In the first part of this blog, I discussed the historical use and current trends in use of tobacco in the military population. This time around we're going to examine another widely-used and socially-sanctioned substance, caffeine. 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.
Of course, a quick soldier’s breakfast (i.e. black coffee and a cigarette) would not be complete without that shot of caffeine. Old WWII ads cheerily show pictures of Service members enjoying a Coca Cola and, interestingly, many Service members would mention the word “coffee” and missing coffee in conversation and even in their archived diaries According to a podcast on NPR’s Hidden Kitchen, the word “coffee” was mentioned in the diaries of Civil War soldiers even more than the words “war”, “mother” or “Lincoln”. Further, one Civil War calvaryman wrote the following quite tellingly in his diary (NPR’s Hidden Kitchen, 25JUL2016):“We are reduced to quarter rations and no coffee. And nobody can soldier without coffee.”
I recall old war stories of pilots and long flights, with the distribution of caffeine or cola nut laced chocolates and, indeed this “Scho-Ka-Kola”, or Aviator’s Chocolate, was made available to German pilots during WWII. Fast forward to today, and I have seen the overwhelming popularity of energy drinks and energy shots among our youth – civilian and active duty alike. Given the long hours, early mornings and late nights, high optempo and disrupted sleep schedules, it is not surprising that caffeine use is up among AD Service members, whether or not they are deployed.
Research supports this, noting that 84% of AD USAF personnel reported use of caffeinated beverages at least 1x per week to help with performance enhancement. This is in comparison to 89% of the general population, to be fair. Commonly used caffeinated beverages included sodas (56%), coffee (45%), teas (36%) and energy drinks (27%). Importantly, for the AD folks surveyed, this use was associated with less sleep, less exercise and tobacco use. (Knapik et al, 2017).
The use of energy drinks and energy shots among our young military personnel is of concern, given the adverse effects of overuse. Research has shown that young enlisted men in operational units are significantly more likely to use energy drinks or energy shots (at least 1x in the past 30 days) than individuals in any other groups. Significantly, they are also more likely to co-injest an energy drink with alcohol (think Red Bull and vodka). (Attipoe et al, 2018; Knapik et. al, 2017;)
Adverse health effects with overuse aside, within a military population, the heavy consumption of energy drinks has been found to be related to mental health problems, aggressive behaviors and fatigue (Toblin et al, 2018). While this speaks to a relationship and not causality, it is important to note that a pattern of use with associated issues is being recognized.
While coffee, colas and energy drinks may present the most readily available forms of caffeine for the Service member, it is important to consider other less conspicuous forms of caffeine use, including the consumption of anhydrous caffeine, caffeine pills and caffeine containing pre and post workout supplements, which are extremely popular amongst our health and weight conscious Service members. Less is known about the aforementioned, at this time.
Maintaining balance and old-fashioned moderation in use is not enough in keeping ahead of the desire to chase that tobacco and caffeine fed energy dragon. Given the newer forms of tobacco and caffeine inundating the market we, as concerned care providers, will need to stay abreast of the changes in product availability, policies regulating use, and health care risks involved in frequent use or overuse. Care should be taken to holistically help the Service member with other energy “regulating” fixes, such as sleep hygiene, nutritional modifications, chronic pain management, behavioral activation and mindfulness, when appropriate.
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.
Attipoe, S., Delahanty, L., Stephens, M., & Deuster, P. A. (2018). Energy Beverage Use Among US Service Members. Military medicine, 183(9-10), e554-e561.
Bray, R. M., Pemberton, M. R., Lane, M. E., Hourani, L. L., Mattiko, M. J., & Babeu, L. A. (2010). Substance use and mental health trends among US military active duty personnel: key findings from the 2008 DoD Health Behavior Survey. Military Medicine, 175(6), 390-399.
Hidden Kitchen on NPR. If War Is Hell, Then Coffee Has Offered U.S. Soldiers Some Salvation Retrieved from: https://www.npr.org/sections/thesalt/2016/07/25/485227943/if-war-is-hell-then-coffee-has-offered-u-s-soldiers-some-salvation
Knapik, J. J., Austin, K. G., McGraw, S. M., Leahy, G. D., & Lieberman, H. R. (2017). Caffeine consumption among active duty United States Air Force personnel. Food and Chemical Toxicology, 105, 377-386.
Larson, M. J., Wooten, N. R., Adams, R. S., & Merrick, E. L. (2012). Military combat deployments and substance use: Review and future directions. Journal of Social Work Practice in the Addictions, 12(1), 6-27.
Meadows, S., Engel, C., Collins, R., Beckman, R., Cefalu, M., Hawes-Dawson, J., . . . Williams, K. (2018). 2015 Health Related Behaviors Survey of Active Duty Military Personnel: Substance Use Among U.S. Active-Duty Service Members. RAND: doi: 10.7249/rb9955.7
McLellan, T. M., Riviere, L. A., Williams, K. W., McGurk, D., & Lieberman, H. R. (2018). Caffeine and energy drink use by combat arms soldiers in Afghanistan as a countermeasure for sleep loss and high operational demands. Nutritional neuroscience, 1-10.
Smith, B., Ryan, M. A., Wingard, D. L., Patterson, T. L., Slymen, D. J., Macera, C. A., & Millennium Cohort Study Team. (2008). Cigarette smoking and military deployment: a prospective evaluation. American Journal of Preventive Medicine, 35(6), 539-546.
Toblin, R. L., Adrian, A. L., Hoge, C. W., & Adler, A. B. (2018). Energy drink use in US Service members after deployment: associations with mental health problems, aggression, and fatigue. Military medicine, 183(11-12), e364-e370. Retrieved from: https://doi.org/10.1093/milmed/usy205