of one year. Generally, inpatient care is reserved for those individuals with long-standing problems of abuse, but for whom prognosis for recovery is favorable with proper treatment.

Navy

The Navy Alcohol and Drug Safety Action Program (NADSAP) as prescribed by OPNAV Instruction 5350.4B provides three levels that differ somewhat from the Army tracks.

Level I is mandatory attendance at a 36-hour substance abuse awareness program and evaluation by the Counseling and Assistance Center (CAAC) to determine whether referral to Level II or III is needed.

Level II is for individuals who need more than Level I but who are not diagnosed as dependent. The CAAC provides outpatient counseling and aftercare monitoring as needed. The counseling will not normally exceed 4 weeks, but CAAC services may be used for longer periods as part of an aftercare program.

Level III provides 6 weeks of inpatient treatment at a residential rehabilitation facility, combined with an unlimited period of aftercare monitoring. Level III is designed for individuals who have been diagnosed as alcohol or drug dependent (not just abusers) by a physician or clinical psychologist, and who possess exceptional potential for continued useful service.

Air Force

The Air Force Substance Abuse Reorientation Program (SART) as prescribed by Air Force Instruction 36-2701 identifies five tracks.

Track 1 is return to duty. This action would be taken if evaluation concludes there is no indication of past or present substance abuse.

Track 2 is attendance at the Substance Abuse Awareness Seminar if the subject was involved in an isolated substance abuse-related incident and appears unlikely to have recurring difficulties.

Track 3 is reorientation. This is for individuals who do not meet the diagnostic criteria for a alcohol abuse or alcohol dependence but have demonstrated improper use of substances. Typically, individuals categorized as “problem drinkers” go into this track. Individuals attend the Substance Abuse Awareness Seminar, participate in a short-term counseling and skills-development program designed to redirect the subject’s behavior, and attend at least one Alcoholics Anonymous meeting to become familiar with its program. Participants in Trace 3 are expected to abstain from alcohol during the course of the program, which should be completed within 60 days.

Track 4 is treatment, which may be either outpatient treatment (Track 4a) or inpatient treatment in a residential treatment facility (Track 4b), depending upon circumstances and medical recommendation. This is designed for individuals diagnosed as alcohol abusers or alcohol dependent who have demonstrated a genuine potential and desire for further useful service as well as a high probability for successful completion of the program. Alcohol abusers remain in Track 4 for at least 7 months (typically, 30 days in treatment and 6 months in aftercare). Alcohol dependent individuals remain in Track 4 for at least one year (typically, 30 days in treatment and 11 months in aftercare).

Track 5 is transitional counseling for individuals who have failed Track 3 or 4 and others who are being processed for return to civilian life.

Criteria for Medical Diagnosis
Of Abuse or Dependence

A diagnosis of alcohol abuse or dependence should be made by a credentialed medical professional. Medical criteria for a formal diagnosis of any substance abuse or dependence, including alcohol abuse or dependence, are defined by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The criteria are as follows:

Substance Dependence

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

(1) tolerance, as defined by either of the following:

(a) a need for markedly increased amounts of the substance to achieve intoxication or desired effect

(b) markedly diminished effect with continued use of the same amount of the substance

(2) withdrawal, as manifested by either of the following:

(a) the characteristic withdrawal syndrome for the substance

(b) the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

(3) the substance is often taken in larger amounts or over a longer period than was intended

(4) there is a persistent desire or unsuccessful efforts to cut down or control substance use

(5) a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects

(6) important social, occupational, or recreational activities are given up or reduced because of substance use

(7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption.

Substance Abuse

A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following occurring within a 12-month period:

(1) recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)

(2) recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)

(3) recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)

(4) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., argument with spouse about consequences of intoxication, physical fights)

B. The symptoms have never met the criteria for Substance Dependence for this class of substance.

Additional Sources of Information

Much of this information on the alcohol issue is taken from Heuer, R. J. (1991). Alcohol Use and Abuse: Background Information for Security Personnel. PERS-TR-91-010. Monterey, CA: Defense Personnel Security Research Center.

Every third year the U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, publishes a Special Report to the U.S. Congress on Alcohol and Health. This thick volume summarizes the results of recent research, nationwide, on alcohol abuse and alcoholism. The Eighth Special Report is dated September 1993. This report and a catalog of other publications on alcohol may be obtained without charge from the National Clearinghouse for Alcohol and Drug Information, phone 1-800-729-6686. The National Clearinghouse Internet site is www.health.org.

The prevalence of all forms of substance abuse is monitored annually by two major national surveys. The National Household Survey on Drug Abuse is based on a national probability sample of persons age 12 and older living in U.S. households.. The Monitoring the Future survey interviews high school seniors in public and private schools, with annual follow-up questionnaires mailed to a sample of previous participants from each high school graduating class since 1976. Both surveys are sponsored by the National Institute on Drug Abuse. Results may be obtained without charge from the National Clearinghouse for Alcohol and Drug Information, phone 1-800-729-6686.

The Internet site for the National Institute of Alcohol Abuse and Alcoholism is www.niaaa.nih.gov.

The Worldwide Survey on Substance Abuse and Health Behaviors Among Military Personnel has been conducted five times since 1980, the last in 1992. It is conducted for the Assistant Secretary of Defense (Health Affairs) and the Department of Defense Coordinator for Drug Enforcement Policy and Support.

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