A Day in the life of an Adolescent

   

A Day in the Life of American Adolescents: Substance Use Facts

In the United States in 2006, one third of adolescents aged 12 to 17 drank alcohol in the past year, one fifth used an illicit drug, and one sixth smoked cigarettes.  Although

the percentage of adolescents using alcohol and drugs declined between 2002 and

2006, the percentage of persons aged 12 to 17 receiving substance abuse treatment

has remained relatively stable.  In 2005, 7.7 percent of all persons admitted to

publicly funded treatment facilities were aged 12 to 17.  Office of Applied Studies

(OAS) in the Substance Abuse and Mental Health Services Administration (SAMHSA)

collects, analyzes, and disseminates critical public health data. OAS manages three

national data collections that offer insight into adolescent substance use and

treatment: the National Survey on Drug Use and Health (NSDUH), the Treatment

Episode Data Set (TEDS), and the National Survey of Substance Abuse Treatment

Services (N-SSATS). This issue of The OAS Report presents facts about

adolescent substance use, including initiation, and receipt of treatment for substance

use “on an average day. Data presented in this report from the 2006 NSDUH and

the 2005 TEDS are for adolescents aged 12 to 17; data presented from the 2005 N-

SSATS are for youth under 18.


First Substance Use


According to the 2006 NSDUH, 10.6 percent of adolescents aged 12 to 17 drank

alcohol for the first time in the past year, and 5.8 percent used an illicit drug for the first

time. The 2006 NSDUH also indicates that on an average day during the past year,

 adolescents aged 12 to 17 used the following substances for the first time (Figure 1):

  • 7,970 drank alcohol for the first time;
  • 4,348 used an illicit drug for the first time;
  • 4,082 smoked cigarettes for the first time;
  • 3,577 used marijuana for the first time;
  • 2,517 used pain relievers nonmedically for the first time;
  • 1,603 used inhalants for the first time;
  • 1,281 used hallucinogens for the first time;
  • 909 used cocaine for the first time;
  • 860 used stimulants nonmedically for the first time;
  • 236 used methamphetamine for the first time; and
  • 86 used heroin for the first time.

 Number of Adolescents Aged 12 to 17 Who Used Cigarettes, Alcohol, or Illicit Drugs for the First Time on an Average Day: 2006 NSDUH
Substance Number of Adolescents
Alcohol 7,970
Any Illicit Drug 4,348
Cigarettes 4,082
Marijuana 3,577
Pain Relievers* 2,517
Inhalants 1,603
Hallucinogens 1,281
Cocaine    909
Stimulants*    860

Source: SAMHSA, 2006 NSDUH.


Cigarette, Alcohol, and Illicit Drug Use


According to the 2006 NSDUH, more than 8 million adolescents aged 12 to 17 drank alcohol in the past year, nearly 5 million used an illicit drug, and more than 4 million smoked cigarettes. In addition, on an average day during the past year, adolescents aged 12 to 17 used the following substances (Figure 2):

  • 1,245,240 smoked cigarettes;
  • 630,539 drank alcohol;
  • 586,454 used marijuana;
  • 49,263 used inhalants;
  • 26,645 used hallucinogens;
  • 13,125 used cocaine; and
  • 3,753 used heroin.

Number of Adolescents Aged 12 to 17 Who Used Cigarettes, Alcohol, or Illicit Drugs on an Average Day: 2006 NSDUH
Substance Number of Adolescents
Cigarettes 1,245,240
Alcohol    630,539
Marijuana    586,454
Inhalants      49,263
Hallucinogens      26,645
Cocaine      13,125
Heroin        3,753

Source: SAMHSA, 2006 NSDUH.

The 2006 NSDUH also indicates that:

  • adolescents who used alcohol in the past month drank an average of 4.7 drinks per day on the days they drank; and
  • adolescents who smoked cigarettes in the past month smoked an average of 4.6 cigarettes per day on the days they smoked.


Substance Abuse Treatment


TEDS reported that in 2005 there were 142,646 admissions for adolescents aged 12 to 17 to substance abuse treatment programs (TEDS data come primarily from facilities that receive some public funding). TEDS also indicates that on an average day in 2005, adolescent admissions to treatment presented with the following substances as the primary substance of abuse11 (Figure 3):

  • 255 with marijuana;
  • 72 with alcohol;
  • 24 with stimulants;
  • 10 with cocaine;
  • 7 with opiates; and
  • 7 with other drugs.

Number of Adolescents Aged 12 to 17 Admitted to Publicly Funded Substance Abuse Treatment Facilities on an Average Day, by Primary Substance of Abuse: 2005 TEDS
Substance Number of Adolescents
Marijuana 255
Alcohol   72
Stimulants   24
Cocaine   10
Opiates     7
Other Drugs     7

Source: SAMHSA, 2005 TEDS.

The 2005 TEDS also indicates that on an average day in 2005, the number of adolescent admissions to substance abuse treatment were referred by the following sources12 (Figure 4):

  • 189 by the criminal justice system;
  • 66 by self-referral or referral from other individuals;
  • 43 by schools;
  • 37 by community organizations;
  • 22 by alcohol or drug treatment providers; and
  • 18 by other health care providers.

