oversight

Alcoholism Among Military Personnel

Published by the Government Accountability Office on 1971-11-02.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

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              ~P.IF’TROLLER     GENERAL     OF      THE   UNiTED     STATE!3
                              WPSWINGTQN.    D.C.     2OS48




       TEs     is our report  on alcoholism    among military                       personnel
made   pwtiwnt      to your request  of October   22, 1970.

         In zwcordance     with the agreements    reached with your office,
-written    a2mments     cm our abservations   have been obtained  fro-m the
Departnxznt      02 Defense and are included     in this report.

                                            Sincerely              yours,




                                            Comptroller                General
                                            of the United              States

The Ho~~xable     Harold   E. Hughes,   Chairman
Subcomzz&tee     on Alcoholism    and Narcotics                        ,5 /,’ 9 L
Comrni~-~e    on Labor and Public     welfare
United S%ztes Senate
                                                        ALCOHOLISM AMONGMILITARY PERSONNEL
                                                            B-164031(2)



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WTlYTilE REVIEW WAS MADE

     The General   Accounting  Office (GAO) review of alcoholism     among military
     personnel was made at the request of the ChairriiZi~~ SubctitiitLee    on Alco-
     holism and Narcotics,    Senate Committee on Labor and Public Welfare.
     (See app. I.}

     Background

     Previously   GAO had made a similar      study, at            the request       of the Chairman,
     concerning    Federal civilian   employees.     In           that   report GAO estimated   that
     the Federa 1 Government could realize        annual            savings of from $135 million
     to $280 mi llion    from an alcoholism    program            for civilian   employees,   assuming
     prevalence   rates of alcoholism     ranging from             4 to 8 percent.        (See app.     III.)


FINDINGS AND CONCLlJSIOIiS

     Substantial       savings,   as well as humanitarian     benefits,           can be realized
     fr&v the establishment         of a comprehensive    alcoholism            control program for
     military personnel.          (See p. 19.)

     The Department       of Defense (DOD) has no corilplete,             reliable     data   that   show
     the extent       of alcoholism  in the Armed Forces.

     For each l-percent  reduction  in the incidence    of alcoholism,   the potential
     gross savings could be about $24 million     annually.    If the incidence    is
     comparable to the estimated   average 5 percent in the civilian       work force,
     then the potential  annual gross savings could amount to about $120 million.
     (See pp. 5 and 16 to 18.)

     Although        the incidence of alcoholism    in the military     population  may be no
     greater       than that of the civi fian population,     it cou!d be a more serious
     problem       because of the frequently     dangerous and critical      duties involved.

     Many sertior  command and staff     officers     at military    bases in the United
     States and overseas sdho ta?ked about this believed             that the incidence     of
     alcoholism   among military    personnel was negligible         and, in any event, was
     lower than that among the civilian          population.      But others closely    involved
     with alcoholism     believed that the incidence         was at least the same as that in
     the civilian    work force.    (See pp. 5 and 6.)
    !
               Factors which could affect     the incidence    of alcoholism                     among military  per-
.           ,, sonnel included:     scciaf climate,    family separations,                      IOW cost and ready
        *      availabi iity  of alcoholic   beverages,    and boredom.

               Factors     which      could    discourage     the development   of alcoholism  among military
               personnel         included     military    discipline   and standards   and the lower average
               age of the military.                (See pp. 7 and 8.)

               Negatl've attitudes   and punitive    statutes     and regulations                   have resulted  in
               hiding the problem.      The military    alcoholic    has little                  incentive   to come
               forward   and seek help.    (See pp. 9 to 12.)

               No DOD-wide alcoholism       prevention    and rehabilitation       program existed          for
               military    personnel,    nor were there any guidelines          specifying      procedures       to
               be followed     in treating   them.     As a result     the treatment      given to the mili-
             . tary alcoholic     at many bases was limited.           Alcoholism    rehabilitation         pro-
               grams, however, have been formally           established     at some military        i nstalla-
               tions,   and DOD has recently      established      a task force to study all aspects
               of alcohol    abuse among military       personnel.       (See pp. 13 to 15.)




               The Secretary          of Defense     should    establish    a comprehensive           alcoholism    control
               program     for     military     personnel     which would    provide     that

                 --alcoholism     be recognized as a disease which is treatable      rather    than
    :               as misconduct    which is punishable    and changes %o pertinent    reg~~!ati~ns
                    and proposals    for changes in legislation    needed to accomplish     that pur-
                    pose be made expeditiously,

                 --educational   programs be established to inform military    personnel  of
                    the dangers of the abusive use of alcohol    and to convince supervisors
                    that many alcoholics  can recover and become fully   productive,

                 --rehabilitative     measures be made available                to all     military        personnel
                    having alcoholism    problems, and

                 --DOD undertake   a study to determine                 more precisely the incidence               of
                    alcoholism  and problem drinking.                  {See pp. 19 and 20.)




               D3D concurred    with GAO's recommendations             concerning   establishment   of educa-
               tional  programs,    availability       of rehabilitative        measures, and studies     to
               more precisely    deterMine       the incidence     of alcoholism     and problem drinking.
               (See app. 11.)      COD-nide policies       will be established         in the near future
               to achieve these goals.
kitt: reqect    to @,0's -rnm~ndatinn
                                * "YV..-..I..-- -. -.. that ajc~hnfism       be considered     a
disease rather       than misconduct,           DOD would prefer       to recognize     alcoholism
as a conditl'on     which is preventable              and treatable      through the application
of enlightened       attitudes      and techniques         since disease is equated with
physical   disability        Aich     is compensable.

GAO recognizes    that certain    statutes    and regulations     affecting    military
compensation   hold alcoholism     to be misconduct.        As stated earlier,        however,
these statutes    and regulations      have resulted   in hiding the alcoholism          prob-
lem.   GAO believes    that if they are not modified,         there is little       assurance
that this condition     will   be corrected.

Title    V, section    501, of Public Law 92-729, amending the Military          Selective
Service Act, requires          the Secretary     of Defense to make such recommendations
for additional      legislation       as are necessary to deal with the problem of drug
and alcohol dependence.            GAO believes    that the Secretary's   recommendations
properly    should include        proposals   to deal with the problems of recognizing
alcoholism    as a disease..         These problems include   those involving   pay, re--
tirement,    and related       benefits.     (See pp. 21 and 22.)




