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Sunday, July 19, 2009

Smoking In the Military

Bobby McCarter, a retired veteran who served 20 years in the Navy, expresses his opposition to a complete ban on smoking in the armed services. McCarter says, “They need that cigarette break for stress relief. I’m totally against that, and I think the Pentagon should leave it alone.”

A tobacco ban would confront a military culture, in which "the image of the battle-weary soldier in fatigues and helmet, fighting for his country, has frequently included his lit cigarette."

True, troops worn out by repeated deployments often rely on cigarettes as a so-called "stress reliever." A study requested by the VA and Pentagon and conducted by the Institute of Medicine found that tobacco use in the military has increased after the wars in Iraq and Afghanistan began. Military deployment is associated with smoking initiation and, more strongly, with smoking recidivism, particularly among those with prolonged deployments, multiple deployments, or combat exposures.

The Defense Department already restricts smoking on military installations, much in the same way airports and other public buildings set aside designated smoking areas. However, restriction does not keep the addicted soldier from smoking.

Tobacco use costs the Pentagon $846 million a year in medical care and lost productivity, says the report, which used older data. The Department of Veterans Affairs spends up to $6 billion in treatments for tobacco-related illnesses, the study reports. The bill also represents 80 percent of the $5 billion annual cost of treating pulmonary disease among military retirees as directly attributable to smoking.

If the monetary costs of smoking don’t get the attention of the Pentagon officials, the report also identifies what it says is a “strong association between tobacco addiction and mental-health problems, among them mood disorders, schizophrenia and substance abuse” — not ideal states of health for military candidates.

The bottom line, the study says, is that while the Pentagon and the VA have made strides toward reducing smoking and chewing, “tobacco use continues to impair military readiness.”

Along with a phased-in ban, the report recommends requiring new officers and enlisted personnel to be tobacco-free, eliminating tobacco use on military installations, ships and aircraft, expanding treatment programs and eliminating the sale of tobacco on military property. "Any tobacco use while in uniform should be prohibited," the study says. Actual implementation of these requirements is expected to take many years.

But smoking in the military remains much more common than in the general public, the report finds — smokers have dropped to only about one in five Americans overall, but they make up more than one in three service members.

Smoking and Stress

In reality, people who smoke to reduce stress are only adding to their stress, according to a new review of psychological studies in the American Psychological Association's American Psychologist. Psychologist Andy Parrott, Ph.D., of the University of East London says the evidence shows that the apparent relaxant effect of smoking only reflects the reversal of the tension and irritability that develop during nicotine depletion. Far from acting as an aid for mood control, nicotine dependency seems to increase stress. An increase in anxiety results. Smoking and Post-Traumatic Stress Disorder According to a study published on the British Medical Journal website, a threefold increase in new cases of self-reported post-traumatic stress disorder symptoms among combat-exposed military personnel since 2001 has occurred. New onset post-traumatic stress disorder symptoms or diagnosis is reported by up to 87 per 1000 combat-deployed personnel and up to 21 per 1000 non-combat deployed personnel.

VA officials say treating PTSD and getting veterans to stop smoking are both important health issues. One study finds that people who are dependent on nicotine are twice as likely to develop PTSD following exposure to a traumatic event.

Also, the Department of Defense Center for Deployment Health Research (Naval Health Research Center, San Diego, California 2008) finds prevention programs should focus on the prevention of smoking relapse during or after deployment.

Combat exposure has been critically assessed and new onset post-traumatic stress disorder symptoms have been measured using recognized criteria. Other information, such as cigarette smoking and problem alcohol drinking, have also been recorded in the research. Findings include: (1) New onset symptoms are proportionately higher among participants who are female, divorced, enlisted, and in those who report being a current smoker or problem drinker at baseline. (2) For military women, stress associated with being a woman in the military is predictive of illicit drug use and cigarette use. (3) More effective stress management strategies may need to be implemented for military men to reduce the link between stress and heavy alcohol use, illicit drug use, and smoking. (The American Journal of Drug and Alcohol Abuse, 1999) According to a current report on MSNBC, reaching for a cigarette to cope with a flashback is all too common among sufferers of post-traumatic stress disorder. The nicotine hit may feel good but scientists say its brain action probably makes their PTSD worse in the long run. Although PTSD patients say a cigarette helps their mood when they're having symptoms, the extra attention may be reinforcing bad memories.

"If you think about your traumatic event and you smoke your cigarette, you can think about it even better," explains the VA's Beckham. PTSD specialist Dr. Jean Beckham, a psychologist at the Durham, N.C., Veterans Affairs Medical Center.

Certainly, quitting the smoking habit will help PTSD sufferers, not make their pain worse. According to studies (American Journal of Psychiatry 162:1311-1319, July 2005) stopping smoking is not associated with worsening symptoms of PTSD.

Some Curious Current Policy

"The military complicates attempts to curb tobacco use by subsidizing tobacco products for troops who buy them at base exchanges and commissaries," says Kenneth Kizer, a committee member and architect of California's anti-tobacco program.

Seventy percent of profits from tobacco sales — $88 million in 2005 — pays for recreation and family support programs, according to a study by Kizer.


Does smoking contribute to the performance of an active service person or to the elimination of stress for either an active service person or a military veteran? In other words, is Bobby McCarter correct in saying that smoking gives the armed services needed stress relief? If you answer "yes," you must believe that a cigarette is the best means of delivering nicotine and the least intrusive method of that delivery. Remember, all people react differently under stress. We must not infringe on non-smokers who stress when those around them smoke.

The general misconception of smoking is that a cigarette helps in calming calm people down. Stress in not reduced due to smoking. On the contrary, smoking a cigarette maintains the reducing level of nicotine in the blood that makes people feel relieved. Why doesn't a nicotine patch or gum work the same way? Maybe a nicotine injection or drink would deliver this relief to those who are addicted. Does the service provide spitoons for those who chew tobacco or take snuff?

Strong leadership could make the military tobacco-free in five to 10 years, according to Kenneth Kizer. President Obama, he says, could set an example for the military by ending his own smoking habit once and for all. Last month, Obama said he is "95% cured" but "there are times when I mess up" and smoke.

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