Number of Substance Abuse Treatment Admissions among Adolescents Aged 12 to 17 on an Average Day, by Principal Source of Referral: 2005 TEDS
Source of Referral Number of Admissions
Criminal Justice System 189
Self or Other Individuals   66
Schools   43
Community Organizations   37
Treatment Providers   22
Other Health Care Providers   18

Source: SAMHSA, 2005 TEDS.

In addition, N-SSATS, which collects information on substance abuse treatment at both publicly and privately funded facilities, reports how many active clients13 under the age of 18 received the following types of substance abuse treatment on an average day in 2005 (Figure 5):

  • 76,240 were clients in outpatient treatment;
  • 10,313 were clients in non-hospital residential treatment; and
  • 1,058 were clients in hospital inpatient treatment.

 Number of Adolescents Under Age 18 Who Were Clients in Publicly or Privately Funded Substance Abuse Treatment Facilities on an Average Day, by Service Type: 2005 N-SSATS
Service Type Number of Adolescents
Outpatient 76,240
Non-hospital Residential 10,313
Hospital Inpatient   1,058

Source: SAMHSA, 2005 N-SSATS.

National Survey on Drug Use and Health part 3

      Continuing in the theme of providing you with the latest research information, the following just-published data is from the latest survey taken by SAMHSA and encompasses 2008. This is just the  summary data. For the complete report click here

     

Initiation of Substance Use (Incidence, or First-Time Use) within the Past 12 Months

   In 2008, an estimated 2.9 million persons aged 12 or older used an illicit drug for the first time within the past 12 months. This averages to almost 8,000 initiates per day and is similar to the estimate for 2007. A majority of these past year illicit drug initiates reported that their first drug was marijuana (56.6 percent). Nearly one third initiated with psychotherapeutics (29.6 percent, including 22.5 percent with pain relievers, 3.2 percent with tranquilizers, 3.0 percent with stimulants, and 0.8 percent with sedatives). A sizable proportion reported inhalants (9.7 percent) as their first illicit drug, and a small proportion used hallucinogens as their first drug (3.2 percent).In 2008, the illicit drug categories with the largest number of past year initiates among persons aged 12 or older were marijuana use (2.2 million) and nonmedical use of pain relievers (2.2 million). These estimates were not significantly different from the numbers in 2007.In 2008, there were 729,000 persons aged 12 or older who had used inhalants for the first time within the past 12 months; 70.4 percent were under age 18 when they first used. There was no significant change in the number of inhalant initiates from 2007 to 2008, but the number in 2008 was significantly lower than the estimate in 2005 (877,000).The number of past year initiates of methamphetamine among persons aged 12 or older was 95,000 in 2008. This estimate was significantly lower than the estimate in 2007 (157,000) and was less than one third of the number estimated in 2004 (318,000).Following substantial drops in initiation between 2002 and 2003, estimates of initiation of Ecstasy and LSD among persons aged 12 or older have increased significantly. Between 2003 and 2008, the number of Ecstasy initiates increased from 642,000 to 894,000, and the number of LSD initiates increased from 200,000 to 394,000.Most (84.6 percent) of the 4.5 million past year alcohol initiates were younger than age 21 at the time of initiation.The number of persons aged 12 or older who smoked cigarettes for the first time within the past 12 months was 2.4 million in 2008, similar to the estimate in 2007 (2.2 million) but significantly higher than the estimate for 2002 (1.9 million). Most new smokers in 2008 were under age 18 when they first smoked cigarettes (58.8 percent); however, the number of persons initiating smoking at age 18 or older increased from about 600,000 in 2002 to 1 million in 2008.

      Youth Prevention-Related Measures

   Perceived risk is measured by NSDUH as the percentage reporting that there is great risk in the substance use behavior. The percentage of youths aged 12 to 17 perceiving great risk in smoking marijuana once or twice a week increased from 51.5 percent in 2002 to 55.0 percent in 2005, but dropped to 53.1 percent in 2008. A decline from 2005 to 2008 also was observed for using LSD once or twice a week (76.2 percent in 2002, 76.1 percent in 2005, and 73.9 percent in 2008). Between 2002 and 2008, the percentages who reported great risk in using alcohol and cigarettes increased. In 2002, 63.1 percent of youths reported great risk in smoking one or more packs of cigarettes per day, and in 2008 the percentage increased to 69.7 percent. In 2002, 38.2 percent reported great risk in binge drinking once or twice a week, and in 2008 the percentage increased to 40.5 percent.Almost half (49.2 percent) of youths aged 12 to 17 reported in 2008 that it would be “fairly easy” or “very easy” for them to obtain marijuana if they wanted some. Around one quarter reported it would be easy to get cocaine (22.1 percent). About one in seven (13.8 percent) indicated that LSD would be “fairly” or “very” easily available, and 13.0 percent reported easy availability for heroin. Between 2002 and 2008, there were declines in the perceived availability for all four drugs.A majority of youths aged 12 to 17 (90.8 percent) in 2008 reported that their parents would strongly disapprove of their trying marijuana or hashish once or twice. Current marijuana use was much less prevalent among youths who perceived strong parental disapproval for trying marijuana or hashish once or twice than for those who did not (4.3 vs. 29.8 percent).In 2008, 11.1 percent of youths aged 12 to 17 reported that they had participated in substance use prevention programs outside of school within the past year. This was lower than the percentage reported in 2002 (12.7 percent). Almost four fifths (78.0 percent) reported having seen or heard drug or alcohol prevention messages from sources outside of school, lower than in 2002 when the percentage was 83.2 percent. The percentage of school-enrolled youths reporting that they had seen or heard prevention messages at school also declined during this period, from 78.8 to 75.9 percent.      