                                               3
                        Contents
                                                            Page

DIGEST                                                      '1



  1      INTRODUCTION                                            4

  2      ALCOHOLISMAMONGMILITARY PRESONNEL--HOW
         PREVALENTIS IT?                                         5

  3      DOESMILITARY SERVICE ENCOURAGE          ALCOHOL-
         ISM?
             Factors encouraging alcoholism
                  Social climate
                  Family separations
                  Low cost and ready availability
                     of alcoholic     beverages
                  Boredom
             Factors discouraging       alcoholism
                  Military   discipline     and standards
                  Lower age of military       personnel

  4      POLICIES, PRACTICES, AND ATTITUDES AFFECT-
         ING THE MILITARY ALCOHOLIC                              9

   5     CURRENTALCOHOLISMPROGRAMS                           13
            Rehabilitation                                   13
            Prevention                                       15
            Current efforts in DOD to deal with
               alcoholism                                    15

   6     THE -ALCOHOLICIS WORTHHELPING                       16
             Civilian    experience                          16
             Estimated costs of alcoholism       among
                military   personnel                         17

  7      CONCLUSPONS  AND RECOMMENDATIONS                    18
            Conclusions                                      18
            Recommendations                                  18

   8     AGENCYCOMWZNTS
                      AND GAO EVALUATION                     21
                                                                Page
:i          9    SCOPE OF REVIEW                                 23

     APPENDIX

             I   Letter dated October 22, 1970, from the
                   Chairman, Subcommittee on Alcoholism and
                   Narcotics, Committee on Labor and Public
                   Welfare, United States Senate                 27

        II       Letter dated August 13, 1971, from the
                   Principal  Deputy Assistant  Secretary of
                    Defense (Health and Environment)             30
      III        Summary of Report on Substantial   Cost
                   Savings from Establishment   of Alcoholism
                   Program for Federal Civilian   Employees      31
        IV       Potential     Costs of Military   Alcoholism    34
                                    ABBP;EVIA'TIONS

     DOD         Department     of Defense

     GAO         General     Accounting   Office
                                                     ALCOHOLISM AMONGMILITARY PERSONNEL
                                                     B-164031 (2)




DIGEST
m--m--




    The General Accounting Office     (GAO) review of alcoholism among military
    personnel    was made at the request of the Chairman, Subcommittee   on Alco-
    holism    and Narcotics, Senate Committee on Labor and Public Welfare.
    (See app. I.>



     Preriously   GAO had made a similar     study,   at     the request of the Chairman,
     concerning   Federal civilian    employees.     In    that report GAO estimated     that
     the Federal Government could realize        annual      savings of from $135 million
     to $280 million    from an alcoholism    program      for civilian   employees,  assuming
     pr-eualence  rates of alcoholism    ranging from        4 to 8 percent.    (See app. III.)




    Su&stantiat     savings,    as well as humani tarian     benefits,     can be realized
    frm     the establishment     of a comprehensive     alcoholism      control program for
    mi7-3tary   personnel.      (See p. 19.)

    TIE   Department of Defense (DOD) has no complete,             reliable   data   that   show
    the   extent of alcoholism in the Armed Forces.

     Fw each l-percent     reduction  in the incidence    of alcoholism,   the potential
     grass   savings could be about $24 million     annually.    If the incidence    is
     cczparable    to the estimated  average 5 percent    in the civilian    work force,
     thazn the potential   annual gross savings could amount to about $120 million.
     (See pp* 5 and 16 to 18.)

    Alkhough     the incidence of alcoholism    in the military     population  may be no
    greater    than that of the civilian     population,  it could be a more serious
    prabfem    because of the frequently     dangerous and critical      duties involved.

    Many senior command and staff          officers     at mi 1 itary    bases in the United
    SQtes       and overseas \dho talked    about this believed          that the incidence     of
    alcoholism      among military    personnel     was negligible       and, in any event, was
    f=Ager than that among the civilian            population.        But others closely    involved
    WS 31 alcoholism      believed  that the incidence         was at least the same as that in
    tL    civilian    work force.     (See pp. 5 and 6.)
    4
        .       .
-                   :   Factors which could affect    the incidence    of alcoholism               among military  per-
            .           some7 included:    social  climate,    family  separations,               low cost and ready
                        avafiabiiity  of aJcoholic  beverages,     and boredom.

                        Factors which could discourage     the development   of alcoholism  among mi'litar:
                        personnel inc'luded mifitary   discipline   and standards   and the lower average
                        age of the military.     (See pp. 7 and 8.)

                        #4egative attitudes  and punitive    statutes     and regulations             have resulted  in
                        biding the problem.     The military    alcoholic    has little            incentive   to come
                        for%lard and seek help.    (See pp. 9 to 12.)

                        #o DOD-wide alcoholism        prevention    and rehabilitation       program existed          for
                        Cmifitary   personnel,     nor were there any guide'lines         specifying      procedures       to
                        be followed     in treating    them.     As a result     the treatment      given to the mili-
                        tary alcoholic     at many bases was limited.            Alcoholism    rehabifitation         pro-
                        grams9 however, have been formally            established     at some military        instal‘la-
                        Wons, and DOD has recently          established      a task force to study all aspects
                        af alcohol abuse among military           personnel.       (See pp. 13 to 15.)




                        The Secretary  of Defense should establish   a comprehensive                       alcoholism    contra
                        program for military   personneJ which would provide   that

                           --alcoholism     be recognized as a dl'sease which is treatable    ra.ther U-fan
                              as misconduct    which is punishable   and changes to pertinent    regulations
                              and proposals    for changes in Jegislation   needed to accomplish     that pur-
                              pose be made expeditiously,

                           --educational   programs be estabJished to inform military    personnel   of
                              the dangers of the abusive use of alcohol    and to convince supervisors
                              that many alcoholics  can recover and become fully   productive,

                           --rehabilitative     measures be made available             to all   military        personneJ
                              having alcoholism    problems, and

                           --DOD undertake      a study to determine         more precisely the incidence               of
                              alcoholism     and problem drinking.          (See pp. 19 and 20.)




                        IXD concurred    with GAO's recommendations            concerning   establishment   of educa-
                        E:ionaJ programs,    avaiJabiJity      of rehabilitative        measures, and studies     to
                        sore precisely    determine      the incident e of alcoholism         and problem drinking.
                        (See app. II.)      DOD-wide policies       will   be established      in the near future
                        Lo achieve these goals.
     I .
    -‘,
     I . %th    respect   tn GAO's recommendation          that alcoholism     be considered    a
          disease ra%er        than misconduct,     DOD would prefer     to recognize     alcoholism
    !     as a condi%ion which is preventable
          of enlighsned        attitudes
                                                         and treatable
                                            and techniques
                                                                           through the application
                                                               since disease is equated with
          physical   d$sabitity        whjch is compensable.

         GAO recagn%zes that certain       statutes   and regulations     affecting   military
         compensatian    hold alcoholism    to be misconduct.       As stated earlier,       however,
         these stat&es     and regulations     have resulted   in hiding the alcoholism         prob-
         lem.   GAO aelieves   that if they are not modified,         there is little      assurance
         that this condition     will   be corrected.

         Title    V, s:zction     501, of Public Law 92-129, amending the Military          Selective
         Service A&,        requires      the Secretary     of Defens.-0 to make such recommendations
         for additional        legislation       as are necessary to deal with the problem of drug
         and alcohz% dependence.              GAO believes    that the Secretary's   recommendations
         properly    should include          proposals    to deal with the problems of recognizing
         alcoholism      as a disease.         These problems include those involving      pay, re-
         tirement,     and related       benefits.     '(See pp. 21 and 22.)




i
                                CHAPTER1

                              INTRODUCTION

       Our review of alcoholism      among military  personnel was
ma&e at the request of the Chairman, Subcommittee on Alco-
hoEism and Narcotics,      Senate Committee on Labor and Public
WeLfare.     (See app. I.)    Previously,   at the request of the
CWrman,     we had made a similar      study concerning Federal
ciTZlian   employees.    In that study (summarized in app. III),
we .estimated that the Federal Government could realize          an-
nusl savings of $135 million       to $280 million    from an alco-
hoX.ism program for civilian      employees, assuming a prevalence
of alcoholism    ranging from 4 to 8 percent.

