VIETNAM: DRUG USE IN

In the spring of 1971, two members of Congress (John Murphy and Robert Steele) released an alarming report alleging that 15 percent of U.S. servicemen in Vietnam were addicted to Heroin. The armed forces were attempting to cope with the drug problem by combining military discipline with "amnesty." Anyone found using or possessing illicit drugs was subject to court martial and dishonorable discharge from the service; but drug users who voluntarily sought help might be offered "amnesty" and brief treatment. This policy apparently was having little impact, since heroin use had increased dramatically over the preceding year and a half.

Because the United States was trying to negotiate settlement of the war, military forces in Vietnam were being rapidly reduced. About 1,000 men were being sent back to the United States each day, many of them to be discharged shortly thereafter to civilian life. If the reported rate of heroin addiction among servicemen were accurate, this rapid reduction in force meant that hundreds of active heroin addicts were being sent home each week. Concerned about the social problems that could ensue from such an influx of addicts, President Richard M. Nixon charged his staff with seeking an effective response. Domestic Council staff members Jeffrey Donfeld and Egil Krogh, Jr., sought advice from Dr. Jerome H. Jaffe, then on the faculty of the University of Chicago, who had previously prepared a report for the president on the development of a national strategy for the treatment of drug dependence. Dr. Jaffe recommended a radical change in the policy for responding to the problem of drug use in the military. The suggested plan included urine testing, to detect heroin use, and treatment rather than court martial when drug use was detected. President Nixon endorsed the plan and the military responded with such remarkable rapidity that, on June 17, 1971, less than six weeks from the time it was proposed, the plan was initiated in Vietnam.

In fact, there was no way to know whether the new approach would be better than the old one, no reliable information on the actual extent of drug use and addiction, and no solid information on which to base estimates of how many servicemen would require additional treatment after discharge. To obtain information on the extent of drug use, the effectiveness of treatment, and the relapse rates it would be necessary to find and interview the servicemen at time of discharge and at various intervals after discharge.

In June 1971, President Nixon also announced the formation of the Special Action Office for Drug Abuse Prevention (SAODAP) charged with coordinating the many facets of the growing drug problem and named Dr. Jaffe as its first director. One of the first tasks of the office was to evaluate the results of the new drug policy for the military, especially as it was implemented in Vietnam. SAODAP arranged for Dr. Lee Robins, of Washington University in St. Louis, to obtain records from the Department of Defense and the Veterans Administration to conduct the study. The findings on drug use prior to and during service are summarized here. The drug-using behaviors of the servicemen after their return to civilian life are described in a separate article (see Vietnam: Follow-Up Study).

Around 1970, before going overseas, about half the army's enlisted men had had some experience with illicit drugs. However, only 30 percent had tried any drug other than Marijuana. At that time, the most common civilian drugs other than marijuana were Barbiturates and Amphetamines. Before going to Vietnam, only 11 percent of soldiers had tried an Opiate, and those who did so generally took cough syrups containing Codeine, not heroin or Opium.

The men sent to Vietnam had either been drafted or had enlisted. Toward the end of the war, when drug use in the United States was highest, draftees were chosen by a lottery designed to make selection less susceptible to social-class biases. This produced draftees who were a reasonably representative sample of young American men. Those who enlisted voluntarily, however, who made up about 40 percent of the armed forces, were disproportionately school dropouts. Many of them enlisted before reaching draftable age because of their limited occupational opportunities. They also arrived in Vietnam with considerably more drug experience than the draftees.

Men who were sent to Vietnam before 1969 found marijuana plentiful but little else in the way of illicit drugs (Stanton, 1976). Some amphetamines were available—in part, because the military issued them to help men stay alert on reconnaissance missions. In 1969, heroin and opium began to arrive on the scene, and by 1970-1971 these opiates were very widely available. Marijuana was still the most commonly used illicit drug, but opiates outstripped amphetamines and barbiturates in availability. Heroin and opium were relatively cheap and very pure, so pure that the soldiers could get ample effect by smoking heroin in combination with Tobacco or marijuana. This made opiates appealing to men who would have been reluctant to inject them.

At the height of the use of opiates, in 1971, almost half the army's enlisted men had tried them; of those who tried them, about half used enough to develop the hallmarks of addiction—Tolerance and Withdrawal symptoms (Robins et al., 1975). Marijuana use was even more common; about two-thirds of these soldiers used it. The estimates come from an independent survey of a random sample of army enlisted men eight to twelve months after their return from Vietnam, after the great majority had been discharged (Robins et al., 1975). Previous studies in Vietnam (Stanton, 1972; Roffman & Sapol, 1970; Char, 1972) or among men still in service after return (Rohrbaugh et al., 1974) were less reliable, because of difficulties in collecting a random sample, use of questionnaires rather than interviews (which can lead to careless responses or failure to answer completely), and because the surveys were being done by the army itself, while the men were still subject to possible disciplinary action.

The standard tour of duty for Vietnam soldiers was twelve months. Drug use typically began soon after arrival in Vietnam, showing that it was not at all difficult to find a supplier. Older men used less than younger soldiers, career soldiers less than those serving their first term. Drug experience before induction was a powerful predictor of use in Vietnam (Robins et al., 1980). Essentially all those with drug experience before enlistment used drugs in Vietnam. Of course, there were also some soldiers who used drugs there for the first time.

One interesting observation was that men who drank Alcohol in Vietnam tended not to use opiates, and opiate users tended not to drink (Wish et al., 1979). This is a very different pattern from the one seen in the same men both before and after Vietnam, when drinkers were much more likely to use illicit drugs than abstainers.

Soldiers who used drugs had more disciplinary problems, on average, than those who abstained. However, the great majority of drug users received little or no disciplinary action and were honorably discharged. Although there were instances in which drug use impaired a soldier's combat readiness, evidence is lacking that it had much impact on soldiers' ability to carry out orders or wage war.

(See also: Addiction: Concepts and Definitions ; Drug Testing and Analysis ; Military, Drug and Alcohol Abuse in the U.S. )

BIBLIOGRAPHY

Char, J. (1972). Drug abuse in Vietnam. American Journal of Psychiatry, 129 (4), 123-125.

Robins, L. N., Helzer, J. E., & Davis, D. H. (1975). Narcotic use in Southeast Asia and afterward: An interview study of 898 Vietnam returnees. Archives of General Psychiatry, 32 (8), 955-961.

Robins, L. N., Helzer, J. E., Hesselbrock, M., & Wish, E. (1980). Vietnam veterans three years after Vietnam: How our study changed our view of heroin. In L. Brill and C. Winick (Eds.), Yearbook of substance use and abuse. New York: Human Science Press.

Roffman, R. A., & Sapol, E. (1970). Marijuana in Vietnam: A survey of use among Army enlisted men in the two Southern corps. International Journal of the Addictions, 5 (1), 1-42.

Rohrbaugh, M., Eads, G., &Press, S. (1974). Effects of the Vietnam experience on subsequent drug use among servicemen. International Journal of the Addictions, 9 (1), 25-40.

Stanton, M. D. (1976). Drugs, Vietnam, and the Vietnam veteran: An overview. American Journal of Drug & Alcohol Abuse, 3 (4), 557-570.

Stanton, M. D. (1972). Drug use in Vietnam: A survey among Army personnel in the two Northern corps. Archives of General Psychiatry, 26 (3), 279-286.

Wish, E. D., Robins, L. N., Hesselbrock, M., & Helzer, J. E. (1979). The course of alcohol problems in Vietnam veterans. In M. Galanter (Ed.), Currents in alcoholism. New York: Grune & Stratton.

Lee N. Robins