TABLE 2-5 Health Care Burden Attributable to Substance Use Disorder and Three Other Mental Disorders, and Rank Among 139 Diseases and Conditions, Active Duty Component of U.S. Military, 2011

  Medical Encountersb Individuals Affectedc Bed Daysd
Major Category/Conditiona No. Rank No. Rank No. Rank
Anxiety disorder 475,546 6 68,672 20 28,738 4
Substance abuse disorder 395,021 7 36,276 36 53,589 1
Adjustment disorder 385,122 8 89,563 15 26,456 5
Mood disorder 377,334 9 61,996 23 51,694 2

NOTES: The surveillance period was January 1 to December 31, 2011. The surveillance population included all individuals who served in the active duty component of the U.S. Army, Navy, Air Force, Marine Corps, or Coast Guard at any time during the surveillance period.

aMajor categories and conditions modified from the Global Burden of Disease study. Rank is rank among 139 major categories and conditions.

bMedical encounters = total hospitalizations and ambulatory visits for the condition (with no more than one encounter per individual per day per condition).

cIndividuals with at least one hospitalization or ambulatory visit for the condition.

dTotal bed days for hospitalization and lost duty days due to the condition, measured as days confined to quarters and one-half day for a visit for the condition.

SOURCE: Adapted from Armed Forces Health Surveillance Center, 2012a, Table 1.

disproportionately large morbidity and health care burdens relative to the number of service members affected, a further implication is that high priority should be given to focusing prevention resources and research on determining what effective universal, selective, and indicated prevention interventions could be introduced or expanded.

Substance Use and Comorbid Conditions

Substance use disorder prevention, diagnosis, and treatment must take into account the comorbid conditions that often result from the effects of war on service members. A recent Institute of Medicine (IOM) report notes that “the trauma of combat, high-stress environments, or simply being deployed to a theater of war can have immediate and long-term disruptive physical, psychological, and other consequences in those who are deployed to foreign soil and to their family members” (IOM, 2010, p. 39).

Studies have suggested that multiple deployments and the high levels of stress associated with combat exposure and injury may increase the likelihood of behavioral and mental health issues among service members, including drug and alcohol abuse, posttraumatic stress disorder (PTSD), and depression (Shen et al., 2012; U.S. Army, 2012). PTSD has been associated



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