Vietnam: Follow-Up Study

In the summer of 1971, the U.S. military forces in Vietnam were being rapidly reduced. To deplete the forces there quickly, many men were being sent home before the usual tour of twelve months was complete. A urine-screening program was established in July to detect the recent use of illicit drugs by men scheduled to depart Vietnam for the United States. Those detected as positive were kept for DETOXIFICATION for about seven days, retested, and sent home only if they had a negative test. The urine screening was initiated in response to great concern that many members of the military had become addicted to HEROIN in Vietnam. The fear was that they might continue their addiction in the United States. Because the great majority of those returning were due for discharge on return, the MILITARY would have no further control over them. They might present overwhelming problems to the legal system and to veterans' hospitals.

To learn whether this fear was justified, the SPECIAL ACTION OFFICE FOR DRUG ABUSE PREVENTION (SAODAP) launched a follow-up study with the collaboration of the Department of Defense, the Veterans Administration, the National Institute of Mental Health, and the Department of Labor. The goal was to learn how many men had actually been addicted in Vietnam, whether those addicted would continue to use heroin after return and how many would be readdicted after return. The study was conducted by Washington University in St. Louis, with Lee N. Robins, Ph.D., as principal investigator (Robins, 1973, 1974; Robins et al., 1975).

The group believed to be most at risk of addiction was army enlisted men, who spent their whole tour of duty on Vietnam soil, rather than on ships or in the air like men in the navy or air force. Thus, two groups of 500 army enlisted men were selected for the follow-up, a random sample of men returning in September 1971, and a sample of men whose urines had been positive when tested just prior to departure for the United States that month. The overlap between the two groups selected made it possible to estimate what proportion of all army enlisted men had tested positive. Military records of all those selected were reviewed to verify the date of their departure from Vietnam and to obtain a civilian address and the names of close relatives who would know where to contact them. Records were also used to verify the men's reports of drug problems in the service. To protect from subpoena the confidentiality of the information given by the men, a certificate of confidentiality was obtained. Then each interview was identified only by a randomly selected number placed on its mailing envelope but not on the interview proper. The interview was then mailed to another country, where a second random identification number was selected to replace the original one. A list connecting the first number to identifiers was held in the United States, and a list linking the first number to the second one was kept abroad, so that no one in either country could link names to interviews.

Almost 900 men were personally interviewed eight to twelve months after their return from Vietnam. The response rate was extraordinary: 96 percent of the sample initially selected were personally interviewed. The men were extremely frank—97 percent of men whose military record showed drug use had reported it to the interviewer. Two findings were especially surprising. First, use of narcotics in Vietnam was much more common than the military had estimated. Almost half (43%) of the army enlisted men had used heroin or opium in Vietnam, and 20 percent had been addicted to narcoticsthere. Second, only a tiny proportion (12%) of those addicted in Vietnam became readdicted in the year after return (Robins et al., 1974). Follow-up again two years later showed that this low rate of readdiction continued (Robins et al., 1980). During their second and third years home, addiction rates among men drafted were not significantly greater than among men who qualified for the draft but did not serve. This surprisingly low rate of relapse could not be attributed to abstention from narcotics after return; half of those addicted in Vietnam did use again after return. Those who went back to narcotics were predominantly men who had used drugs before they entered the service.

Although the principal finding of this study was that heroin addiction in Vietnam had a much better outcome than expected, there were men whose addiction continued on return home. Treatment for them was no more effective than for men who developed addiction in the United States (Robins, 1975).

Addiction: Concepts and Definitions; Opioid Dependence; Treatment; Vietnam: Drug Use In)

ROBINS, L. N. (1975). Drug treatment after return in Vietnam veterans. Highlights of the 20th annual conference, Veterans Administration Studies in Mental Health and Behavioral Sciences. Perry Point, MD: Central NP Research Laboratory.

ROBINS, L. N. (1974). The Vietnam drug user returns, Special Action Office Monograph, Series A, No. 2. Washington, DC: U.S. Government Printing Office

ROBINS, L. N. (1973). A follow-up of Vietnam drug users, Special Action Office Monograph, Series A, No. 1. Washington, DC: Executive Office of the President.

ROBINS, L, N., DAVIS, D. H., & NURCO, D. N, (1974). How permanent was Vietnam drug addiction? American Journal of Public Health, 64 (Suppl), 38-43.

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

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

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