National Survey on Drug Use and Health part 2

 

As promised, here are SAMHSA’s findings on alcohol use in America. Pretty interesting stuff really. I hope you find it as enlightening as I did.

Alcohol Use

  • Slightly more than half of Americans aged 12 or older reported being current drinkers of alcohol in the 2008 survey (51.6 percent). This translates to an estimated 129.0 million people, which was similar to the 2007 estimate of 126.8 million people (51.1 percent).
  • In 2008, more than one fifth (23.3 percent) of persons aged 12 or older participated in binge drinking. This translates to about 58.1 million people, similar to the estimate in 2007. Binge drinking is defined as having five or more drinks on the same occasion on at least 1 day in the 30 days prior to the survey.
  • In 2008, heavy drinking was reported by 6.9 percent of the population aged 12 or older, or 17.3 million people. This rate was the same as the rate of heavy drinking in 2007. Heavy drinking is defined as binge drinking on at least 5 days in the past 30 days.
  • Among young adults aged 18 to 25 in 2008, the rate of binge drinking was 41.0 percent, and the rate of heavy drinking was 14.5 percent. These rates were similar to the rates in 2007.
  • The rate of current alcohol use among youths aged 12 to 17 was 14.6 percent in 2008, which is lower than the 2007 rate (15.9 percent). Youth binge and heavy drinking rates in 2008 were 8.8 percent (lower than the 9.7 percent rate in 2007) and 2.0 percent, respectively.
  • Past month and binge drinking rates among underage persons (aged 12 to 20) declined between 2002 and 2008. The rate of past month underage drinking declined from 28.8 to 26.4 percent, and the rate of past month binge drinking declined from 19.3 to 17.4 percent.
  • Past month alcohol use rates declined between 2002 and 2008 for those aged 12 or 13 (4.3 to 3.4 percent), 14 or 15 (16.6 to 13.1 percent), 16 or 17 (32.6 to 26.2 percent), and 18 to 20 (51.0 to 48.7 percent).
  • Among persons aged 12 to 20, past month alcohol use rates in 2008 were 17.2 percent among Asians, 19.0 percent among blacks, 22.9 percent among those reporting two or more races, 23.1 percent among Hispanics, 26.4 percent among American Indians or Alaska Natives, and 30.1 percent among whites.
  • In 2008, 56.2 percent of current drinkers aged 12 to 20 reported that their last use of alcohol in the past month occurred in someone else’s home, and 29.6 percent reported that it had occurred in their own home. About one third (30.8 percent) paid for the alcohol the last time they drank, including 8.3 percent who purchased the alcohol themselves and 22.3 percent who gave money to someone else to purchase it. Among those who did not pay for the alcohol they last drank, 37.4 percent got it from an unrelated person aged 21 or older, 21.1 percent from another person under 21 years of age, and 21.0 percent from a parent, guardian, or other adult family member.
  • In 2008, an estimated 12.4 percent of persons aged 12 or older drove under the influence of alcohol at least once in the past year. This percentage has dropped since 2002, when it was 14.2 percent. The rate of driving under the influence of alcohol was highest among persons aged 21 to 25 (26.1 percent).

We will provide additional findings from the National Survey on Drug Use and Health in future posts as time and money permit. Please stay tuned.

National Survey on Drug Use and Health part 1

I found some information just recently published by the Substance Abuse and Mental Health Services Administration, SAMHSA, which is a division within the U.S. Department of Health and Human Services. This information is from the latest National Survey on Drug use and Health for 2008. It is a  pretty exhaustive study but enlightening nevertheless.  This is not the place to go into the details of the full report but, I thought you might be interested in the Highlights which are presented below. If you would prefer to view the entire report follow the underlined link.

This report presents the first information from the 2008 National Survey on Drug Use and Health (NSDUH), an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The survey is the primary source of information on the use of illicit drugs, alcohol, and tobacco in the civilian, noninstitutionalized population of the United States aged 12 years old or older. The survey interviews approximately 67,500 persons each year. Unless otherwise noted, all comparisons in this report described using terms such as “increased,” “decreased,” or “more than” are statistically significant at the .05 level.

