War and Drugs: A Toxic Relationship

By Cesar Pintado

INTRODUCTION

War has a long history of intimate association with drugs and alcohol. They have often served to prepare for combat, as a cultural bond, and to cope with the physical and psychological hardships of service. The nature and impact of these substances reveal changes and continuities as medical innovation has brought new possibilities[i]. Human nature, however, offers less novelty and it is easy to recognize patterns from the earliest known cases.

To begin with, a distinction must be made between "official" substances, prescribed and distributed by the military authorities, and those "self-prescribed" by the combatants themselves. There is not much literature on the subject, but recent works such as Lukasz Kamienski's Drugs in War analyze in- depth the whole spectrum of the alteration of consciousness for war purposes, from the distribution of wine to cheer up the troops to the American plans to spray Soviet troops with LSD.

The author highlights the use of alcohol, used as an anesthetic, stimulant, relaxant, and strengthener. The British Empire cannot be understood without rum, which was given to sailors and soldiers, nor the Russian army without vodka. In Chechnya, soldiers even exchanged armored vehicles for cases of vodka to better withstand the rigors of campaign life.

His book follows the use of alcohol and drugs chronologically, up to the current wars, with ISIS on captagon (fenethylline) and the Americans using the new generation psychostimulant modafinil, which is very effective in combating fatigue and sleep deprivation[ii].

Free access was available until well into the 20th century for many now banned substances prolonged the addiction that many soldiers brought from their service

https://culturacolectiva.com/historia/drogas-que-se-recetaban-como-medicinas

A LITTLE BIT OF HISTORY

In general, the use of certain substances by combatants is as old as combat itself and depends on their cultural conditioning factors and (obviously) on the substances available. In Ancient Greece, soldiers were enervated with opium and wine; Hannibal's armies used mandrake (atropine) in their war against the African tribes; the Siberian tribes and the Vikings used hallucinogenic mushrooms (mainly amanita muscaria) profusely; Inca warriors consumed coke leaf; African warriors used a wide variety of drugs, ranging from kola nut to hashish; in Asia, opium was used by both local warriors and Europeans. In the 19th century, the use of morphine was already common in conflicts in Europe and North America, but it was the 20th century with its improved pharmacology that brought modern drugs.

Without a doubt, World War I was the war of cocaine, which could be bought in most pharmacies. The product synthesized from the old coca leaf was distributed to British, German, Australian,[A1]  and Canadian troops to increase their performance.

World War II brought methamphetamine (mainly under the name of Pervitin) and amphetamine (benzedrine), while continuing to use all of the above[iii]. In the Winter War between Finland and the USSR, the distribution of pharmaceuticals to the troops reached almost unbelievable extremes. In December 1940, Finnish military pharmacies stocked 117,500 5 mg heroin tablets, 469,500 1 mg morphine tablets, 917 kg of opium and 351 kg of morphine[iv]. Although Nazi Germany was the first to investigate the military use of amphetamines in 1938, throughout the conflict, Great Britain, the United States, Japan and Finland authorized the distribution of speed among their military[v].

Korea was the scene of extensive speed use, like other Cold War conflicts. But it was Vietnam that became known as the first pharmacological war because of the unprecedented use of both legal and illegal substances. Perhaps the most striking thing was not that many demoralized soldiers got hooked on drugs that were more affordable and accessible than at home. It is that much of the addiction was caused by the official supply. Since World War II, not much research had been done on the effect of amphetamines on troop performance, so the US military commanders supplied speed profusely. This was especially true for units on long reconnaissance missions. It was common to exceed the established doses (about 20 mg of dextroamphetamine for 48-hour combat missions); and the amphetamines were handed out, in the words of one veteran, "like candies".

In 1971, a report by the Congressional Crime Committee revealed that between 1966 and 1969, the U.S. military had used 225 million stimulant pills, primarily Dexedrine (dextroamphetamine), an amphetamine derivative almost twice as strong as the Benzedrine used in World War II. Soldiers infiltrating Laos on four-day missions were given a medical packet that included 12 pills of Darvon (a mild painkiller), 24 of codeine (an opioid painkiller) and 6 of Dexedrine. They were also injected with steroids.