       The following  definitions of "alcoholism"   and "problem
drfTtker*' were used in our review and were taken from the Na-
timal     Industrial Conference Board's report,   "Company Con-
tra2.s for Drinking Problems," published in March 1970.

      “YAl~ohoiism:     a highly complex illness:          tiIL is
      a chronic disease characterized           by repeated ex-
      cessive drinking     which interferes       with the indi-
      viduals'   health,   interperso-nal     relations    or eco-
      nomic functioning.        If untreated,     alcoholism      be-
      comes more severe and may be fatal.             It may take
      several years to reach the chronic phase."

      ggProblem drinker:    To management, a problem
      drinker is any employee whose drinking affects
      his work adversely,     Regardless of whether a
      physician WOUid classify    the employee as an al-
      coholic,  his drinking   is hurting the company."

D=Zng our review we interviewed      more than 600 individuals
at *over 30 military    locations in the continental  United
St.cz"Les and overseas.
                                       CHAPTER2

                 &&COHQLISM AMONG MILITARY                PERSON-N?L--

                              HOW PREVALENT IS IT?

         The przvalence        of alcoholism          in the military         services
cannot be determined            accurately       because there          is very little
statistica%ly         valid    data.      In   our    interviews      we   obtained
personal      estimates      of incidence         ranging       from 0 to 40 percent.
Such diverse        responses       indicated       that     these   estimates        may
be affected        by the interviewee's             rank, religious          beliefs,
personal      observations,         and   drinking       habits     and   by  the extent
of the interviewee1          s personal        contact      with large numbers of
personnel.         Although      the incidence          estimates     were subjective,
the informzzion          developed       during     our review       indicated        that
there may b 2 a serious             alcoholism        problem among military
personnel,         At the same time there appeared                   to be an inabil-
ity or reltiztance          among some military             personnel      to recognize
the existerzce         of any problem.

        Many-ssnior          command and staff           officers      we talked      with
believed      that     the incidence         of alcoholism          among military
personnel       ~t;as negligible        and, in any event,             was lower than
that among the civilian                population.           On the other hand many
of those we talked             with,    including        military       physicians,       psy-
chologists,         chaplains,       Alcoholics        Anonymous members, and
others     close -1y involved          with alcoholism,           made estimates          of
incidence       d?ich      were comparable         with those for the civilian
work force;         others     made estimates          which were higher.             Various
individuals         in the Department           of Defense,         the Veterans        Ad-
ministration,          and the Department            of Health,         Education,      and
Welfare,      x&o had official            responsibilities            in this area, also
made estimates           of the incidence          of alcoholism           and problem
drinking      zzng       the military,         which were comparable              with esti-
mates of i-zxzidence           in the civilian           work force.          An official
 in the OffPze         of the Secretary           of Defense (Health             and Envi-
ronment)      hr-s stated        that 'I*z.t is commonly assumed that the
incidence       Is at least         comparable       to the estimates            of 4 to
8 percent       pi
                ,-ven      in civilian       industrial         surveys."        A study
completed       -5n 1969 by an Air Force officer,                     in -which he asked
over 200 randomly             selected      squadron       commanders to identify
known probfem          drinkers       in their     commands, disclosed              an inci-     '
dence of about 4 percent.
       zany individuals      said that alcoholism was most preva-
lent among senior noncommissioned officers            and commissioned
officers,   primarily     affecting    personnel who had 10 or more
years of military       service.    Also   alcoholism  is reportedly
less a problem in the military          services than in the general
population    because the servicemen are primarily         young and
alcoholism    is considered a problem of the older individual.
We were told that today young servicemen have turned to
drugs rather than to alcohol.

        Nonetheless about 38 percent of the problem drinkers
identified     by squadron commanders in the study referred       to
above were in the 17' to 24 age group.       That study concluded
that tiers were two broad groups of problem drinkers:          (1) the
younger servicemen whose drinking       was repetitive,    was undis-
ciplined,     and had caused themselves and their commanders
problems and (2) older servicemen FThose alcoholism problem
had t&en on more serious       physical   and psychological    aspects.
       Officials    of the National Council on Alcoholism be-
lieved that the incidence of alcoholism             in the military      xas
no less than lin ir?&stry.         The Co*uncil identified        three vari-
ables which influenced         the incidence in a particular          popula-
tion: average age, male-to-female           ratio,    and the extent of
permrssiveness      toward drinking     behavior.      The officials     be-
lieved also that the last two variables            operated so strongt,y
in the military       tha+L the effect of the low average age was
somewhat lessened.         They believed further       that the heavy-
drinking     younger servicemen were also abusing alcohol but
that their problem was less visible            to responsFble officials.




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1                                              CHAPTER3
I




                      Many factors were identllfied by the individuals    we in-
               terviewed which could affect the incidence     of alcoholism
               among military     personnel. Some of the frequently    mentioned
               factors follow.



               Social       cfiEEite

                       The use of alcoholic    beverages in the military        services
               tradi.tionally    has been accepted and dates back at least to
               the time x5lx.n 'iiqiior rations were given to servicaen.             Nil-
               ita-ry social life has catered        around activities      where the
               extensive use of alcohol generally          is expected.     A few ex-
               amples are: hail-and-farewell,        promotion,   cocktail,     and
               wetting-dcmn     parties;  '%appy hours" at the various clubs;
               &rid %eer busts!' for the troops.         l&z have bezor: told by an
               Alcoholics     ,Anonymous maber that the continual        round of man-
               datory co&tai% parties makes it difficult            for military     al-
               coholics -20 avoid a drinking      environinent.
               Family       sezarations

                    Military   servicemen often are separated from their               fam-
               ili@S    lIn the opinion of some of those we interv+ewed,
               these separations     tend to encourage more drinking.

               Low cost 2.2.d ready availability
               of alcoholic   beverages

                      GenezaPly a'fcoholfc beverages are sold to military               ser-
               vicemen a% lo7er prices,         especially     overseas, than the prices
               charged to the general public,             During happy hours the al-
               ready lo= prices are further discounted.                An economical
               price,   co*zpl.ed
                            _      with  ready   availability,      tends   to increase
               ccnsumption,       Other persons that we interviewed,           however,
               felt that these factors were not significant               in encouraging
               excessive drinking.         llley said that drinking       by alcoholics
               and problem drinkers       would not be affected materially           by
               accessib%iity      and price advantages.
    ..
.




               If recreational  facilities     are not adequate, particu-
         larly in remot2 overseas locations,        the servicman   turns to
         the military   club wh2re activities     frequently   are centered
         around the conszqtion     of alcohol.



