CAVANAUGH: A random breathalyzer test will be administered to marines, and positive results may lead to substance abuse counseling or even punishing by commanders. The new policy has been spurred by reports that show military drug and alcohol abuse is increasing while access to drug treatment in the military is reportedly compromised by stigma and staffing shortages. Joining me are my guests, doctor Robert Anthenelli is associate chief for alcohol health in the VA in San Diego. Thank you for joining us. ANTHENELLI: My pleasure. CAVANAUGH: John Veneziano is a retired marine, and part of the Camp Pendleton substance abuse counseling center. VENEZIANO: Thank you. CAVANAUGH: In issuing this report, the institute of medicine admits drinking is part of military culture. How much a part of military culture is it, would you say? ANTHENELLI: Well, we've known since the creation of the military that drinking and drug use has played an important role in some of the recreational activity, and as a result we've been dealing with military high rates of use among military personnel throughout all the wars. CAVANAUGH: Is it part of the culture though? Is it part and parcel, the hard-drinking marine attitude? That kind of thing? ANTHENELLI: Well, the military is primarily comprised of young men. CAVANAUGH: Yeah. ANTHENELLI: So that's the heaviest drinking union we have. So there's that element. Then there's some cultural aspects where use of alcohol as a recreational substance is part of the ethos. CAVANAUGH: Right. John, let me ask you in your experience as a former marine, how often do marines -- you know, how much a part of being a marine is drinking? VENEZIANO: Well, like the doctor said, we have a young force, and we're bringing them in from the civilian sector, and we're not making alcoholics, we're just being very aggressive in dealing with people who abuse alcohol and may have an alcohol problem such as alcohol dependency. So it's there. If you're over 21, it's okay to drink, it's just not okay to get drunk and tear things up and beat on people and things like that. So it's the same as in the civilian sector except we're a little more aggressive, we're more assertive with, oh, you smell of alcohol, that's not an acceptable behavior for you. CAVANAUGH: Right, right. The new report says binge drinking has increased. Do you see an increase in alcohol consumption in Camp Pendleton? ANTHENELLI: I don't know that I see an increase. I think it comes and goes with the forces coming back to Camp Pendleton. Obviously there's more active duty members there. It goes with the number of forces that are on Camp Pendleton. If we have all the forces back at Camp Pendleton, we may see a larger number coming through my doors. But I don't know that we've seen any spike. Obviously with the war that's been going on, that's more people have used alcohol probably than maybe previously, but I don't know that there's a spike. CAVANAUGH: Doctor, what could be the reasons that could trigger more drinking? VENEZIANO: Well, one of the possible reasons is of course because of the length of the conflict and the fact that military staff are redeploying multiple times, an increased length of stress, one prominent factor is thought to be the chronic stress that military families are under. Another factor is that in certain situations, again, this is a very high-drinking age group. So that combination of the chronic stress in the group that's most susceptible to heavy drinking or binge drinking episodes probably is leading to some of these higher numbers that the most recent surveys are detectiving. CAVANAUGH: John, this new policy is considered the toughest drinking policy in the U.S. military. If you could, could you explain the new breathalyzer program and how the tests will be conducted? VENEZIANO: Well, it's going to be used as a deterrent. We're not changing the drinking law requirements. We're just asking for the Marines to come to work and be substance-free, alcohol-free. So these breathalyzers are hand-held units. And they'll -- each commander, battalion and squadron unit will have at least one, and they will be able to, if they detective an odor of alcohol, they'll have it readily available, they'll be able to say we have had a long weekend, whatever their decision is to deploy that, whether they want to do a percentage per month, per week, but we're asking that they do everybody, every marine at least twice a year. CAVANAUGH: And that's with or without cause? VENEZIANO: Right CAVANAUGH: You don't actually have to smell any alcohol. VENEZIANO: Correct. CAVANAUGH: Is this while marines are on duty? VENEZIANO: Yes. When we say on duty, we're on duty 24/7. CAVANAUGH: Okay. VENEZIANO: But I think what you're asking is from, like, 7:00 to 16:00, that would be the normal hours. But we have marines working 24 hours. So we wouldn't expect them to be drinking at all. But we're expecting marines to come in at 7:30 with no alcohol in their system. And we talked earlier. And if you go out and drink the night before, it will metabolize through the body at a regular rate. But if you go out and drink a case of beer, you start at midnight, you're probably going to have some alcohol in your system come 7:00 in the morning. And that's what we don't want to happen. CAVANAUGH: Right. And in looking at this, the limits that are going to be used, they are very low! A marine or sailor who registers a BAC of .01 can be registered for counseling. Isn't is that extremely low? VENEZIANO: I think it's a reasonable expectation to have you come to work alcohol-free, with zero. Zero. I do it every day, and my staff does it, and the majority of the Marine Corps does T. But there's a few that go out and tie one on, and they shouldn't be having any alcohol because they're fixing aircrafts, they're flying aircrafts, they're working on heavy artillery, tank, and we want them clean and sober. CAVANAUGH: To contrast that, our driving laws