When one thinks about substance use or addiction in the military, one’s mind may automatically go to alcohol. Although the prevalence of alcohol use and abuse can be considerable, we would be remiss to overlook the historical use and current trends in use of two other legally and socially sanctioned substances within our military population: tobacco and caffeine.
Talk to anyone who has been through a war, and – military or civilian alike - you will hear fond recollections of rare luxuries i.e. rationed or black market goods, including alcohol and chocolates but, mainly, stories of cigarettes and good coffee (and sometimes cola). Depending on the era, the brands and availability of each may have varied; however, tobacco and caffeine have consistently long been the fuel on which many a war was fought.
In hard times (think rough circumstances and compromised living conditions), the comfort of a cigarette or pipe with one’s comrades was much appreciated and provided some levity to battle fatigue. With the exception of periods at boot camp or OCS, smoking has enjoyed a long, uninterrupted tradition within the military. To hear, “The smoking lamp is lit,” signaled a welcome reprieve to a sailor’s arduous workday. For soldiers in country, the presence of two to four cigarettes and 10 matches within one’s K-Ration or MRE, represented some warm creature comforts of home while in theater. These mini cigarette packs would remain a constant in the MREs of many a soldier until around the mid-1970s. A hot commodity (I have heard), countless Poker games were played for either the Chiclets or, mostly, the cigarettes in one’s meal.
For the weary soldier , sailor, Marine or Airman, tobacco solved many problems. It replaced meals in times of scarcity and sleep in times of deprivation. It filled hours of rote boredom, provided a vehicle for social activity and, in the extreme, helped to distract and dull one’s senses a bit from physical pain or injury. A kind medic might remember, cigarette first, morphine drip next.
Given its many uses and portability, tobacco use went hand in hand with deployment. Many a Service member has reported “Doc, I only smoke (chew) when I’m deployed”. Deployed Service members are also more likely to use one or more forms of tobacco (Talcott et al., 2013) and individuals who have been exposed to combat are more likely to be current, heavy smokers (Larson et al., 2012). Deployments are also associated with smoking initiation and, to a greater degree, smoking recidivism (re-starting smoking) – particularly for those who have experienced prolonged deployments that are longer than nine months, multiple deployments, and/or combat exposure (Smith et al., 2008).
Although more than 50% of Service members reported smoking in 1980, cigarette smoking among military Service members has declined consistently over the past 35 years (Bray et al., 2010). While tobacco use, particularly, cigarette smoking, overall, is on the decline with both civilians and Service members alike, research has shown that Service member rates of tobacco use tend to be lower than that seen in the civilian population now as compared to the past. Supporting this, the 2015 DoD Health Related Behaviors Survey of Active Duty (AD) Military Personnel report compared AD military smoking behaviors with civilian data from the 2014 National Survey on Drug Use and Health (NSDUH) and found that the military rates of cigarette smoking (13.9%) were indeed now lower than the civilian rates of smoking (16.8%).
This decrease has been attributed to growing health initiatives focused on smoking cessation (and perhaps increased cost) within both the civilian and military populations. Regarding the latter, a 2016 DoD initiative was implemented raising the price of tobacco products on military bases to match that within the local community. This was in line with the CDC findings that simply raising the price of tobacco alone, is the most effective way to reduce tobacco use. (Military Times, Karen Jowers, April 29, 2016). In addition to this, I have seen tobacco cessation incentives promoted to Service members within our hospital, including medical support for cravings, nutrition and fitness consultations and complementary teeth whitening. But has tobacco use decreased overall, or just changed?
While traditional cigarette smoking has been on the decline, there has been an increase in in e-cigarette use and vaping, with 11% of AD Service members reportedly using e-cigarettes on a daily basis. Significantly, this percentage is 3 times higher than that reported by the civilian population during that period (2015 DoD Health Related Behaviors Survey of Active Duty Service Members) and many members relate that they are hoping to use e-cigs as a means of tapering off of cigarettes for good. Despite these intentions, both the CDC and the FDA are now working with local health departments to investigate “a multistate outbreak of severe pulmonary disease linked to e-cigarette use” (DoD Guidance Detecting and Reporting DoD Cases of Severe Pulmonary Disease Associated with E-cigarette Use, dated 17SEP19).
Obviously e-cigarette use and vaping is not without it’s dangers, as was previously thought. Recent military news has abounded with warnings about cannabinoid containing vape fluids, operational dangers posed by e-cigarettes aboard ships (they are a no-go) and unfun pulmonary consequences of using fun-flavored tobacco cartridges or vape fluids. As a result, directives have gone out presenting the caveats of use to Service members and, as of September, all four branches have banned the sale of e-cigarette and vaping products from the base/post exchanges. As of October 1, 2019, this ban is in full effect.
But if tobacco is the spark to the battle weary individual, it is surely coffee or caffeine that is gas that feeds the ever-elusive energy flame. Join us next week for part two, where we'll explore caffeine use in the military.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Kim Copeland, Psy.D., is a Military Internship Behavioral Health Psychologist with the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Copeland is currently physically based at Naval Medical Center Portsmouth.
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