         -Military   discipline    and standards
                  We were advised that alcoholism           and problem drinking
         would ruin a s2rvicmanfs            career if, as a result,         he could
         not perform his duties or met other military                  standards and
         that the high degree of hman reliability                required     in cer-
          tain occupations,       such as aircraft       pilot and nuclear tech-
         nician,     militated    against the developmnt         of alcoholism.
         Also the military        services are considered to have a lesser
         problem because the military            population,    coqared with the
         civilian     population,     is highly controlled       and supervised
         and because the military           services are continually         screening
         IIiilitEEy F2~So~21 for s2cmity            clearances,     reerriistments,
         and so forth.
          Lower age of military         personnel

                Since alcoholism    is generally    considered to be Tnore
         prevalent   among the middle-aged,      the younger age of person-
         nel in the services and early retirements           tend to lower the
         incidence   of alcoholism.     Heavy drinking,     however, often
         starts among younger servicencn and could develop progres-
         sively into a more serious problem.
                POLICIES, I'RACTICES, AND ATTITUDES

                 AFFECTING THE MILITARY ALCOHOLIC

       Military   regulations   and certain   statutes   deal puni-
tively   with those intemperate     in the use of alcohol.      Sec-
tion 972 of title      10 of the United States Code provides that
an enlisted     member of the Armed Forces who is unable to per-
form his duties for more than 1 day because of the intem-
perate use of drugs or alcoholic        liquor must make up such
time, which is categorized       as bad time.     Section 802 of
title   37 of the United States Code adds that a serviceman
absent from duty for a continuous period of more than 1 day
because of disease that is directly         caused by the intem-
perate use of alcohol or drugs is not entitled           to pay for
that period of absence.
      The official  stated policy of DOD and the military       ser-
vices on &Lo&J-&      coi-fs-~qtian "uy military  3~~ser~izl is ""io
encourage abstinence,      enforce moderation,   and punish over-
indulgence.lf

       Military     regulations      generally    provide that injuries       di-
rectly    and proximately        resultin, 0 from the intemperate use of
alcohol are due to misconduct and are not considered to be
in the line of duty and thus result               in the loss of certain
entitlements       to the serviceman, although illnesses             which are
the secondary re,rmlt of the intemperate                use of alcohol usu-
ally are considered to be in line of duty.                   The Uniform Code
of Military      justice     cites being drunk on duty9 being drunk
and disorderly,        and drunken and reckless          driving as punish-
able offenses.         Military     regulations     provide also that the
alcoholic      or problem drirker         may be considered ineligible
for a security        clearance or may be separated from the ser-
vice.     Although the rewlations             generally   provide for an
opportwiity      to overcome the problem through counseling               and
rehabilitation        prior to any adverse action., rehabilitative
measures are not delineated              and the lack of adequate treat-
ment programs further           negates the stated compassionate in-
tent of such provisions.
    '1 We have been informed that, because the military            ser-
vices often deal punitively        with alcoholism,       there is a
tendency to cover up the problem throughout             the chain of
command and there is little        incentive     for an individual    to
come fomard openly and seek help.             The problem is hidden
and covered up as long as possible by the man himself,               his
family,    or a sympathetic    commanding officer       so as not to
jeopardize    the serviceman's     career.      Doctors have told us
that some of their colleagues         are reluctant    to diagnose
patients    as alcoholics    and often cite related illnesses.
Consequently medical, personnel,          legal, and other administra-
tive records are poor indicators          of the incidence of alcohol-
ism among military      personnel.

      This situation       is similar     to that which existed many
years ago for venereal disease until             regulations    were modi-
fied so that it was no longer considered misconduct.                  This
modification      of regulations      avoided driving     the problem un-
dergrollnd and provided for early detection              and treatment.
DOD's handling of alcoholism           is in contrast with its han-
dling of the drug problem where amnesty and rehabilitation
programs hqy~n
            i*u1 L. hnmn
                    YLLII started and widely publicized.

      Little has been done by the military          establishment      to
deal with the problem of alcoholism unless an individual
has become at least partially      ineffective      in his duties or
has committed one or more punishable          offenses,    such as being
absent without leave, drunk and disorderly,             or involved    in
some traffic   mishap while intoxicated.          Some individuals
stated their Se'lief that a man should be allowed to dri&
until he gets into trouble.      Most of the bases that we vis-'
ited had no regulations    on how to handle an alcoholic             or a
problem drinker.    We  have  been   told   that   commanders     are  al-
lowed a great deal of discretion        and may take any one or
more of the following    approaches.

      1. Leave him alone:  The alcoholic    may be carried along-
         by sympathetic commanding officers    until he retires
         either because he elects to or because he is encour-
         aged to.

      2. Transfer him: The problem drinker may merely               be
         passed from one command to another.
      3. Counseling or treatment:    The individual   is counseled
         by his commandin,0 officer   or the chaplain or is sent
         to the hospital  for counseling,   medical or psychiat-
         ric treatment,  or referral   to Alcoholics  Anonymous.

      4. l?ulli shment : This could be a reprimand, extra duties,
         reduction     in rank, loss of security   clearance,   bar
         to reenlistment,      or separation   from the service.

       Alcoholism was designated a disease by the World Health
kganization      in 1951 and by the American Medical Association
i2-k 1956, The hospital       commander at one base believed that
c%xzonic alcoholism      and problem drinking     represented     moral
an2 spiritual     deficiencies.      He said that alcohol was not an
a&.Gictive drug and that he found it difficult            to accept the
praise     that alcoholism was a disease.         According to a chap-
la211 at the base, hospital        personnel were reluctant       to treat
alcoholics     and they referred     them to facilities      in the civil-
iaz2 community for treatment.

       At two bases where there were alcohofi.sm treatment pro-
.grzz~s, the base commanders did not permit the existence of
th& programs to be publicized.      A study by a Navy doctor re-
vez&ed some antipathy    among the doctors at one naval hospital
tcx?ard the treatment of alcoholics,      This seemed to confirm
a tiew exorctssed by other professional     medical personnel
~kat there was a reluctance    among some doctors to treat al-
C~5OliCS,

       JI base commander we interviewed      believed that a hard-
1S.ne disciplinary     approach of separation      from the service
&ould     be talken toward the alcoholic.      At another activity,
sszT?eral officials    stated that the general Army policy was
z-2.~%to tolerate   alcoholics.     In their view there was no
place in the Army for an alcoholic         or a problem drinker,    ex-
cept that special efforts       were made to retain men close to
~5etirement.

      The Chief of the Navyqs 3ureau of Medicine           and Surgery
sEated in 1966 that:

      **-k?i* it would thus appear that current policies
      tend to hide the illness    and thus interfere   with
      early detection,    management by leadership,

                                    f 1
..

          nonmedical counseling,     medical and psychiatric
          treatment and disposition,     when appropriate.    All
          too often the individual,     whether Regular or Re-
          serve, officer   or enlisted,    is protected by his
          superiors   because, if separated or discharged,
          he will lose all his *earned' equity in retire-
          ment benefits   accuxmlated over his years of ac-
          tive service.     Since the Naval Establishment    does
          not consider alcoholism     a disease, a member is not
          compensated for the 'earned'       equity if he is sep-
          arated from service    due to chronic alcoholism."

           A recent DOD fact sheet on alcoholism     reiterated    these
     tiews and recognized that alcoholism    control    in DOD had not
     bezn adequate, that current DOD practices      dealt punitively
     w3~h alcoholics,   and that DOD did not consider alcoholism:
     as a disease.    The fact sheet also called for the removal of
     t.k stigma attached to alcoholism    and recovered alcoholics.




                                     12
                                CHAPTrn 5            .




        At t&e time of our review, no DOD-wide alcoholism        reha-
bilitatioz.   program existed,   nor were there any guidelines
specifying    procedures to be followed in treating     alcoholics.
As a result    the treatment given to the military     alcoholic
depended 0x1 the attitudes     and interests  of the local com-
manders azxd medical officers.