Those psychoactive substances not only sought to improve combat capabilities, but also to reduce the mental damage caused by stress. For the first time in military history, potent antipsychotics such as chlorpromazine (manufactured by GlaxoSmithKline as Thorazine) were routinely prescribed. The massive use of this new psychopharmacology and the numerous deployment of psychologists go some way toward explaining the low rate of combat trauma recorded in operations. While the percentage of mental breakdowns in World War II had been 10%, in Vietnam it was 1.2; this was a misleading result. Narcotics and anti-psychotics only relieved symptoms and, taken without proper therapy, delayed a problem already installed in the psyche. A problem that can flare up later with worse consequences, including post-traumatic stress disorder (PTSD).

The number of U.S. Vietnam veterans affected by PTSD is impossible to know exactly, but the National Vietnam Veterans Readjustment Study published in 1990 found that 15.2% of combatants suffered from PTSD[vi].

The research revealed that among the military, the percentage of regular amphetamine users increased from 3.2% upon arrival in Vietnam to 5.2% at the end of their service.

In the Gulf War, many U.S. military personnel took unapproved drugs as protection against Iraqi biological and chemical agents. Congress claimed that they could be ordered to take them only on the direct order of the president or if the president declared a national emergency[vii]. The medical consequences among veterans extend to this day.

Low morale, easy access and even some official collaboration made Vietnam the perfect storm for drug abuse

https://mayooshin.com/wp-content/uploads/2019/01/vietnam-soldier-snorting.jpg

OTHER CONSIDERATIONS

Not all drugs used by the military have such a dark story, although they are not without their dangers. For example, it is common to use energy drinks to improve physical performance or stay alert. Many of these drinks contain three times as much caffeine as the same volume of coffee. The abuse of these drinks often causes irritability, hypertension, loss of sleep, and, in the long run, the opposite of the intended effect.

Another ancient companion of the military, except in Islamic cultures, is alcohol. Whether as a social lubricant, liquid courage, anesthetic substitute, disinfectant, depressant or simply a drink in the absence of drinking water, alcohol is as deeply integrated into military culture as virility itself. And although today drunkenness is less well regarded, alcoholic beverages are still the first narcotic resource of Western armies.

The military is also under constant pressure to stay within established body mass indexes. Some resort to extreme measures to lose weight, such as massive doses of diuretics, laxatives or high-caffeine activators. A 2014 study claimed that 67% of active U.S. military personnel took some dietary supplement. In special operations units, the percentage exceeded 75%[viii] .

Dexedrine is one of the most commonly used drugs by the U.S. military as a "go pill"

https://www.etsy.com/es/listing/675520541/vintage-dexedrine-spansule-smith-kline?show_sold_out_detail=1&ref=nla_listing_details

CURRENT STATUS

Drug use in the armed forces is not always the responsibility of unscrupulous commanders or troubled soldiers. Many services are performed under very specific conditions that are far from easy to solve. For example, the cockpit of an aircraft (especially a combat aircraft) is a very confined space where crews face long hours of routine with little mobility, quick decisions, technical complexity and the use of powerful weaponry. Add the stress of combat and enemy fire, and the fatigue that is otherwise a problem can be, in this case, deadly. Amphetamine has proven effective, but the effects on heart rate, blood pressure and behavior are also evident.

With a mission completed, crews often have the hours counted down to rest and return to the air in a different time zone and with their sleep rhythm broken. It's a routine that breaks the circadian cycle and forces crews to alternate depressants with activators. It can be argued that the work rhythm is not always equally intense, but the truth is that many crews would like to have a sleep switch when the occasion arises.

After the Gulf War, the USAF suspended the go-pill program fearing health effects on aircrews. But the program resumed in 1996, with strict protocols, because of the operational needs in the Balkans. Today the rules for the use of go-pills are very strict, but commanders are reluctant to give concrete orders to crews who must make subjective decisions to meet specific objectives. As one USAF commander [A3] [A4] noted in the Gulf War, "if you don't trust them with medication, you can't trust them with a $50 million aircraft"[ix].

