Standing before a packed hall of 700 military doctors and medics here, the deputy commander of the nation's elite special operations forces warned about an epidemic of chronic pain sweeping through the U.S. military after a decade of continuous war.
Be careful about handing out narcotic pain relievers, Lt. Gen. David Fridovich told the audience last month. "What we don't want is that next generation of veterans coming out with some bad habits."
What Fridovich didn't say was that he was talking as much about himself as anyone. For nearly five years, the Green Beret general quietly has been hooked on narcotics he has taken for chronic pain — a reflection of an addiction problem that is spreading across the military.
Hospitalizations and diagnoses for substance abuse doubled among members of U.S. forces in recent years. This week, nurses and case managers at Army wounded care units reported that one in three of their patients are addicted or dependent on drugs.
In going public about his drug dependency during interviews with USA TODAY, Fridovich, 59, echoes the findings of an Army surgeon general task force last year that said doctors too often rely on handing out addictive narcotics to quell pain.
An internal Army investigation report released Tuesday revealed that 25% to 35% of about 10,000 soldiers assigned to special units for the wounded, ill or injured are addicted to or dependent on drugs, according to their nurses and case managers. Doctors in those care units told investigators they need training in other ways to manage pain besides only using narcotics.
"I was amazed at how easy it was for me or almost anybody to have access and to get medication, without really an owner's manual," says Fridovich, deputy commander of the nation's roughly 60,000 Green Berets, Army Rangers, Navy SEALS and secretive Delta Force teams.
For such a high-ranking military officer, publicly acknowledging drug dependency was unprecedented.
Retired Army major general Paul Eaton, a former commander in Iraq, says Fridovich has now joined a small cadre of senior military leaders willing to discuss publicly personal struggles, such as living with post-traumatic stress disorder. Such admissions are difficult professional decisions, Eaton says.
"Nobody wants to show weaknesses. You want to be perceived as perfection," he says. "But sometimes moral courage kicks in where moral courage is demanded."
Fridovich agreed in recent weeks to talk openly about his reliance on drugs as part of what he says is a personal commitment to push the Army into better addressing pain management and drug addiction.
"Here's my story," he says. "I feel like there is some real value — maybe cathartic, don't know — but really, more than anything else, how can you help people?"
His own experiences are his bona fides on the issue, Fridovich says, and others agree.
"This is huge for Fridovich to be willing to talk about this as a three-star general," says Gen. Peter Chiarelli, Army four-star vice chief of staff. "We're finally coming clean and admitting at all levels this is an issue."
Fridovich says narcotics altered his personality, darkened his mood and management style and strained his 35-year marriage.
When Fridovich finally went through treatment and detoxification to reduce his drug reliance in 2008 — he still relies on weaker doses of narcotics to combat pain — his wife, Kathy, hid or destroyed more potent pain pills so he could not use them.
"I was fighting the pain. And I was fighting the injury. And I was fighting the narcotics," he says. "We have an obligation to the soldiers to look them in the eye and say, 'I know what you're going through. You don't want to be like this for the rest of your life. You don't have to be.' "
Pentagon statistics show the number of pain-relief prescriptions given to troops, including narcotics, growing 86% from 2001 to 2009, when 3.7 million doses were handed out. That dipped last year to 3.5 million prescriptions, the data reveal, but is still more than any year prior to 2009.
From 2005 to 2009, the number of troops diagnosed each year with substance abuse disorders jumped 50% to nearly 40,000, the Pentagon says. And substance abuse hospitalizations increased from 100 troops per month in 2003 to more than 250 per month in 2009.
"The abuse is getting higher and higher and more and more," Fridovich says, "and that leads to a very dark, deadly, dangerous place."
An unrelenting pain Narcotics entered Fridovich's life in May 2006, after he severely injured his back exercising between trips to war zones. At the time he was a two-star general in command of all special operations forces — Green Berets, Navy Seals and Army Rangers — operating in the Pacific.
Fresh from a trip to Iraq and slated to go to the Philippines, he was in a Marine base gymnasium on Oahu leg-pressing 400 pounds when lower vertebrae shattered. Doctors later said his back was brittle from decades of soldiering and scores of parachute drops.
He said he felt a twinge at the time and worked through it, continuing a regimen of weight-lifting, handball and racquetball for several days.
But by Memorial Day, he awoke barely able to stand. "All I could do was just lie in bed and writhe," Fridovich recalls, describing pain radiating from his lower back down his left leg.
"It felt like someone had taken a baseball bat from here to here," Fridovich says, gesturing from waist to kneecap.
In the emergency room at Tripler Army Medical Center in Honolulu, X-rays showed shattered bones and pinched nerves. Motrin and morphine were the first medications, followed by fistfuls of fast-acting roxicet and longer-lasting Oxycontin, both listed by the federal government as highly addictive with significant potential for abuse.
