There are lots of reasons why military service members are more prone to abuse alcohol than their civilian counterparts: They’re mostly male, they're mostly young and they're under a lot of stress.
But experts say there's another reason unique to service members: They usually can't seek substance abuse treatment without their commanders finding out.
"A lot of it is the concern about stigma. It's the concern about derailing careers," said Benjamin Nordstrom, chief clinical officer at Phoenix House, a substance abuse treatment center.
"People really get concerned that it's going to lead to them not being able to deploy, it's not going to allow them to get promoted, or it's going to get them into some kind of trouble," Nordstrom said.
Researchers have known for years that the lack of confidentiality in the military can keep problem drinkers from getting help. A recent study showed the possible benefits of discreet intervention.
The University of Washington School of Social Work invited soldiers at nearby Joint Base Lewis-McChord to examine their drinking habits. Researchers put up posters around the base that recruited the soldiers and made it clear that commanders wouldn't be notified.
After the soldiers were assessed, counselors talked with soldiers about their drinking in an hour long phone call. During the call, counselors acted as a sounding board to help participants reflect on the role that alcohol or drugs played in their life.
Study director Denise Walker at UW’s Innovative Programs Research Group said the intervention allowed participants to understand the consequences of their drinking without fearing for their jobs.
"They don't even have to walk into a building that would ordinarily say 'Army substance abuse program,'" Waker said. "They just need to pick up the phone."
The results were promising. When researchers checked back six months later, the soldiers in the study cut their average number of drinks per week nearly in half, from 32 to 14.
"You can imagine the effects on your health if you're drinking 32 drinks a week and then go down to 14," Walker said. "14 drinks per week is actually within healthy guidelines that the National Institute on Alcoholism and Alcohol Abuse considers to be a relatively healthy level of drinking. So not only were these reductions statistically significant, they're clinically meaningful."
The Department of Defense funded Walker's study, but so far has not changed its substance abuse intervention procedures. While the Army has experimented in the past with confidential substance abuse programs, it has not rolled them out widely.
"There has not been any regulatory changes as of yet in that area," said Lt. Col. Christopher Ivany, the Army director of psychological health.
He said the issue of confidentiality is complex, but he said military leaders are open to policy changes.
"The Army is looking at all the options to determine if those are possible. And if so, what the best way is to go about that," Ivany said.
Walker – whose research was published in the Journal of Consulting and Clinical Psychology – said she has contacted leaders at Joint Base Lewis-McChord about the study, but has heard nothing back. Though the Army has long been reluctant to provide confidential substance abuse treatment, Walker said soldiers need what she calls "a safe place" to talk candidly about their drinking.