A case of friendly fire occurred in 2002 in which a U.S. Air National Guard F-16 dropped a 500-pound laser-guided bomb on a Canadian light infantry unit in Tamak, Afghanistan, killing four men. The pilot's legal defense argued that the error was primarily due to the stimulant provided by the Department of Defense. Now, the USAF authorizes the use of three sleep medications (Restoril, Ambien and Sonata) and two stimulants (Dexedrine and Provigil) for certain crews in particular situations. All crews must test these medications during their training to ensure that they have no adverse effects. If this is the case, it appears in their medical records and they are not authorized to use the medication. In USAF combat aircrews, the use of the stimulants Dextroamphetamine and Modafinil is approved only on long duration missions and in aircraft where the pilot flies alone or cannot stand up. At any sign of abuse or adverse effect, use is immediately discontinued and the causes are investigated[x].

Whether because of less frequent combat missions or because of control measures, drug use rates tend to be lower today. U.S. military physicians issued nearly 3.8 million prescriptions for painkillers in 2009, more than four times the amount prescribed in 2001[xi] . For example, the 2015 Health Related Behaviour Survey research revealed that less than 1% of US military personnel reported such use[xii] and 4% admitted to abusing one or more prescription drugs. In comparison, 22.3% of civilians between the ages of 18 and 25 were illicit drug users [xiii]. However, statistics show that drug use increases after leaving the service: 3.5% of veterans admitted to using marijuana and 1.7% other drugs[xiv].

Alcohol abuse is more common, and greater exposure to traumatic experiences carries a higher risk. The aforementioned report found that 5.4% of military personnel drink regularly (vs. 6.7% of adults overall), but that binge drinking was more common (30%). Veterans also exhibit more consumption than active-duty personnel (56.6% according to a 2017 study by the National Survey on Drug Abuse). In fact, 65% of veterans starting a detox program report alcohol as the substance they abuse the most [xv].

More socially accepted, alcohol has a long tradition in the military. However, its consumption today is much more moderate than it was a few decades ago

https://media.defense.gov/2012/Apr/07/2001917842/-1/-1/0/120404-F-OC707-700.JPG

When leaving the service

All veterans go through a readjustment crisis when they leave active duty and reintegrate into civilian life. Certain military-specific stressors have traditionally been associated with an increased risk of drug and alcohol use: exposure to combat, witnessing the suffering of civilians and peers, or the challenges of reintegration (family, work, etc.). Addicted veterans are also three to four times more likely to have mental disorders such as PTSD, depression and anxiety[xvi] .

Sixty-three percent of Afghanistan and Iraq veterans diagnosed with substance abuse disorder also had PTSD. In the United States, suicides among veterans and active-duty military are more frequent than among the civilian population:, about 20 per day in 2014[xvii] . In 2016, the suicide rate among veterans was 1.5 times higher than among non-veteran adults[xviii] .

Sleep management in operations is one of the main causes for drug abuse, even authorized ones

https://api.army.mil/e2/c/images/2015/09/10/408808/max1800.jpg

CONCLUSIONS

War remains a powerful means for the popularization of certain drugs. Armies sometimes "export" them on deployment or bring them home on their return, from the armies of Alexander the Great to the ISAF.

The little attention paid by historians to the military use of drugs is understandable: it is an uncomfortable subject, it is often secret, and it undermines confidence in armies. Especially if they have been responsible for the addiction.

The stresses of operations, the culture of military life and the requirements of service offer both risks and protections when it comes to alcohol and drug use. Deployment for younger people is often associated with starting to smoke, drink, use drugs or engage in risky activities. Today, zero tolerance policies, screening and professional consequences that can prevent use can also stigmatize military personnel and discourage them from seeking needed treatment. Once personnel leave the service, many of the protective influences disappear and drug use becomes a major problem.

The use of psychoactive substances by combatants is surrounded by myths and stereotypes rooted in a social conception based on false or exaggerated ideas. This has often led to the dehumanization of the enemy, to justify defeats or to look to veterans as scapegoats for national problems. It is not decent to turn a soldier into an addict, but it is even less decent to blame him for moral and military failure.