Doctors wanted him to wait on surgery to gauge progress. "That was a little bit more than wishful thinking," Fridovich says now.
Eager to quell pain and resume command, Fridovich during one 24-hour period swallowed five dozen Oxycontin pills. His calculus was simple, he says: If the drugs were for pain relief, more drugs must equal more relief.
But the price was a disturbing fogginess of mind and dark, frightening thoughts. Fridovich recalls contemplating, almost irrationally, whether he should simply have his stricken left leg amputated and be done with it.
He says he pulled out the written warnings about narcotics and realized he was in treacherous territory. "That scared the hell out of me, (the) anxiety, depression, real bad thoughts," he recalls. "I got scared so bad that I stopped."
Fridovich says he immediately cut his consumption of pills drastically — but not entirely. Instead, Fridovich fell into a lifestyle he now concedes was a mistake — ingesting two to four pain pills daily, even as he continued commanding troops and moving up through the ranks.
The demands of his job, the need to travel by plane and helicopter around the globe and stay functional, meant that the roxicet and Oxycontin pills would be part of his daily diet.
"Somebody should have challenged me," he says. "I should have challenged myself and said, "Wow, I'm on this stuff way too long. What's the deal?' "
'I knew he was taking a lot'
His wife, Kathy, the college sweetheart he married on the eve of joining the Army in 1976 — the couple have one child, a daughter — found herself in a dilemma. She could see her husband was in chronic pain, but she hated the medication.
"I don't like the drugs," says Kathy Fridovich. "I knew he was taking a lot. I read all the little fine print. Drugs are scary."
She became her husband's conscience, urging him to find a way off the drugs.
For a time in Hawaii, Fridovich sought out acupuncture and managed to reduce his intake of narcotics.
He received his third star in July 2007, and an assignment asdirector of the Center for Special Operations. He and Kathy moved to Tampa, where Special Operations Command headquarters are located and the acupuncture treatment ended. Special Operations troops have played a central role in the Iraq and Afghanistan wars since 9/11 and the pressure on Fridovich to remain fully functional meant that the pain had to be kept in check. The easiest way was the pills, he says.
"Starting a new job and wanting to do well, he just worked as hard as he could, and they helped him get through," Kathy Fridovich says. "(But) I kind of wondered about the quality of what he was doing."
"I did, too," echoes Fridovich.
The drugs were altering his personality. Fridovich found himself becoming cross with colleagues and less tolerant of new ideas. "I found myself being, in some ways, very isolated, very combative," he says. "It's not what I wanted to be known for. I wanted to build teams. I wanted to bring people together."
Doctors at Walter Reed Army Center in Washington, D.C., finally decided to operate on Fridovich's back in January 2008. The surgery removed shattered bone and fused vertebrae. It would provide some long-term relief, but for a while the pain intensified.
Oxycontin and roxicet no longer were enough. He was given morphine.
Within a few weeks back in Tampa, doctors finally advised the three-star general that he had a long-standing dependency on narcotics. He needed some way of managing his pain without relying only on drugs.
At the time, Special Operations doctors were facing the same issues with soldiers suffering chronic pain, dependency or addiction. They found the Andrews Institute for Orthopedics and Sports Medicine, a Pensacola-based center that provides an array of services including surgery, rehabilitation and pain management.
Fridovich would be the test subject.
For four weeks, doctors, therapists and rehab specialists worked with Fridovich through physical training, psychological counseling and nutrition to train his body in more natural ways to deal with pain. They also put him through detoxification.
He was placed on a weaker narcotic, buprenorphrine, less amenable to abuse.
Detoxification left Fridovich physically and emotionally wrung out, he says, suffering the shakes, sweats, aches and nausea. "It's the most sickening feeling that racks your entire body," he says.
Fridovich — who was named deputy commander of Special Operations Forces in May 2010 — says the therapy, detox and reduction in narcotics cleared his head, eased his temperament and brightened his outlook on life. "I should probably take an ad out in a national newspaper apologizing for everything I've said or done, because I'm a different person," he says with a grin.
He hopes one day to leave narcotics behind entirely.
When the Army's surgeon general office developed a plan last year to institute service-wide some of the same holistic methods that helped Fridovich, the general was part of the campaign.
"I want to be involved," Fridovich says. "I want to listen to where this is going and see if my playing a part would lend any sense of urgency or importance — get it moving in a way that we start getting things done."
He says Army medicine must be better prepared to treat pain with aggressive monitoring of medication, drug education, acupuncture, nutrition and proper exercise. "We ask great things of (soldiers). Don't we owe them great things as well?" Fridovich says. "It's about the human expense."