Illicit Drug Use

  • In 2008, an estimated 20.1 million Americans aged 12 or older were current (past month) illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. This estimate represents 8.0 percent of the population aged 12 years old or older. Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically.
  • The rate of current illicit drug use among persons aged 12 or older in 2008 (8.0 percent) was the same as the rate in 2007 (8.0 percent).
  • Marijuana was the most commonly used illicit drug (15.2 million past month users). Among persons aged 12 or older, the rate of past month marijuana use in 2008 (6.1 percent) was similar to the rate in 2007 (5.8 percent).
  • In 2008, there were 1.9 million current cocaine users aged 12 or older, comprising 0.7 percent of the population. These estimates were similar to the number and rate in 2007 (2.1 million or 0.8 percent), but lower than the estimates in 2006 (2.4 million or 1.0 percent).
  • Hallucinogens were used in the past month by 1.1 million persons (0.4 percent) aged 12 or older in 2008, including 555,000 (0.2 percent) who had used Ecstasy. These estimates were similar to the corresponding estimates for 2007.
  • There were 6.2 million (2.5 percent) persons aged 12 or older who used prescription-type psychotherapeutic drugs nonmedically in the past month. These estimates were lower than in 2007 (6.9 million or 2.8 percent).
  • The number of past month methamphetamine users decreased by over half between 2006 and 2008. The numbers were 731,000 in 2006, 529,000 in 2007, and 314,000 in 2008.
  • Among youths aged 12 to 17, the current illicit drug use rate remained stable from 2007 (9.5 percent) to 2008 (9.3 percent). Between 2002 and 2008, youth rates declined significantly for illicit drugs in general (from 11.6 to 9.3 percent) and for marijuana (8.2 to 6.7 percent), cocaine (0.6 to 0.4 percent), prescription-type drugs used nonmedically (4.0 to 2.9 percent), pain relievers (3.2 to 2.3 percent), stimulants (0.8 to 0.5 percent), and methamphetamine (0.3 to 0.1 percent).
  • The rate of current marijuana use among youths aged 12 to 17 decreased from 8.2 percent in 2002 to 6.7 percent in 2006 and remained unchanged at 6.7 percent in 2007 and 2008.
  • The rate of current hallucinogen use among youths aged 12 to 17 increased from 0.7 percent in 2007 to 1.0 percent in 2008.
  • Rates of current use of illicit drugs in 2008 were higher among young adults aged 18 to 25 (19.6 percent) than for youths aged 12 to 17 (9.3 percent) and adults aged 26 or older (5.9 percent). Among young adults, there were no changes from 2007 to 2008 in the rate of current use of marijuana (16.5 percent in 2008), psychotherapeutics (5.9 percent), and hallucinogens (1.7 percent). The rate of cocaine use in this age group declined from 2.6 percent in 2005 to 1.5 percent in 2008.
  • From 2002 to 2008, there was an increase among young adults aged 18 to 25 in the rate of current nonmedical use of prescription pain relievers (from 4.1 to 4.6 percent) and in LSD (from 0.1 to 0.3 percent). There were decreases in the use of inhalants (from 0.5 to 0.3 percent) and methamphetamine (from 0.6 to 0.2 percent).
  • Among those aged 50 to 59, the rate of past month illicit drug use increased from 2.7 percent in 2002 to 4.6 percent in 2008. This trend may partially reflect the aging into this age group of the baby boom cohort, whose lifetime rate of illicit drug use is higher than those of older cohorts.
  • Among persons aged 12 or older in 2007-2008 who used pain relievers nonmedically in the past 12 months, 55.9 percent got the drug they most recently used from a friend or relative for free. Another 18.0 percent reported they got the drug from one doctor. Only 4.3 percent got pain relievers from a drug dealer or other stranger, and 0.4 percent bought them on the Internet. Among those who reported getting the pain reliever from a friend or relative for free, 81.7 percent reported in a follow-up question that the friend or relative had obtained the drugs from just one doctor.
  • Among unemployed adults aged 18 or older in 2008, 19.6 percent were current illicit drug users, which was higher than the 8.0 percent of those employed full time and 10.2 percent of those employed part time. However, most illicit drug users were employed. Of the 17.8 million current illicit drug users aged 18 or older in 2008, 12.9 million (72.7 percent) were employed either full or part time. The number of unemployed illicit drug users increased from 1.3 million in 2007 to 1.8 million in 2008, primarily because of an overall increase in the number of unemployed persons.
  • In 2008, 10.0 million persons aged 12 or older reported driving under the influence of illicit drugs during the past year. This corresponds to 4.0 percent of the population aged 12 or older, the same as the rate in 2007 (4.0 percent), but lower than the rate in 2002 (4.7 percent). In 2008, the rate was highest among young adults aged 18 to 25 (12.3 percent).

Well, there you have the latest information as to what Americans are doing with illicit drugs. In a followup post we’ll provide the survey’s findings on Alcohol Abuse in America. Please stay tuned.

 

Monitoring the Future

The following text is a portion of the annual report by the University of Michigan Institute for Social Research on the drug use habits of American adolescents. It is only the “Overview” and “Summary”. For the full report in PDF format follow this link.