        At BXXD~of the installations           that we visited,    treat-
ment 17as Limited,      compared with that provided under formally
established     alcoholism rehabilitation           programs at the Long
Beach Naval Station,        California;       Fort Booming, Georgia; and
Wright-Pazterson      Air Force Base0 Ohio. The pilot programs
at these %kree installations            received top-level      support, and
?-l-3
   - 13-.---E
 &AIL r-a,cii p?-S~p~-o;l ixxolved ~12th the programs were con-
cerned ~i:h alcoholism        on a full-time        basis.   The treatment
approach Is muItidisciplinary,             drawing on the knuwledge and
techniques     of psychiatry,      psycholo,~,      and medicine, with the
core of "rseatment centered around participation                in Alcoholics
Anonymous and other forms of individual               and group therapy,

       From the beginning of the Long Beach program in Febru-
ary 1965, over 500 enlisted -men md 37 officers        have been
treated;   the overall   recovery rate was 50 to 60 percent.
The clinC-c acrommodates from 30 to 35 resident       patiats     for
treatmen% for 30 to 90 days,       A E-bed hospital    ward is uti-
Xzed for detox2fication       when necessary. Military      personnel.
outside +cne Long Beach area have been sent to the clinic           for
treatme.nC 1

      Abozt 200 officers      and enlisted     men have received alco-
holism treatment      at Xright-Patterson       since 1966. According
to the director      of that progrm,      Isalmost 90 percent of the
patients   have made satisfactory       military     and personal read-
justment   following    return to duty."1 The Surgeon General of
the Air Z'orce recently      has established       additional  clinics  at




                                      13
- !!




       Lackland Air Force Base, Texas, and Eglin Air Force Base,
       Florida.   These clinics   are available to eligible personnel
       throughout  the Air Force.

              From March 1970 through January 1971, about 190 indi-
       viduals received treatment under the Army's Fort Benning
       program, including    41 who participated     in the resident por-
       tion of the program.     The residents    perform their normal
       military   duties during the day and return to a "halfway"
       house in the evening.,    We estimated that the annual operat-
       ing cost for this clinic    was about $150,000, with an initial
       investment of $75,000.

               A few other installations         had attempted to provide in
       varying degrees some of the          same services made available       by
       the clinics.      The existence      of some alcoholism     rehabilita-
       tion efforts     was dependent      on individuals    with a strong in-'
       terest,      The program could      cease unless these individuals,
       when rotated,     were replaced      with individuals     having the same
       degree of interest      in such     efforts.

              For example, several years ago one large Army installa-
       tion had a treatment and prevention          program which was initi-
       ated jointly     by the commanding officer       of the hospital  and
       the chaplain.~     Their replacenents     did not show equal inter-
       est in the problem of alcoholism,         and the progran was dis-
       continued    early in 1970. Recently a small program was
       started at this base by a psychologist          who had initiated    pro
       gram at several other locations.           According to the psychol-
       ogist,   he was initially    not  allowed    to advertise  his program
       at the base where he was assigned and the program relied            on
       word-of-mouth     publicity.
            The history    of the Air Force clinic    at ‘Wright-Patterson
       is similar,    According to its present director,      the depar-
       ture in 1967 of the individuals     who started the clinic:

            '*'I;-* was followed by the expected but temporary
            discontinuity      in further     development of the pro-
            gram. The patient         population    dwindled and there
            was considerable       uncertainty     about future plans.
            Local interest       in the program was perpetuated      by
            staff    personnel who had been involved in the pro-
            gram."
  He indicated  that the support of the Office of the Surgeon
  General of the Air Force had ensured continuance   of the
  clinic.



          A few installations       had made some prevention        efforts,
  At one base a local alcoholism council             sponsored a seminar
  on alcoholism     and accident proneness which was attended by
  1,200 first-     and second-level      military    and civilian      super-
  visors.     At another base brief mention was made of the con-
  sequences of excessive use of alcohol in drug seminars for
  military    personnel.      At Fort 3enning the prevention           effort
. consisted    of contacting      unit commanders and supervisors             and
  issuing a bulletin        describing   the base's alcoholism         treat-
  ment program.       Also,   alcoholism    prevention    instruction      was
  planned in the base's extensive military             training     programs
  when four additional        personnel could be hired.

  CURRENTEFFORTS IN DOD TO
  DEAL WITH ALCOXCLISM

          In December 1970 the Army issued a letter           encouraging
  commanders of major commands to establish             Alcohol and Drug
  Dependency    Intervention    Councils to advise the commanders
  on matters    of policy    and to develop and coordinate        preven-
  tion and rehabilitation       programs.      Early in 1971 the Assis-
  tant Secretary of Defense (Health and Environment) estab-
  lished an interservice       task force to study all aspects of
  alcohol abuse in the military         services and to develop rec-
  ommendations in policies        concerning alcoholism.        He stated
  that, although the services had programs for cohtrol               of al-
  cohol abuse, he believed that broad DOD policies              were re-
  quired.     Subcommittees are being formed to study prevention,
  detection,    medical treatment,      rehabilitation,      and disposition
  aspects of the problem.         Other matters to be considered in-
  clude causes, prevalence,        social attitudes      and pressures,
  legal aspects, discipline,        and security.
     ._



.-




                           THE ALCOMXIC IS WORTHHFXPING



                 Industry has become increasingly      aware of the extent        ~
          and cost of alcoholism      among all levels of employees.        In
          1968 the National Council on Alcoholism estimated the indus-
          trial    costs of alcoholism at over $4 billion      annually.      In-
          dustrial     costs are the result of direct and indirect       losses
          from such factors as absenteeism, accidents,         bad decisions,
          discharges     and early retirements,   and lowered worker effi-
          ciency and morale.      As a result of these losses, industry
          has been establishing      alcoholism rehabilitation    programs
          for their employees.       Some of these programs have achieved
          rehabilitation     rates as high as 70 percent.

                Effective     programs encompass recognition       by top manage-
          ment that a problem with alcoholism         exists in the company;
          that it is a sic'kness which affects        perfolmnce;      that super-
          visors all along the line have a responsibility             to counsel
          subordinates     on their performance;     and that, apart from
          humanitarian     reasons, when alcoholism      is affecting     perfor-
          mimce, it is more economical to motivate the employee to
          seek rehabilitation        than to fire him or to do nothing.
          These programs emphasize that the employee's career will
          not be jeopardized       if he seeks the help being offered         to
          him and that only if he refuses that help or if the treat-
          ment is unsuccessful         will he then be discharged.

                  The value ofalcoholismcontrol     and rehabilitation      pro-
          gram for Federal civilian        employees was recognized by
          passage of Public law 91-616, entitled        "Comprehensive Alco-
          hol Abuse and Alcoholism Prevention,        Treatment, and Rehabil-
          itation    Act of 1970."     It provided that appropriate    pro-
          grams and services for alcohol abuse and alcoholism          among
          Federal civilian    employees be established      by the Federal
          Goverrxnent.

                  Ihe Secretary of the Navy in Pkrch 1966 recognized    the
          illness    concept of alcoholism   fo r civilian employees of the
          Navy and further     recognized that alcoholism was a treatable
I   ..




3        illXE%Xi.    He stated that "fifty           to    seventy-five    percent of
         all employed alcoholics            can be rehabilitated         to full activ-
         ity."     The   Secretary      stated  also     that  it  was   Navy  policy to
         establish     local alcoholism        control programs where the com-
         manding officer          determined that a need existed.