prohibit people driving with a .08 or above. Then you're drunk. You can be arrested for drunk driving. But that .01, that would be doctor, maybe just smelling a drink? [ LAUGHTER ] CAVANAUGH: What would that be? ANTHENELLI: Well, that is a low BAC concentration. But I think the spirit of what the Marine Corps is trying to do is really screen for potential alcohol problems. And I think this is really prevention. So when you read the report, it talks about the need to prevent alcohol problems from occurring before they manifest into more severe problems or dependence or abuse. So having a really sensitive level is going to trigger that people who are coming to work are under the influence, come influence, will at least get some counseling to let them know that that's dangerous. Even low levels of alcohol use are dangerous. And of course certainly in the settings where the Marines are working, it's very dangerous. CAVANAUGH: Now if somebody registers a .04 on the test, they can be deemed unfit for duty, and the speculation is that they could, depending on the commander, be subject to punishment. Is that the way you would want to see this go? That marines would be handed out punishment? ANTHENELLI: I don't think it's in the spirit of the institute of medicine report. Part of the goal is to destigmatize binge drinking so it doesn't become more problematic. But at the same time, given the gravity of some of the tasks that marines are charged with, we also have to protect the marines and the people around them. So I don't know the specifics of the Marine policy, but I do think that the ultimate spirit is one of prevention and trying to help people from developing further problems, and being sensitive and getting at it early on is going to be a real positive step in keeping with what the institute of medicine report holds. CAVANAUGH: John, how do you see this playing out if someone actually fails the breathalyzer test at Camp Pendleton? VENEZIANO: Well, I don't use the word fail. CAVANAUGH: Okay. VENEZIANO: They've got a positive reading, or anything above the .01, they're very clear, they want them to be screened by my center. And then recommended either an early intervention program, outpatient treatment. Maybe we identify a person with a .02, and they come in and say, yeah, I thought I was pretty good today. Normally I'm whatever. Oh, well, maybe this is dependency. We will screen for that, or abuse, and put them into some outpatient treatment or maybe even residential treatment. And this is the early detection. We're very aggressive with there, and not just the Marine Corps, but all. DOD is aggressive with this where a lot of agencies or companies, you come to work and you do your job okay. I'm not picking on anybody, but that's just the way it is. And we're going to be aggressive. It's an expectation that you come in alcohol-free to do your job. MAUREEN CAVANAUGH: And I just want to remind people, are the center that John is referring to is Camp Pendleton's consolidated substance abuse counseling center. What kinds of treatment options are available there for marines or for you to refer them to? VENEZIANO: Normally what'll happen if a marine has an incident or self-refer, they will come in, see us, and we'll give them an early intervention, if that's what they need, or if it's deemed they're alcohol or drug dependent, we'll put them in the appropriate level of treatment. It could be anywheres from outpatient, or residential which we have down in Point Loma in the naval subbase. CAVANAUGH: I think you mentioned stigma, Doctor . What kind of stigma might be attached to someone who had a .04, let's say, on this test, and had to be referred to an alcohol treatment or counseling program? Would that affect their career? ANTHENELLI: Well, that's another of the elements that is in the institute of medicine report talking about the need to really rethink the way that we address prevention for substance abuse disorders. And that we destigmatize these things. In some instances, people might have concerns that something bad will happen to them if they have these tests. We want to gives message that no, this kind of health-relevant information that you're going to get, that even at low alcohol levels you're at risk for harming yourself and other folk, that is useful information, and that will allow them to modify their behavior, and it's a positive thing. And if it's done if that spirit, it's going to help destigmatize the problem. VENEZIANO: I stress this continuously to the Marines, to my population, is that coming to my center, coming to the consolidated substance abuse counseling center, I do not end people's career. I can help you prevent this from happening again. It's the behavior that got you here, the DUI, the drunk in public, whatever that incident was, that's what ends people's careers, not the fact that you came into my center. We do not discharge any marines for being alcohol-dependent. They're discharged for behavior problems. CAVANAUGH: Right. VENEZIANO: And that's always a misconception, that you're coming down there and your career is over. No, no. It's something you did that got you in bigger trouble. We've got people who get better and they come back and spend 20, 30 years in the Marine Corps. I had a marine that was a master sergeant, he said I went into your program when I was a lance corporal and look at me now. And I said that's what this program is all about. CAVANAUGH: Do you think targeting abuse like this might be an early way to prevent suicides in the military? There are some people who self-medicate by using alcohol. And the issue of suicide has been an issue in recent years. ANTHENELLI: Certainly. The use of alcohol and other drugs is very much a risk factor for suicides. This would tie into, in a larger way, a way to help prevent suicides in the military. CAVANAUGH: Does this extend at all to military families? There are some members of a marine's family, perhaps