Monitoring the Future 

Monitoring the Future (MTF) is a long-term study of American adolescents, college students,and adults through age 50. It has been conducted annually by the University ofMichigan’s, Institute for Social Research since its inception in 1975. It is supported under aseries of investigator-initiated, competing research grants from the National Institute onDrug Abuse.The need for a study such as MTF is clear. Substance use by American young people hasproven to be a rapidly changing phenomenon, requiring frequent assessments and reassessments.Since the mid-1960s, when it burgeoned in the general youth population, illicit druguse has remained a major concern for the nation. Smoking, drinking, and illicit drug useare leading causes of morbidity and mortality, both during adolescence as well as later in life.How vigorously the nation responds to teenage substance use, how accurately it identifies theemerging substance abuse problems, and how well it comes to understand the effectiveness ofpolicy and intervention efforts largely depend on the ongoing collection of valid and reliabledata. Monitoring the Future is designed to generate such data in order to provide an accuratepicture of what is happening in this domain and why, and has served that function well for thepast 33 years. Policy discussions in the media; in government, education, and public health institutions; and elsewhere have been informed by the ready availability of extensive and accurate information from the study relating to a large number of substances.The 2008 MTF survey encompassed over 46,000 eighth-, 10th-, and 12th-grade studentsin almost 400 secondary schools nationwide. The first published results are presented in this report. Recent trends in the use of licit and illicit drugs are emphasized, as well as trends inthe levels of perceived risk and personal disapproval associated with each drug. This studyhas shown these beliefs and attitudes to be particularly important in explaining trends in use.In addition, trends in the perceived availability of each drug are presented.A synopsis of the design and methods used in the study and an overview of the key resultsfrom the 2008 survey follow this introductory section. This is followed by a section foreach individual drug class, providing figures that show trends in the overall proportions ofstudents at each grade level (a) using the drug, (b) seeing a “great risk” associated with its use(perceived risk), (c) disapproving of its use, and (d) saying that they think they could get it“fairly easily” or “very easily” if they wanted to (perceived availability). The years for whichdata on each grade are available are 1975–2008 for 12th graders and 1991–2008 for 8th and10th graders, who were first included in the study in 1991.The tables at the end of this report provide the statistics underlying the figures; in addition,they present data on lifetime, annual, 30-day, and (for selected drugs) daily prevalence.1 Forthe sake of brevity, we present these prevalence statistics here only for the 1991–2008 interval,but statistics on 12th graders are available for earlier years in other publications from thestudy. For each prevalence period, the tables indicate which of the most recent one-yearchanges (between 2007 and 2008) are statistically significant. The graphic depictions of multiyear trends often indicate gradual, continuing change that may not reach significancein a given one-year interval. A much more extensive analysis of the study’sfindings on secondary school students may be found in Volume I, the second monographin this series, which will be published later in 2009.2 Volume I also contains a more completedescription of the study’s methodology, as well as an appendix explaining how to test the significance of differences between groups or of trends over time. The most recent such volumeis always available on the study’s Web site under Publications.MTF’s findings on American college students and adults through age 50 are not covered inthis early Overview report because the data from those populations become available laterin the year. These findings will be covered in Volume II, the third monograph in this annualseries, which will be published later in 2009.Volume II also contains a chapter dealing with national trends in HIV/AIDS-related riskand protective behaviors among young adults 21 to 30 years old. Volumes in these annualseries are available from the DrugPubs Research Dissemination Center at 877-NIDANIH(877-643-2644); or by e-mail at drugpubs@nida.nih.org. They also may beviewed and downloaded from the study’s Web site. Further information on the study,including its latest press releases, a listing of all publications, and the text of manyof them may be found on the Web site at www.monitoringthefuture.org. Monitoring the Future’s main data collection involves a series of large, annual surveys of nationally representative samples of public and private secondary school students throughoutthe coterminous United States. Every year since 1975, a national sample of 12th gradershas been surveyed. In 1991, the study was expanded to include comparable, independentnational samples of 8th and 10th graders. The year 2008 marked the 34th survey of 12th graders and the 18th survey of 8th and 10th graders.  Sample Sizes The 2008 sample sizes were about 16,300, 15,500, and 14,600 in 8th, 10th, and 12thgrades, respectively. In all, about 46,000 students in 386 secondary schools participated.Because multiple questionnaire forms are administered at each grade level, and becausenot all questions are contained in all forms, the number of cases upon which a particular statisticis based may be less than the total sample size. The tables here contain notes on the numberof forms used for each statistic if less than the total sample is used. Field Procedures University of Michigan staff members administer the questionnaires to students, usually in theirclassrooms during a regular class period. Participation is voluntary. Parents are notified wellin advance of the survey administration and are provided the opportunity to decline their child’sparticipation. Questionnaires are self-completed and formatted for optical scanning.In 8th and 10th grades the questionnaires are completely anonymous, and in 12th grade theyare confidential (name and address information is gathered to permit the longitudinal follow-upsurveys of random subsamples of participants for some years after high school). Extensive to protect the confidentiality of subjects and their data. All procedures are reviewed and approvedon an annual basis by the University of Michigan’s Institutional Review Board (IRB)for compliance with federal guidelines for the treatment of human subjects.  