                Hany of the costs incurred because of alcoholism         among
         employees of industry   and Federal civilian      employees    are
         incurred also because of alcoholism        among the military.
         Obviously some of the areas of costs are of an intangible
         nature and are not readily     susceptible    to cost measurement
         either in the military   services or in industry.

                 The National Council on Alcoholism has estimated that
         it    costs employers an amount equivalent           to about 25 percent
         of the average annual pay of each alcoholic                employee.    Ap-
         plying the Council's        estimate to the military         services re-
         sults     in xi estimated potential.     annual cost to the Govern-
         ment of about $48 million         for each 1 percent of alcoholism
         incidence in the military         services.      (The computation of the
         estimate is shown in app. IV.)            If the incidence of alcohol-
         ism in the military       services averaged about 5 percent,
         which was estimated by the Council for the civilian                  work
         force,      then the potential    annual    cost  to   the  (Government
         would be about $240 million.

                If a recovery rate of 50 percent'     was attained   from
         the establishment    of an alcoholism   control program for mil-
         itary personnel,    then the potential   gross saving     could be
         about $24 million    for each 1 percent of reduced incidence,
         or about $120 million      at an assumed incidence of 5 percent.
         Offsetting    this potential   saving would be the cost of an
         alcoholism control     program which was one of the areas to be
         considered by the DOD task force on alcohol abuse.


         1The assumed recovery rate was based on rates experienced
          at cxi:;ting  pilot clinics in military and civilian alcohol-
          ism programs.



                                                17
       An illustration     of the cost of military       alcoholism
would be the cost to train a replacement if the individual
was lost to the service because of alcoholism.               Fur in-
stance, information       obtained from DOD sources showed that
training     an Air Force bomber pilot costs about $200,000,
training     a precision-measuring-equipment        technician    costs
about $20,000, and training         an Army ground-control-radar
repairman costs about $lO,OOO. These are basic, entry-
level costs and do not consider the investment in additional
training     and experience of an individual       after completion
of training      at the entry level in these skills.           Qbviously
it would cost considerably         more to replace an experienced
senior commissioned or noncomssioned            officer     with 10 or
more years9      service than someone at the entry level.            For
example, the investment in training          a Navy F-4 pilot
through designation       as a naval aviator was reported to be
about $100,000 but rose to about $450,000 after 4-l/2 years'
designation      as a naval aviator.
                                CHM'TER7

                  CONCLUSIONSAND RECOMMENDATIONS



        Although the incidence of alcoholism            in the military
population     may be no greater than that of the civilian              popu-
lation,     it could be a more serious problem because of the
frequently     dangerous and critical        duties involved,        Negative
attitudes     and punitive   statutes     and regulations      have re-
sulted in hiding the problem,            Although there have been
some educational      and rehabilitation       efforts,     substantial
savings, as well as humanitarian            benefits,     can be realized
from the establishment       of a DOD-wide, comprehensive alcohol-
ism control program.       We believe that the costs to establish
such a program would be less than the costs of doing nothing.

      The need for the military      services to help their alco-
holics was well stated by the commanding general of a large
base who told-us    that he was not too concerned with the ac-
tual percentage of alcoholics       but that, as long as any seg-
ment of the military     population   was afflicted  by an illness
of any kind, they should be helped.

      We also note that DOD has recognized its obligations
to military  personnel by establishing     social programs, such
as Projects 100,000, Transition,     and Referral,    Although
some efforts  are being made within DOD to deal with alco-
holism among military     personnel, we believe that a eompre-
hensive alcoholism    control program is needed,



       We believe that changes must be made in attitudes,           pol-
icies,   and practices     for the military    services to have a
successful    alcoholism    control program.     Alcoholism should
be recognized as a disease which is treatable            rather than
as misconduct which is punishable,           We recommend that DOD
move expeditiously       to change pertinent    regulations    and pro-
pose any changes in legislation         needed to accomplish that
puqose,
         Most importantly,       the stigma attached to alcoholism
should be removed.           This will require attitudinal    changes
at all levels of command and among medical personnel,              so
that the alcoholic         is not impeded from seeking help because
he might jeopardize          his career if he admits to an alcoholism
problem.      We recommend that a comprehensive education pro-
gram be initiated       to inform military      personnel of the dan-
gers of the abusive use of alcohol.              In addition, supervi-
sors at al.1 levels need to be convinced that many alcoholics
can recover and be fully productive            and that early identi-
fication     and referral       of alcoholics  to appropriate  treatment
facilities     is an important element of a successful         alcohol-
ism control program.

      We recommend that rehabilitative        facilities        and services
be made available    to all military    personnel having alcohol-
ism problems, with the understanding        that, if a man refuses
rehabilitation    or is not successfully     rehabilitated         and re-
turned to normal duty in a reasonable period, he will then
be subject to separation    from the military          service.
      We recommend also that studies be undertaken by D9D to
determine more precisely     the incidence of alcoholism  and
problem drinking.     The results   of these studies will assist
in determining    the extent and amount of resources required
for a comprehensive alcoholism      control program.
I-
f



,-




i



                    AGENCYCOWZNTS AND GAO EVALUATION

            In commenting on the draft of this report,           the Princi-
     pal Deputy Assistant       Secretary of Defense (Health and En-
     tironment)     emphasized the humanitarian       benefits    to be gained
     from a comprehensive alcoholism          control program and did not
     cake issue with our estimates of the economic savings to be
     g.eined.     He concurred in our findings       and those recommenda-
     &ions concerning establishment          of educational    programs,
     availability     of rehabilitative      measures, and studies to de-
     -x-mine the incidence        of alcoholism    and problem drinking.
      CSee app. II.>

           The Deputy Assistant    Secretary advised that acceptance
     CZZ our recommendation that alcoholism be recognized as a
     &sease would present difficulties       to DOD, since a disease
     55 considered a physical    disability    and is therefore com-
     psm&le     under existing  statutes.    He vent on to say, in
     prt,   that:

           *'*** it would be preferable      to recognize chronic
           alcoholism    as a condition    which is preventable
           and treatable     through the application     of en-
           lightened   attitudes    and techniques   toward this
           condition,    both on the part of supervisory      per-
           sonnel and medical. department personnel,"

           We recognize that certain statutes           and regulations     af-
     Eecting military     compensation currently        hold alcoholism     to
     %e misconduct,      As stated earlier,      however (see pp. 9to 12),
     the effect of punitive      statutes,    policies,     and regulations
     Eas been to hide the problem of alcoholism.              If they are
     xzst modified,   there is little      assurance that this condition
     -~5ll be corrected,

            Public Law 92-129, amending the Military      Selective  Ser-
     rice Act, was enacted on September 28, 1971, with provisions
     f,or identification    and treatment of persons dependent on
     &cohol     and drugs in the Armed Forces.      Both Houses of the
     Congress agreed to these provisions     with the understanding
     that they were a prelude to further     legislative    actions by
     zheir   respective  Armed Services Committees.

                                         21
. -




             Title V, section X&of        the act requires the Secretary
      of Defense to prescribe      and implement procedures and provide
      necessary facilities      to identify,      treat,    and rehabilitate
      members of the Armed Forces who are dependent on drugs or
      alcohol.     The Secretary is also required to report to the
      Congress 60 days after enactment of the act (1) the plans
      and programs which have been initiated              and (2) such recom- I
      seendations for additional      legislation        as are necessary to ef-
      fectively    combat drug and alcohol dependence in the Armed
      Forces and to treat and rehabilitate            effectively    any member
      found to be dependent on drugs or alcohol.

