prospective health analysis in the military, will soon be reporting survey data for military spouses (DoD, 2012). These data may serve as a first step toward providing some of this important information.

Data on trends in combined alcohol and drug use disorders for military dependents (spouses and children up to age 18) were included in the analyses of record data from the MDR database discussed above for active duty and reserve component personnel based on counts of ICD-9 codes (DoD, 2011b). Figure 2-9 displays the trends from FY 2004 to FY 2009. Similar to the patterns for the active duty and reserve components, rates of SUDs show gradual increases over the years for dependents in the Marine Corps, Navy, and Air Force. Dependents in the Army show the highest rates and a gradual increase from 2004 to 2006, but a sharp increase from 2006 to 2008 and a decline in 2009. It is of interest that the pattern for dependents is similar to that for the active duty and reserve components, suggesting that there may be family patterns of alcohol and drug use leading to SUD diagnoses.

HEALTH CARE BURDEN OF SUBSTANCE USE DISORDERS

DoD recently published analyses of the absolute and relative morbidity burden among the armed services in 2011, grouping all medical encounters into 139 diseases and conditions (Armed Forces Health Surveillance Center, 2012a) based on ICD-9 codes. The morbidity burden attributable to a condition had four measures: (1) total number of medical encounters, (2) total number of service members affected (i.e., had one medical encounter for the condition), (3) total bed days during hospitalization, and (4) total number of lost duty days associated with seeking medical care for the condition. Table 2-5 shows the absolute numbers and ranks for the morbidity burden associated with substance abuse disorder and three selected mental disorders on three of these measures. As shown, the burden of substance abuse disorder for medical encounters ranked seventh among 139 conditions and for hospital bed days ranked first, even though it ranked only thirty-sixth for individuals affected. Substance abuse disorder and mood disorders accounted for nearly one-quarter (24 percent) of all hospital days. Together, the four mental disorders shown in the table (substance abuse, mood, anxiety, and adjustment) and two pregnancy- and delivery-related conditions accounted for one-half (50.3 percent) of all hospital bed days. Four conditions—upper respiratory infections, substance abuse disorder, mood disorders, and back problems—accounted for 24 percent of all lost duty days (Armed Forces Health Surveillance Center, 2012a).

These data suggest that DoD should place high priority on the development of new policies and programs to reduce the morbidity burden associated with substance abuse. Given that substance abuse imposes



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