Measures A standard set of three questions is used to determine usage levels for the various drugs(except for cigarettes and smokeless tobacco).For example, we ask, “On how many occasions(if any) have you used marijuana . . . (a). . . in your lifetime? (b) . . . during the past 12months? (c) . . . during the last 30 days?” Each of the three questions is answered on the sameanswer scale: 0, 1–2, 3–5, 6–9, 10–19, 20–39, and 40 or more occasions.For the psychotherapeutic drugs (amphetamines, sedatives [barbiturates], tranquilizers,and narcotics other than heroin), respondents are instructed to include only use “. . . on yourown—that is, without a doctor telling you to take them.” A similar qualification is used inthe question on use of anabolic steroids. For cigarettes, respondents are asked two questionsabout use. First they are asked, “Have you ever smoked cigarettes?” (the answer categoriesare “never,” “once or twice,” and so on). The second question asks, “How frequentlyhave you smoked cigarettes during the past 30 days?” (the answer categories are “not at all,”“less than one cigarette per day,” “one to five  cigarettes per day,” “about one-half pack perday,” etc.). Smokeless tobacco questions parallel those for cigarettes. Alcohol use is measured using the three questions illustrated above for marijuana. A parallel set of three questions asks about the frequency of being drunk. A different question asks, for the prior two-week period, “How many timeshave you had five or more drinks in a row?” Perceived risk is measured by a question asking, “How much do you think people risk harming themselves (physically or in other ways), if they“try marijuana once or twice,” for example. The answer categories are “no risk,” “slight risk,” “moderate risk,” “great risk,” and “can’t say, drug unfamiliar.” Disapproval is measured by the question “Do YOU disapprove of people doing each of the following?”followed by “trying marijuana once or twice,” for example. Answer categories are “don’t disapprove,” “disapprove,” and “strongly disapprove.” In the 8th- and 10th-grade questionnairesa fourth category, “can’t say, drug unfamiliar,” is provided, and is included in the calculations.Perceived availability is measured by the question “How difficult do you think it would be foryou to get each of the following types of drugs, if you wanted some?” Answer categories are“probably impossible,” “very difficult,” “fairly difficult,” “fairly easy,” and “very easy.” For8th and 10th graders the additional answer category, “can’t say, drug unfamiliar,” is offeredand included in the calculations. In recent years, the trends in drug use havebecome more complex, and thus more difficult to describe. A major reason for thisincreased complexity is that cohort effects—lasting differences between classcohorts—have emerged, beginning with the increases in drug use during the early 1990s.These effects result in the various grades reaching peaks or valleys in different years,and thus usage rates sometimes move in different directions. We have seen such cohorteffects for cigarette smoking throughout most of the life of the study, but they were muchless evident for the illicit drugs until the mid- 1990s. The 8th graders have been first to showturnarounds in illicit drug use, and they have generally shown the greatest proportional declinesfrom recent peak levels of use, attained for the most part during the 1990s, while theproportional declines have generally been the least at 12th grade.This year we have introduced an additional set of tables providing an overview of drug usetrends for the three grades combined. While there are important differences by grade, thisapproach gives a more succinct summary of the general nature of trends over the last severalyears. Later sections in this monograph deal separately with each class of drugs and providedata for each grade individually. Overall, this was another year of modestchange in the use of most illicit drugs, much as was true in 2005–2007. Looking across Tables1–4, one can see that very few one-year changes (2007–2008) reached statistical significance, and those that did showed declines. In particular, amphetamines showed a significantdecrease again this year in lifetime, annual, and 30-day prevalence rates; all of these declineswere small this year, but many of them continue previous trends. Ritalin showed further declinethis year in two of the three grades, though the declines were not statistically significant.Other significant declines for all three grades combined occurred for annual prevalence ofcocaine and crack and for 30-day prevalence of any illicit drug other than marijuana.Some other drugs continued their gradual downward trends this year; though the2007–2008 changes are not significant, these declines have cumulated across the years tobecome significant, both statistically and substantively, including use of any illicit drug,amphetamines, Ritalin specifically, methamphetamine and crystal methamphetamine(ice). Most of the modest declines this year occurred for the stimulant drugs, including cocaineand crack. Among the drugs that generally held steady this year in at least two of the three grades monitored were any illicit drug, marijuana, any illicit drug other than marijuana (except for a signifi cant decline in 10th grade),inhalants, hallucinogens taken as a class (although 12th graders showed a non-significant increase in 2007–2008), LSD, hallucinogensother than LSD, PCP, ecstasy (MDMA), sedatives (barbiturates), tranquilizers, heroin,narcotics other than heroin (data available for 12th grade only), OxyContin specifically,and Vicodin specifically. Many of these drugs are holding steady at levels well below theirrecent peaks, LSD being a particularly notable example. As can be seen in Tables 1–4,the declines since the recent peak levels are highly significant for most drugs, indicatingthe