              We believe that the Secretary of Defense properly
      should include in his proposals to the Armed Services Com-
      ?;littees p contemplated by Pubf.ic I.aw 92-129, recommendations
      IX deal with the problems of recognizing       alcoholism    as a
      &sease.      These problems inckde    those involving    pay, re-
      tirement,     and related benefits.




                                         22
                                                                                   --   ..-__---.-     .--.--   ,.,



.   -
        ..


                                                     CHAPTER9

                                                SCOPE OF REVIEW

                      Our review        was made dtlring        early     1971 at the Office             of
             8-z Secretary          of Defense,       the headquarters            of the military
             SEY vices,     and over 30 Army, Navy, Air Force,                       and Marine
             Gxrps instal.lations.             At the installations               we interviewed
             more than 600 personnel               including        commanders,        staff   judge
             a&gocate      officials      9 provost      marshal       personnel,       medical      per-
             s=xnel,      base chaplains,          and senior        noncommissioned          officers,
             Specifically         we asked questions            concerning        (1) the inci-
             deuce of alcoholism             among military          personnel,        (2) the fac-
             tors     in the military         environment        which might tend to en-
             ccxrage      or discourage        alcoholism,          (3) the alcoholism            treat-
             msnt programs available               to the bases, and (4) the policies
             azz2 practices         followed     in handling         alcoholic       military       mem-
             be.Ts o Most of the military                installations          that we visited
             hzd large troop populations                 and were located            in the conti-
             ns::.rtaZ United       States,    EuroPej and the Far East.

                     We met with representatives            of local     and State alcohol-
             isx councils        as well as the National          Council   on Alcoholism,
             local      chapters   of Alcoholics       Anonymous,    the Veterans     Admin-
             iszration,        and the Department        of Health,    Education,and     Wel-
             fare.       Ve attended      open Alcoholics     Anonymous meetings        and
             visited      the rehabilitation       clinics    at the long Beach Naval
             Sfaztion       and at Fort Benning.

                     We did not attempt       an e,xhaustive      search of all       statutes
             a?<3 regulations     affecting     the military       alcoholic;      however,
             scae of the more pertinent           are included       in this report.         A
             search    of the literature       on alcoholism       in the military         ser-
             vfzes    T<as made principal1     y through      the use of the Classified
             Abstract     Archive   of Alcoholism      Literature       maintained     by the
             Crater    of Alcohol    Studies,     Rutgers    University,       New Bruns-
             wi ckg New Jersey,
..




     APPENDIXES




        25.
                                           October       22,   1970

The Honorable      Elmer   B, Staats
Comptroller      General  of the United         States
44 l “G” Street,    N, W.
Washington,     i?. c. 20548

Dear    Mr.   Staats:

  You will ret all that in May,           1970, 1 requested       that ydnr offi-i=e
 conduct a study to determine              the cost savings which might be brought
 about in the civilian        and military      branches    of the Goyernment
 through    the implementation           of a strong Federal        alcoholism
 personnel     program.         The request      was based, in part,         upon our
 Subcommittee’s        I’indings that treatment         which is tied to employment
 personnei     programs:         where alcoholism        is dealt: with at a less
 advanced     stage and with strong motivational              tools,    has brought
 about recovery       rates much higher than those found in clinic                    and
ho spit al 5 etting 6 which are unrelated            to such an environment,              It
was also based upon a deep and increasing                   concern      in the Congress
about the growing          impact    of alcoholism      on our society,        I felt
that if it were clear there was a sound economic                     basis,    as well
as a humanitarian           basis,   for establishing      such a program,          that that
information      would be of key importance             to the Subcommittee            and
would be of great interest            throughout     the Executive       Branch     as well.

After    visiting     with your staff about the fact that a study of this type
- a cost-saving           study -- was a new type of a study for the General
Accounting        Office to conduct and that the alcoholism          personnel
programs        area was one in which your personnel            had not previously
worked,       we agreed that the study should be limited           to the civilian
branch     of the Government,          in order to first determine,      in that
more limited         area,    the extent to which firm    results   might be
obtained      in a study of this kind,

As you ~IIOW, the study was highly successful,           both in terms     of
nbt;;ining professionally   rc!iabfc    cizta and in terms    of providing    an
extremely   useful document      to the Congress,     the other branches      of
-   -
        ..   . L!ilvmDIX I




                  the Federal      Government,        and to State governments,           about the
                   sigr?ificant   cost savings which can be obtained by establishing
                   such programs*         The report     has received       extremely     favorable
                  comment       by health professionals        both within      and outside the
                  Government;        it has been received       favorably     by businessmen
                  and by the business        media as well {the Wall Street Journal
                  placed its story on the report           on the front page),        The Committee
                  on Labor and Public          Welfare   is making      a committee       print of
                  the report,      so that it may be distributed          to the members        of
                  Congress      and to State and local groups and organizations                 who are
                  interested     in it.   Public demand for the document              from the
                  Coi+ttee        Las been high.

                  Because of the success              of the study, I would now like to request                   that
                 a similar        study be made in the military               branch of the Government.
                  Certainly      the reasons       for carrying         out such a study in the civilian
                 branch of rhe Federal              Governnlent        apply to the military          branch     as
                 well,      In facts there are indications               that the need for such a study
                 in the military         area is even more pressing.                  The majority         of our
                 young men are required                 to serve in the military            service     and are
                 encouraged          to go on to careers          there as well,         As a result,       we have
                 a special       obligation     to them.        Our Subcommittee            has found many
                 indications        that men, often with many years’                  training,      are being
                 forced to retire           or are being removed            with no benefits         and less
                 than honorable          discharges        because they are the victims               of alcoholism.
                 It would be extremely             helpful     for Congress,         as well as the Executive
                 Branch,       to know the economic              impact     of a program         which would
                 encourage         a somewhat        different     approach      to this problem.           There
                 are indications          that cost savings would affect the veterans                     area as
                 well.      According        to the Veterans         Administration,          one in every six
                 beds in our Veterans             Hospitals       is now occupied          by a patient who
                 is an alcoholic         or who has alcohol-related               problems.         Though a
                 report      on th c military       branch would pose problems                  which the
                 report      on the civilian       branch did not, I am hopeful that the expertise
                 which the men who worked                   on the earlier       report have now obtained
                 could now be used to advantage                   in the military        area.

                  It would be helpful   ii y3ur         office    could designate        a representative                .
                  of the General   Accounting           Office    to contact Mr.         Wade Clarke,          Counsel
        to the Subcommittee,     for     additional information      concerning the

        areas which such a study         might cover and the supportive
        information  or assistance        the Subcommittee      might be in a position
        to provide.

        Thank   you for   your   consideration.

                                                  Sincerely   yours,




                                                     9OLD E. HUGHES
                                                  Chairman,     Special Subcommittee
                                                    on Alcoholism      and Narcotics




    L




-
                                ASSISTANT         SECRETARY           OF DEFENSE
                                           WASHINGTON.         D. C. 20301




 HEALTH       AND
                                                                                               AUG 1971
ENVIRONMENT




        Mr. Forrest    R. Browne
        Associate   Director,   Defense Divi
        U.S. General Accounting      Office

         Dear Mr. Browne:

         The GAO draft report on *tAlcoholism Among Nilitary                    Personnel"      (OSD
         Case #3299) has been reviewed and evaluated.                             .

