Soldier’s alleged killing of Afghan civilians opens discussion on troops’ use of prescription drugs

The issue of how the military deals with mental health heated up again following Staff Sgt. Robert Bales’ alleged killing of 17 Afghan civilians.

Bales’ attorney, John Henry Browne, says he wants to review the medications Bales was taking at the time of the shootings. So far, though, there’s been no confirmation that Bales was in fact on any drugs.

Last year, more than 100,000 active-duty Army troops were prescribed anti-depressants, narcotics, sedatives, anti-psychotics or anti-anxiety drugs. David Rudd, director of the National Center for Veterans Studies, said part of the issue is the stress of the job.

“Part of the issue is that we have to think about and consider what the demands are on the force, that 10 years of war in Iraq and Afghanistan and now continuing conflict in Afghanistan has strained the force so sinificantly that oftentimes what you see is that policy is sometimes dictated by demands, and that means having an adequate number of people to meet the demands of the job,” Rudd said.

However, Bart Billings, a former military psychologist, questioned the effectiveness of prescription drug use for soldiers, citing a New York Times report from August that looked at just that issue.

“The writer who wrote the story, Benedict Carey, described three journal articles, one in the Journal of American Medicine’s jounal, JAMA, British Medical Journal and Australian Medical Journal, which pointed out very clearly that anti-psychotics as well as anti-depressants are not effective in treating combat stress,” Billings said. “And there’s plenty of evidence that show that these medication not only aren’t effective, but the side-effects are disastrous. They have a black box warning, which is a very critical warning for medications, and the first warning on the black box is suicidality. The second is poor judgment. The third is anger and hostility, which can translate into homicide, so basically what we’re doing is we’re looking at a medication that may create more problems than it helps.”

Billings said the effects of sedatives are similar to the black box warning. He cited a Los Angeles Times’ story on Patrick Burke, who, according to the article, suffered from polysubstance-induced delirium from a combination of alcohol, sleep deprivation and the 40 milligrams of Dexedrine he was taking.

Rudd disputed some of Billings’ claims and believes medication is necessary in many cases.

“I will tell you that we currently run a treatment program at Fort Carson where we’re treating suicide attempters, and medicines are critical sometimes early in the process of treatment. Now, I will tell you that we don’t want people to be on medications for indefinite periods of time, but I certainly have seen medicine save lives,” Rudd said.

Rudd also disagreed with Billings on the dangers of medications with black box warnings. 

“I actually was involved in an early group that looked at those charts and classified those behaviors. I think it’s critical to understand that when the FDA black box warning was placed on those medications, it was originally based on pediatric anti-depressant trials. In 4,400 cases, not a single person committed suicide,” Rudd said. “I think it’s important to recognize that. The numbers are relatively small. You’re talking about a 2 percent event rate in the population of those original trials.”

Billings said in more than 30 years of military psychology, he’s learned the first question he believes he should ask soldiers is, “What kind of medication are you on?”