cumulative impact of what have generally been gradual, steady changes. (Ecstasy andLSD are exceptions in that their declines were Rapid at certain times.One noteworthy point is that, in 8th and 12th grades, the declines in use of many drugs maybe ending, as indicated by the leveling of many of the drugs mentioned above. The declines appear ongoing for 10th graders, however. One of the most impressive declines has been inthe use of methamphetamine, which has fallen steadily and substantially since it was first measured in 1999. Given the high addiction potential of this drug, this is an important development. Annual prevalence for the use of methamphetamine in 2008 is 1.2%, 1.5%, and 1.2% for grades 8, 10, and 12, respectively—roughly two thirds below rates observed in 1999.Also of note this year is the slight increase in annual prevalence of marijuana use for thethree grades combined, reflecting increases in grades 8 and 12, but a slight decrease in grade10. None of these changes reached statistical significance, but they may signal a halt to thelong-term gradual decline that we have been reporting for some years. Largely because ofthese changes in marijuana use, the use of any illicit drug in the past year showed a similarpattern of change. Since 2007, particular emphasis has been placed on the use of prescription drugs outside of medical supervision, and on the use of over-the-counter cough and cold medicines to get high. As mentioned above, the use of amphetamines continues to decline. Use of sedatives (barbiturates) (measured in 12th grade only) continues a very gradual decline that began after 2005. Tranquilizer use held fairly steady this year (except for a slight decline in 10th grade), while use of narcotics other than heroin has been the exception, holding steady at historically high levels since 2002 among 12th graders (use for 8th and 10th graders is not reported). The use of two important narcotics, Vicodin and OxyContin, has not changed significantly since peak levels reached in recent years. The misuse of over-the-counter cough and cold medicines, most of which contain dextromethorphan, was first measured in 2006; thismisuse has been declining gradually in 8th and 12th grades since then, while holding steady in10th grade. The use of anabolic steroids had been steadily declining in recent years since peak levels were reached by 8th graders in 2000, by 10th graders in 2002, and by 12th graders in 2004. There was no further systematic change this year. The rates in 2008 are down from those peaks by roughly half. Implications for Prevention The wide divergence in historical trajectories of the various drugs over time helps to illustratethat, to a considerable degree, the determinants of use are often specific to each drug. Thesedeterminants include both perceived benefits and perceived risks that young people come toassociate with each drug. Unfortunately, word of the supposed benefits ofusing a drug usually spreads much faster than information about the adverse consequences.The former—supposed benefits—takes only rumor and a few testimonials, the spread ofwhich has been hastened greatly by the media and Internet. It usually takes much longer forthe evidence of adverse consequences (e.g., death, disease, overdose, addictive potential)to cumulate and then be disseminated. Thus, when a new drug comes onto the scene, it hasa considerable grace period during which its benefits are alleged and its consequences arenot yet known. We believe that ecstasy was the most recent example of this.To a considerable degree, prevention must occur drug by drug, because people will not necessarily generalize the adverse consequences of one drug to the use of others. Many beliefs and attitudes held by young people are drug specific. The figures in this Overview on perceived risk and disapproval for the various drugs—attitudes and beliefs that we have shown to beimportant in explaining many drug trends over the years—amply illustrate this assertion.These attitudes and beliefs are at quite different levels for the various drugs and, more importantly often trend differently over time.  “Generational Forgetting” Helps Keep the Epidemic Going Another point worth keeping in mind is that there tends to be a continuous flow of new drugsonto the scene and of older ones being rediscovered by young people. Many drugs have made acomeback years after they first fell from popularity, often because young people’s knowledgeof their adverse consequences faded as generational replacement took place. We call thisprocess “generational forgetting.” Examples include LSD and methamphetamine, two drugsused widely in the 1960s that made a comeback in the 1990s after their initial popularity fadedas a result of their adverse consequences becoming widely recognized during periods ofhigh use; heroin, cocaine, PCP, and crack are some others. At present, LSD and ecstasy areshowing the effects of generational forgetting, which puts future cohorts at greater risk of havinga resurgence in the use of these drugs. As for newly emerging drugs, examples includenitrite inhalants and PCP in the 1970s; crack and crystal methamphetamine in the 1980s;and Rohypnol, GHB, and ecstasy in the 1990s. The perpetual introduction of new drugs (orof new forms or new modes of administration of older ones, as illustrated by crack, crystalmethamphetamine, and noninjected heroin) helps to keep the country’s drug problem alive.Because of the lag times described previously, the forces of containment are always playingcatch up with the forces of encouragement and exploitation. Organized efforts to reduce thegrace period experienced by new drugs would seem to be among the most promising responsesfor minimizing the damage they will cause. Such efforts regarding ecstasy by the NationalInstitute on Drug Abuse and others appeared to pay off. The psychotherapeutic drugs now make up alarger part of the nation’s overall drug problem than was true 10 years ago, in part because usehas increased for many such drugs over that period, and in part because use of a number ofstreet drugs has declined substantially since themid-1990s. It seems likely that young peopleare less concerned about the dangers of using these drugs outside of medical regimen, likelybecause they are widely used for legitimate purposes. (Indeed, the