Robert M. Bray

Substance Use and Mental Health Trends Among U.S. Military Active Duty Personnel: Key Findings From the 2008 DoD Health Behavior Survey

OBJECTIVE Examine substance use and mental health issues among U.S. military personnel. METHODS Data were from the 2008 (and before) population-based Department of Defense Health Related Behavior Surveys. The sample size for the 2008 survey was 28,546 (70.6% response rate). RESULTS Analyses examined substance use, stress, depression, post-traumatic stress disorder (PTSD), suicidal ideation and attempts, deployment, and job satisfaction. Trends show reductions in tobacco use and illicit drug use, but increases in prescription drug misuse, heavy alcohol use, stress, PTSD, and suicidal attempts. Deployment exacerbated some of these behavior changes. Despite the demanding lifestyle, job satisfaction was high. CONCLUSIONS The military has shown progress in decreasing cigarette smoking and illicit drug use. Additional emphasis should be placed on understanding increases in prescription drug misuse, heavy alcohol use, PTSD, and suicide attempts, and on planning additional effective interventions and prevention programs. Challenges remain in understanding and addressing military mental health needs.

Standardized comparisons of the use of alcohol, drugs, and cigarettes among military personnel and civilians

BACKGROUND Understanding the effectiveness of policies and programs aimed at combating substance abuse in the military requires comparison with the civilian population from which military personnel are drawn. METHODS Standardized comparisons of the use of alcohol, drugs, and cigarettes among military personnel and civilians were conducted with data from the 1985 Worldwide Survey of Alcohol and Nonmedical Drug Use among Military Personnel and the 1985 National Household Survey on Drug Abuse. The two data sets were equated for age and geographic location of respondents, and civilian substance use rates were standardized to reflect the sociodemographic distribution of the military. RESULTS Military personnel were significantly less likely than civilians to use drugs, but were significantly more likely to use alcohol and cigarettes and to engage in heavy use of alcohol and cigarettes. Heavy drinking was especially likely among young military men. Military women were similar to military men in their smoking and drug use patterns. CONCLUSIONS Findings suggest that military policies and programs have been notably effective in reducing drug use, but that efforts to limit alcohol and cigarette use should be intensified. Military efforts directed against alcohol abuse should be targeted toward younger men, while smoking and drug prevention programs should be directed toward both men and women.

Stress and Substance Use Among Military Women and Men

This paper examines the relationship between perceived stress (at work, in family or personal life, and from being a woman in the military) and substance use (heavy drinking, illicit drug use, cigarette smoking) among active-duty military women and men. Data were drawn from over 16,000 respondents to the 1995 Department of Defense Survey of Health Related Behaviors Among Military Personnel. Findings indicated substantial substance use and perceived high stress in the armed forces. Further, the relation between substance use and stress varied by gender. Military women reported substantially lower rates of heavy drinking than men, but had similar rates of illicit drug use and cigarette smoking. Both military women and men were more likely to describe their military duties as more stressful than their family or personal lives; for women, the stress associated with being a woman in the military was second to stress at work. Stress at work or in the family was an important predictor of substance use among military men, but not among military women. For military women, stress associated with being a woman in the military was predictive of illicit drug use and cigarette use. These findings suggest that 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.

Use of the simulation method in the study of jury behavior: Some methodological considerations.

Current literature reviews (Davis, Bray, & Holt, 1977; Elwork & Sales, in press; Gerbasi, Zuckerman, & Reis, 1977) reveal a lively interest in the study of jury functioning. In most of the extant research, simulations in the form of a mock trial have emerged as the primary research vehicle. Despite its popularity, a great deal of criticism has been leveled at this mode of investigation (e.g., Bermant, McGuire, McKinley, & Salo, 1974; Konecni, Mulcahy, & Ebbesen, in press; Colasanto & Sanders, Note 1; Miller, Fontes, Boster, & Sunnafrank, Note 2). While such criticism deserves thoughtful consideration, there also seems to be a need for an analysis that clearly examines variations in mock-trial simulations and their relative strengths and weaknesses.

Alcohol use and negative consequences among active duty military personnel.

AIMS An examination of alcohol use patterns in the active duty military to determine the relations of drinking levels and self-reported negative outcomes. DESIGN A population-based cross-sectional study design using two-stage complex sampling methodology. SETTING Paper and pencil surveys were administered anonymously in groups at 64 U.S. military installations worldwide. PARTICIPANTS Randomly selected active duty members (28,546) at major military installations representing the total active force, with the exception of recruits, cadets, and incarcerated personnel. MEASURES Personnel were classified into five drinking levels ranging from abstainer to heavy drinker based on quantity and frequency of alcohol intake. Negative outcomes were measured as self-reported serious consequences of alcohol use and alcohol-related productivity loss. Risk for other alcohol related problems was assessed by the Alcohol Use Disorders Identification Test (AUDIT). FINDINGS Alcohol negative outcomes showed a curvilinear dose-response relationship with drinking levels. Higher levels of drinking were associated with higher rates of alcohol problems, but problem rates were notably higher for heavy drinkers. Heavy alcohol users showed nearly three times the rate of self-reported serious consequences and over twice the rate of self-reported productivity loss than moderate/heavy drinkers. Heavy drinkers also had the highest risk for alcohol problems on the AUDIT. One fifth of military personnel were heavy drinkers and were most likely aged 18 to 35. CONCLUSIONS Prevention and clinical interventions should include a major focus on heavy drinkers. Commanders and peers should be trained in recognizing signs of heavy alcohol use and in approaching heavy alcohol users in a way that will foster positive attitudes as opposed to defensiveness and stigma.