         The findings  and recommendations     in the GAO study               are concurred       in
         subject to the following  discussion.

        The recognition     of alcoholism        "as a disease which is treatable                   rather
        than as misconduct        which is punishable'*        presents       difficulties,         from our
        standpoint,     due to the equating of "disease"               with "physical         disabilityPr,
        which is compensable.          tie believe thai it would 32 ~rcfera?zle                   t3 recog-
        nize chronic alcoholism          as a condition       which is preventable            and treat-
        able through the application            of enlightened        attitudes        and techniques
        totiwd this condition,         both on the part of supervisory                  personnel      and
        medical department        personnel,      Alcoholic      intoxication,           and offenses
        which are related       to this state,       for which the individual               should be
        held responsible,       should be clearly        differentiated           from the chronic
        underlying    alcoholic     dependency state.

        While we have no basis on which to differ    with the estimated      economic
        savings to be gained from a comprehensive    alcoholic rehabilitation       pro-
        grsm, we believe  that the benefits  should be measured primarily        in terms
        of the htman values involved,   with the savings considered     as balancirg
        off the cost of the program.

        We are in general agreement with the recommendations               concerning    estab-
        lishmznt   of educational    programs,    availability      of rehabilitative
        measures, and studies to more precisely            determine the incidence       of
        alcoholism   and problem drinking.        We anticipate      that in the near future
        Department   of Defense-wide     policies   will be established         to achieve
        these gcals.

                                                                Sincerely,




                                                                Brigadier     G~ncral,     MC USA
                                                                Principal     Deputy
                                                     30
                                                                                                             . .;



                                                                                        APPENDIX III




    D1EES-f
    ------




              The Chairman, Special Subcami ttee on     A7cohol ism and tiarcoti cs, Senate
              hmli -I-k? on Labor and Public Cklfare,    asked the General Accounting Of-
              fice (GAO)to m&e a study to dete?%fne the cost savings to the Govern-
              ment that might be brought about through a program aimed at identifica-
              "ei on 9 prevmti on, and treatment of ai cohol ism among Federal ci vi 1 i an eni-
              glOyC%S *

          The study was requested because of
                --the Subcmtitteels       concern       about   the growing    impact   of alcoholism
                    p-&n 3';'" socj sty B

                --strmg      congressional     and    public interest    in this    important    health
                   area;,
                a-
                     the Subccxwittz's      finding     that treatment tied to employment person-
                     nel prctgrE.;x --under Rich       afcohol”,sm is dealt with in its early
                     st23-"s --md brought Gxwi         recoveries   at rates    much higher     than those
                     in clinics   and h9sp-itals unrelated to such an environment 9
                --the GSS~SavScrgsachieved by private industry,as a result of af-
                   cohai i sm programs, and




              On A1:gust 10, Km,    the Z&ate passed a bill (S. 3835) that provides
              for a &czg;-E+nsjy; &&yaj procyan iccwthe prevention and trestment of
I
                       -it;-? end alcoholism, including the deveiccaent and maintenance
              al CDh67 rr,>t
              of appr-~priate policies and sewIres for Federal civilian employees.

i
   --Alcoholism          is   a disease,     and the alcoholic        is    a sick        person.

  --The      alcoholic        can be helped       and is worth    helping.

  --Alcoholism           is   a public   health     problem   and therefore          is     a public      re-
     sponsibility.

  --There     is     no imunity       to alcoholism       conferred     by background, position
     in life,        profession      or occupation,       or sex.      (See PP- 5 to 7.)

Aicoholism     has been hidden and denied for so long tiat      no one really
knows holi~ many peopl     e are  suffering  from it. Estimates  of the‘number
of alcoholics        in the United States are among the most publicized--and
challenged--statistics        on alcoholism.

Therefore,   in conducting  its study, GAO relied  on information    pravided
by individuals   in Federal agencies,  State governments,    and industry   ERd
by others who have studied the problem of alcoholism       to arrive  at esti-
z?*+-Pc
1.1.."Cd nf
         v * the     prey;fence      of aIc~holjsm       in the    fe&yaj      Govegyznts           the
costs incurred as a result thereof, and the cost savings tha% might re-
sult from an effective Government-wide alcoholism program.

GAO estimated    the number of Federal civilian      employees suffering   from
alcoholism   (at various     assumed rates of prevalence ranging from 4 to
8 percent of the work force)       and the resulting   employer costs TV the
Federal Government (based on a factor       of about 25 percent    of average
annual salary)     as follows:

                                                                  Estimated   annual employer
Estimated prevalence     of alcoholism                             costs due to alcoholism
 aaorq Federa 7 civilian     esolo;lees                                (000,000 oz~itted)
                         Kumber of
                         alcoholic
     Percent
    ~__                  einployees


          ii                       112,000
                                   140,000                                      $275
                                                                                 345
          6                        168,000                                       410
          7                        196,000                                       480
          8                        224,000                                       550

(See pp. 10 to 15.)
    .
.
    .*
         +       Aithorities   $on alcoholism   feel that about 54 of every 100 alcoholic      em-
             -   ployees wod?d be ‘likely to recover as a result        of an employer's alco-
                 holism progz-zm.     Therefore   the estimated  annual employer costs being in-
                 curred by t&e Government among iits civilian       employees might be reduced
                 by over 50 ps-cent     because of an alcoholism    program.   (See p. 16.)

                 Deducting tf-e estimated    cost to the Federal Government         of such a pro-
                 gram--$15 million   annually--the     net cost savin s would       range from $135
                 million  to 5280 million    annually.    (See p. lg.3

                 An effective       Gosernmznt-wide    alcoholism   program9 by he lping reduce the
                 number of a'Zcoho7ics and problem drinkers            in the total   population,
                 would also zzontribute        to t.ne economic and social benefits      which the
                 Federal Government and society           as a whole would obtain from alcoholism
                 programs in general.          There would be reductions     in--among other things--
                 traffic     accfdents,    crime, and the need for b!elfare       and medical serwices
                 attributabfE       to the misuse of alcohol.       (See p. 20.)

                 Finally,  the progrzn wOuld attend to a part of one of the Nation's
                                                       0 time, would give a group of sick
                 major heal%: problems and, at the same.
                 Federal emrpEoyees a greater chance to recower and live decent lives.




                                                             33      .
     T&e potential  costs to the Federilf Government of mili-
tary EIcohoPism for each 1 percent of incidence are computed
as foXLows:

EstimzZed total military  person-
                                  a $19,096,234,000
  nel ;-osts for fiscal year 1972
              divided   by

Estfmzsed average number of
  milZ.%ary personngl during
  fist2.d year 1972                              2,609,409

Gives ,a-verage annQa1 cost     for
  each serviceman                           $        7,300 Cappsox.1 '

Average annual cost for       each
  miIi,i*Zxry alcoholic
  ($7,300 x 25%)                            $        2,825

Fctm2Aal    mual    cost for each
  1 psxent    of incidence
  (2,&X39,409 x 1% x $1,825)      _         $   47,621,550

3-hes= estimates were obtained from "The Budget of the
United States Goverrmxznt Fiscal. Year 1972."




                                      34’