a spouse or so forth, that might have problems with alcohol abuse during long periods of absence, that kind of thing. VENEZIANO: We will see the family members and refer them. We will either treat them at my center or refer them to the civilian sector for care if they need it. So there are some. It doesn't matter how old you are or how young you are or where you come from. Anybody is susceptible if you get your hands on some alcohol and start misusing it. It's a depressant, and when you're depressed and you take a depressant, bad things happen. CAVANAUGH: There were other things cited in the institute of medicine. They were talking about the reason that perhaps treatment programs are not accessible to all the military people who need them. Some of the other reasons that were cited were staffing shortages, inadequate prevention strategies. Are you working toward increasing the staff, increasing the prevention strategies along with this breathalyzer program? VENEZIANO: Well, a lot of the reference in the report was to the VA Department of Defense substance abuse treatment clinical practice guidelines. ANTHENELLI: So they've sat down together and come up with some excellent guidelines. The challenge is getting them implemented. And that I think that's what the report commented on. Now I think the plan is to have even tighter class action between DOD and VA. We have been very successful at implementing some of these things. There's a mandatory screening in place, it's all computerized, it's tied to the medical record, and I think we'll be partnering more with DOD to have some of those practices used more in the DOD. The fact that there are the disparity service, and DOD overseeing everything. But that's a microcosm of alcohol and drug treatment in the United States. Of it is a complex problem. And a lot of different groups are doing it, and we would all benefit from greater coordination. CAVANAUGH: The Marines are the first to do this, as usual; is that right? VENEZIANO: Well, we certainly are in the headlines right now, yes. CAVANAUGH: Okay. When does it start? VENEZIANO: Well, it's going to be implemented in calendar year 2013. So as soon as we've got the green light and the funds to purchase them, we're going to start purchasing those units. It's on its way. They're setting the policy up. So we're just moving along. CAVANAUGH: Okay I want to thank you both very much for explaining this to us.
Sailors have already been punished for using designer drugs such as bath salts and spice. Now, the Marine Corps will require Marines to take random breathalyzer tests twice a year. It's the strictest anti-alcohol policy in the military.
Under the new order, a Marine or sailor who registers a blood-alcohol level of 0.01 percent will be referred for counseling and a Marine can be deemed unfit for duty at 0.04 percent.
John Veneziano, the director of Camp Pendleton's Consolidated Substance Abuse Counseling Center, said the breathalyzers will act as a deterrent, not to "try to catch anybody."
Each commander, battalion and squadron unit will have at least one hand-held breathalyzer, and commanding officers can use the units if they detect an odor of alcohol, Veneziano said.
"They'll be able to say, 'we have had a long weekend,' whatever their decision is to deploy that, whether they want to do a percentage per month, per week, but we're asking that they do everybody, every Marine at least twice a year," he said.
"Again, it's not to go out and catch somebody, it's just to make them aware that there's a possibility that you could come to work and be breathalyzed, and that will hopefully deter some of the Marines from coming in intoxicated or with any alcohol in their system," he added.
He said the breathalyzers can be used with or without cause, either during normal working hours or any time during the day or night.
"We have Marines working 24 hours, so we wouldn't expect them to be drinking at all," he said. "But we're expecting Marines to come in at 7:30 a.m. with no alcohol in their system. And if you go out and drink the night before, it will metabolize through the body at a regular rate. But if you go out and drink a case of beer, you start at midnight, you're probably going to have some alcohol in your system come 7 in the morning. And that's what we don't want to happen."
The new rules come on the heels of a report from the Institute of Medicine, which found that binge drinking by active-duty troops now constitutes "a public health crisis."
The report, commissioned by the Department of Defense, found that binge drinking in the military has increased from 35 percent in 1998 to 47 percent in 2008, the last year data is available.
Dr. Robert Anthenelli, the associate chief of staff for mental health at the San Diego VA Medical Center, said the report also acknowledges drinking is part of the military's culture.
"Well, we've known since the creation of the military that drinking and drug use has played an important role in some of the recreational activities, and as a result we've been dealing with high rates of use among military personnel throughout all the wars," he said.
He also pointed out the military is made up predominantly of young men, a demographic that already sees high levels of drinking.
"Then there's some cultural aspects where use of alcohol as a recreational substance is part of the ethos," he said.
But Veneziano said he hasn't seen an increase in binge drinking at Camp Pendleton.
"I think it comes and goes with the forces coming back to Camp Pendleton," he said. "Obviously there's more active duty members there. It goes with the number of forces that are on Camp Pendleton. If we have all the forces back at Camp Pendleton, we may see a larger number coming through my doors. But I don't know that we've seen any spike. Obviously with the war that's been going on, that's more people have used alcohol probably than maybe previously, but I don't know that there's a spike."