The impact of smoking and other substance use by urban women on the birthweight of their infants.

The impact of maternal smoking and other substance use during pregnancy on infant birthweight is demonstrated in a sample of 766 urban women, using data collected in the Washington, D.C. Metropolitan Area Drug Study (DC*MADS). Women residing and giving birth in the District of Columbia were interviewed in 1992. A multivariable linear regression model was used to quantify the association between birthweight and the mothers use of cigarettes, alcohol, or illicit drugs during pregnancy, while controlling for possible confounding variables. The analysis focused on factors, including prenatal care and substance use during pregnancy that may contribute to low birthweight infants born to this sample of urban, predominantly black women. A womans use of cigarettes, marijuana, and heroin during pregnancy was related to infant birthweight, but her use of alcohol and cocaine during pregnancy was not significantly related. Smoking during pregnancy was a strong predictor for low birthweight, suggesting that targeting more smoking cessation programs for pregnant women, particularly those who may also be illicit drug users, could help reduce adverse health consequences for low birthweight infants.

Trends in Binge and Heavy Drinking, Alcohol-Related Problems, and Combat Exposure in the U.S. Military

Population-based Department of Defense health behavior surveys were examined for binge and heavy drinking among U.S. active duty personnel. From 1998–2008, personnel showed significant increases in heavy drinking (15% to 20%) and binge drinking (35% to 47%). The rate of alcohol-related serious consequences was 4% for nonbinge drinkers, 9% for binge drinkers, and 19% for heavy drinkers. Personnel with high combat exposure had significantly higher rates of heavy (26.8%) and binge (54.8%) drinking than their counterparts (17% and 45%, respectively). Heavy and binge drinking put service members at high risk for problems that diminish force readiness and psychological fitness.

Chaplaincy and Mental Health in the Department of Veterans Affairs and Department of Defense

Chaplains play important roles in caring for Veterans and Service members with mental health problems. As part of the Department of Veterans Affairs (VA) and Department of Defense (DoD) Integrated Mental Health Strategy, we used a sequential approach to examining intersections between chaplaincy and mental health by gathering and building upon: 1) input from key subject matter experts; 2) quantitative data from the VA / DoD Chaplain Survey (N = 2,163; response rate of 75% in VA and 60% in DoD); and 3) qualitative data from site visits to 33 VA and DoD facilities. Findings indicate that chaplains are extensively involved in caring for individuals with mental health problems, yet integration between mental health and chaplaincy is frequently limited due to difficulties between the disciplines in establishing familiarity and trust. We present recommendations for improving integration of services, and we suggest key domains for future research.

Military Report More Complementary and Alternative Medicine Use than Civilians

OBJECTIVES The study objective was to estimate complementary and alternative medicine (CAM) use among active duty military and compare data with civilian use. DESIGN A global survey on CAM use in the 12 previous months was conducted. Final participants (16,146) were stratified by gender, service, region, and pay grade. Analysis included prevalence of CAM use, demographic and lifestyle characteristics. RESULTS Approximately 45% of respondents reported using at least one type of CAM therapy. Most commonly used therapies were as follows: prayer for ones own health (24.4%), massage therapy (14.1%), and relaxation techniques (10.8%). After exclusion of prayer for ones own health, adjusting to the 2000 U.S. census, overall CAM use in the military (44.5%) was higher than that in comparable civilian surveys (36.0% and 38.3%). CONCLUSIONS Military personnel reported using three CAM stress-reduction therapies at 2.5-7 times the rate of civilians. Among the military, high utilization of CAM practices that reduce stress may serve as markers for practitioners assessing an individuals health and well-being.

Relationships between substance use and recent deployments among women and men in the military

Relatively little is known about the proclivity of military personnel to engage in substance use during deployments that do not include direct combat, even though such use has negative implications for military readiness and the safety of personnel. Using data from the 1995 Department of Defense Survey of Health Related Behaviors Among Military Personnel, we examined whether substance use was associated with deployment in the past 30 days among women and men in the military. Regression models, controlling for sociodemographic factors, showed higher rates of heavy alcohol use among deployed women and men than among those not deployed. This relationship was particularly notable for women: Those deployed were almost 3 times more likely than their nondeployed counterparts to report heavy alcohol use. Among men in the military, deployment also was found to be associated with higher rates of cigarette use, nonheavy alcohol use, and alcohol dependence. Implications of these findings are discussed along with directions for future research.