low levels of perceivedrisk for sedatives and amphetamines observed among 12th graders illustrates this point.) Also,prescription psychotherapeutic drugs are now being advertised directly to the consumer,which implies both that they are in widespread use and that they can be used with low risk. Cigarettes and Alcohol The statistics for use of the licit drugs—cigarettes and alcohol—also remain a basis forconsiderable concern. Cigarettes. Nearly half (45%) of American youngpeople have tried cigarettes by 12th grade, and one out of five (20%) 12th graders are currentsmokers. Even as early as 8th grade, one in five (21%) have tried cigarettes, and 1 in 15 (7%) hasalready become a current smoker. Fortunately, there has been some real improvement in thesesmoking statistics over the last 11–12 years, following a dramatic increase earlier in the 1990s.Some of that improvement was simply regaining lost ground, but by 2008, cigarette use hasreached the lowest levels recorded in the life of the study, going back 33 years in the case of 12thgraders. It is particularly encouraging that, after seeming to end a couple of years ago, the declinein use is now continuing. Thirty-day prevalence of cigarette use reached a peak in 1996 at grades 8 and 10, capping a rapid climb from the 1991 levels (when data were first gathered on these grades). Between1996 and 2008, current smoking has fallen considerably in these grades (by 67% and 60%,respectively). For 12th graders, peak use occurred a year later, in 1997, and has had a moremodest decline, dropping to 44% by 2008. However, because of the strong cohort effectthat we have consistently observed for cigarette smoking, we expect the 12th graders tocontinue to show declines, as the lighter using cohorts of 8th and 10th graders become 12thgraders. Overall increases in perceived risk and disapproval appear to have contributed to thisdownturn. Perceived risk increased substantially and steadily in all grades from 1995 through2004, after which it leveled in 8th and 10th grades, but continued rising in 12th grade until2006, after which it leveled and then began to decline in 2008. Disapproval of smoking hadbeen rising steadily in all grades since 1996. After 2004, the rise decelerated in the lowergrades through 2006—again, reflecting a cohort effect in this attitude.It seems likely that some of the attitudinal change surrounding cigarettes is attributable tothe adverse publicity suffered by the tobacco industry in the 1990s, as well as a reductionin cigarette advertising and an increase in antismoking advertising reaching children. Priceis also likely to have been an important factor; cigarette prices rose appreciably in the late1990s and early 2000s as cigarette companies tried to cover the costs of the tobacco settlement,and as many states increased excise taxes on cigarettes. Various other attitudes toward smoking becamemore unfavorable during that interval, as well, though some have since leveled off. Forexample, among 8th graders, the proportions saying that they “prefer to date people whodon’t smoke” rose from 71% in 1996 to 83% by 2008 (with little change since 2003). Similarchanges occurred in 10th and 12th grades, as well. Thus, at the present time, smoking is likelyto make an adolescent less attractive to the great majority of potential romantic partners. Smokeless tobacco use had also been in decline in recent years, continuing into the early2000s, but the decline appears to have ended in all grades. The 30-day prevalence rates forsmokeless tobacco are now down by about half from peak levels. Alcohol use remains extremely widespread among today’s teenagers. Nearly three quartersof students (72%) have consumed alcohol (more than just a few sips) by the end of highschool, and about two fifths (39%) have done so by 8th grade. In fact, more than half (55%)of 12th graders and nearly a fifth (18%) of 8th graders in 2008 report having been drunk atleast once in their life. To a considerable degree, alcohol trends havetended to parallel the trends in illicit drug use. These include a modest increase in bingedrinking (defined as having five or more drinks in a row at least once in the past twoweeks) in the early and mid-1990s, though it was a proportionally smaller increase than wasseen for most of the illicit drugs. Fortunately, binge drinking rates leveled off seven to tenyears ago, just about when the illicit drug rates began to turn around, and in 2002 a drop indrinking and drunkenness began to appear in all grades. Gradual declines have continued inthe years since. The longer term trend data available for 12th graders show that alcohol usage rates, andbinge drinking in particular, are now substantially below peak levels in the early 1980s.  Where Are We Now? Clearly, the problem of substance abuse among American young people remains sufficientlywidespread to merit concern. Today, nearly half (47%) have tried an illicit drug by the timethey finish high school. Indeed, if inhalant use is included in the definition of illicit drug use,over a quarter (28%) have done so as early as 8th grade—when most students are only 13–14years old. One in four (25%) have used some illicit drug other than marijuana by the end of 12thgrade, and 18% of all 12th graders reported doing so during the 12 months prior to the survey.From the perspective of helping to deter future use, we emphasize the considerable proportionsof youth who do not use each of these drugs and who disapprove of their use. The majority (57%)of seniors today made it through the end of high school without ever having tried marijuana, andthree quarters (75%) without using an illicit drug other than marijuana. Further, the great majoritypersonally disapprove of using most illicit drugs, as has been true for many years.Despite the considerable progress made in the past decade, the nation must not be lulled intocomplacency. To some degree this happened in the early 1990s, after the considerable improvementsof the 1980s. Attention to the problem of drug use nearly disappeared from nationalnews coverage, and many governmental and non-governmental institutions withdrew attentionand programmatic support, which likely helped to set the stage for the costly relapse inthe drug epidemic during the 1990s

 

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.