Army suicide report raises concerns about drug abuse

The Army on Thursday released the results of a 15-month study into the service's growing suicide rate. The 350-page report, "Health Promotion, Risk Reduction and Suicide Prevention," provides new context for the 239 suicides (including reservists) and 1,713 attempted suicides in the Army last year.

It also raises alarms about what Army Vice Chief of Staff Gen. Peter Chiarelli calls a "troubling subset" of the force that uses and distributes illegal drugs, and commits crimes. The report noted 146 soldiers died last year after engaging in "high risk" behavior, including 74 who overdosed on drugs.

When including accidental deaths, which frequently result from drinking and driving or drug overdose, more soldiers die by their own actions than in combat, according to the report.

"Equivocal deaths, deaths by drug toxicity, accidental deaths, attempted suicides and drug overdoses are reducing the ranks and negatively effecting [sic] the Army's ability to engage in contingency operations in Iraq and Afghanistan," the report said. Equivocal deaths are those where the facts and circumstances make it impossible to distinguish between death by natural causes, suicide, homicide, or accident.

"No one could have foreseen the impact of nine years of war on our leaders and soldiers. As a result of the protracted and intense operational tempo, the Army has lost its former situational awareness and understanding of good order and discipline," the report said.

Chiarelli said at a Pentagon briefing Thursday that there has been an erosion of commanders' leadership in garrison during the last decade, creating an atmosphere of permissive complacency. For example, the report noted that 1,318 soldiers who failed two or more drug tests and 1,054 soldiers who committed two or more felony offenses were still serving in the Army.

"Leaders are consciously and admittedly taking risk by not enforcing good order and discipline," the report said. It noted that illicit drug and alcohol abuse, disciplinary infractions, misdemeanors, and felony crimes are on the rise.

The researchers found a "clear link" between such behaviors and suicide: Data since 2005 shows 29 percent of suicides included drug or alcohol use and 25 percent of those who took their own lives were involved in misdemeanor or felony investigations.

The report attributed this breakdown to a change in management at garrisons, where soldiers and units essentially are transient tenants at installations: "They are no longer linked to garrisons by a chain of command or senior commander but are regulated only by Army policies, programs and processes," the report said.

As a result, the report found some suicides went undiscovered for weeks, citing the example of a 33-year-old noncommissioned officer who was found dead of a gunshot wound in bed five weeks after he was to have reported to drill sergeant school. His body was discovered only after his landlord reported his rent was unpaid.

"In an organization that prides itself on never leaving a soldier behind, this sobering example speaks to the breakdown of leadership in garrison, which appears to be worsening as the requirements of prolonged conflict slowly erode the essential attributes that have defined the Army for generations," the report said.

Historically, the Army's suicide rate has been considerably lower than the general population's. The civilian demographically adjusted suicide rate is about 19.2 per 100,000. But the Army surpassed that in 2008 with a suicide rate of 20.2 per 100,000.

The "typical" Army suicide victim is a 23-year-old, Caucasian, junior-enlisted male. Most suicides are committed using firearms and often involve drugs or alcohol. Perhaps surprisingly, the risk decreases for soldiers who are married or have one or more deployments. That might be because soldiers who chose to remain in service following combat deployments are more resilient to stress.

A major challenge for service leaders is the fact that ever greater numbers of soldiers are being prescribed antidepressant, psychiatric and narcotic pain medications. While about 106,000 soldiers are estimated to be taking these medications, the relationship between those medications and suicide is not well understood.

"Co-morbidity is a huge issue," Chiarelli said, referring to the simultaneous existence of more than one medical condition, some of which may require incompatible or conflicting treatments. "When you are working behavior health issues and you see the symptoms shared between traumatic brain injury and post-traumatic stress, this becomes very difficult," he said.

"If you get the diagnosis wrong, and you think it's [traumatic brain injury] when it's really [post-traumatic stress] and you prescribe drugs for TBI, those drugs aren't going to help somebody with PTS," he said.

The report recommended the Army conduct comprehensive research and analysis of the impact of increased use of antidepressant, psychiatric and narcotic pain management medications on the force, and that it identify medications that are effective against depression and anxiety without increasing the risk for suicidal behavior.

The study, which was conducted by the Army's Suicide Prevention Task Force, does not contain new policy, but does provide the first comprehensive look at one of the most troubling issues Army leaders face. It also proposes a model for integrating and managing programs across the force designed to promote health, reduce risky behavior and prevent suicide.

In a letter to service leaders accompanying the study, Chiarelli wrote: "Read, study and act on this report. It represents a year's worth of work to research, plan and implement health promotion, risk reduction and suicide prevention. It requires your immediate attention."