Posted: 12/10/2012

WASHINGTON -- In a grim marker of the human cost of the Iraq and Afghanistan wars, the Pentagon reported Monday that active-duty American troops were hospitalized in the United States at three times the peacetime rate -- with mental health injuries comprising the largest category.

The new report by the Armed Forces Health Surveillance Center said that 891,903 troops were hospitalized from October 2001 to June 2012. These patients drove the stateside hospital bed occupancy rate up to 4.2 million days, almost four times the normal peacetime rate, a number that reflects the serious nature of the patients' physical and mental wounds.

Among the 891,903 hospitalizations recorded during the wartime period, 153,936 were for physical injuries and 161,385 were for mental health diagnoses. The report also documented 1.7 million ambulatory visits to military health facilities for mental disorders.

The mental health injuries "directly reflect the nature, durations and intensities of the combat in Afghanistan and Iraq as well as the psychological stresses associated with prolonged and often repeated combat deployments," the report said.

The report on the war wounded comes as the Pentagon acknowledged Monday that the Afghan war is far from over. In its semi-annual report to Congress, the Pentagon said that Afghanistan's Taliban insurgents "remain resilient and determined and will likely attempt to regain lost ground and influence through continued assassinations, intimidation, high profile attacks and the emplacment or improvised explosive devices."

The war assessment also said that "insider attacks" by Afghan soldiers against Americans remain a significant problem. Through September of this year, there were 37 such attacks, compared to 20 attacks in 2011. The increase "has the potential" to weaken the resolve of the NATO allies to continue participating in the war, the report said.

The Defense Department's report on the human cost of the war does not mention wounded Afghan civilians or wounded Afghan troops or insurgents. It also understates the extent of wounded Americans because it does not include hospitalizations or other medical care that took place in the war zone, nor does it take into account veterans or National Guard and reserve troops treated in civilian hospitals.

The report also does not mention the cost of caring for the war wounded. But it noted that the costs and the burden on the military health care system are not expected to decline as the war winds down. In fact, that burden may actually increase as the newly wounded join those who are still recuperating.

More than 50,000 Americans have been wounded in battle since October 2001 in Afghanistan or Iraq, according to Pentagon data updated Monday. Many of them have been severely wounded, as detailed in a 2011 Huffington Post series, Beyond the Battlefield.

Since many of the wounds recorded in the new Pentagon report are "chronically disabling but no longer life-threatening," the patients "will require decades of medical care,' the report said. Until the current patient population and the newly wounded leave active duty, the report says, "the cumulative costs of war-related health care will increase."

The report also detailed the increasing use of illicit drugs within the active-duty military. It said that 70,000 troops were abusing marijuana and prescription drugs, including opiods, and suggested that tens of thousands of others have gone undetected.

But perhaps surprisingly, most of the detected illicit drug use documented in the report was not related to combat. More than two-thirds, 69 percent, was by troops who have never deployed to either Iraq or Afghanistan. That finding runs contrary to the expectation that combat stress, especially during repeated deployments, leads more troops to abuse drugs. But at least according to this survey, the number of diagnosed drug abusers actually declined among those with repeated deployments: 16,371 active-duty troops who were caught using drugs had one deployment; 918 who were caught with drugs reported three deployments; and there were no troops caught with drugs if they had three or more deployments.

That's not good news for the Defense Department, as it suggests that troops assigned to humdrum jobs in garrison -- in their home bases -- turn to drugs more often than those on adventurous combat missions. U.S. troops' strength in Afghanistan has declined this year from 96,000 to about 66,000, and additional reductions are coming. Domestic military bases are already bulging with troops home from Afghanistan and with new recruits who do not expect to deploy.

The Army has already determined that those soldiers in garrison are more likely to engage in drug abuse, crime and other risky behavior than troops who are deployed, both because of increased opportunity and insufficient supervision.