Longitudinal trajectories in recovery capital and associations with substance use among adult drug treatment court clients.

BACKGROUND: Recovery capital (RC) refers to the resources individuals use to support substance use disorder (SUD) recovery. Individuals with SUD who are involved with the criminal justice system often have limited RC. Drug treatment courts (DTCs), including traditional drug treatment courts (tDTCs) and opioid intervention courts (OICs), can link clients to important sources of RC in the short-term, but few studies have assessed RC longitudinally. METHODS: The current study analyzed five waves of data from a one-year longitudinal study on substance use and RC collected from clients of tDTCs and OICs (n=165, 52% male, 75% non-Hispanic White, Age=21-67 years). Mixed-effects models examined (1) within-person trends over time in RC, (2) individual characteristics associated with differences and changes in RC, and (3) patterns of relationships between RC and substance use over time. We also tested differences by court type. RESULTS: First, OIC participants had lower RC at baseline relative to tDTC participants, and there was considerable within-person variability in RC over time. Second, the effect of a high school diploma/GED at baseline on RC change over time was greater for OIC relative to tDTC participants. Third, there was a negative concurrent within-person association between drug use and RC that became stronger over time for OIC relative to tDTC participants. CONCLUSIONS: This study is among the first to examine longitudinal, within-person trajectories in RC. Results revealed important within-person variability over time in RC that was linked to education and drug use, particularly among OIC clients. Findings could help inform DTC treatment approaches.

Longitudinal Effects of Military Separation and Mental Health Symptomatology on Substance Use Among a Cohort of Reservists.

OBJECTIVE: The relationship between mental health and substance use among military populations is well established, and evidence suggests that these risks may be greater for those who have left the military. However, it is less clear what independent effects leaving the military may have on substance use behaviors. This study examined the longitudinal relationship between leaving the military and substance use outcomes (hazardous drinking, frequent heavy drinking, nonmedical use of prescription drugs, illicit drug use) in a cohort of Reserve and National Guard (R/NG) soldiers. Further, we examined whether mental health symptoms moderate the relationship between leaving the military and substance use. METHOD: Analyses used data (N = 485 soldiers) from the first four annual waves of Operation: SAFETY, an ongoing prospective cohort study of U.S. Army R/NG soldiers and their spouses. We used generalized estimating equations (GEEs) to examine the relationships between military status (former vs. current soldier) and substance use outcomes over 4 years. Last, we examined interactions between military status and mental health indicators (anxiety, anger, depression, and posttraumatic stress disorder) on substance use over time. RESULTS: After we controlled for sex, age, race, years of military service, sleep problems, bodily pain, and substance use norms, being a former soldier, compared with being a current soldier, was associated with greater odds of current illicit drug use (adjusted odds ratio = 2.86, 95% CI [1.47, 5.57]; p < .01). Mental health symptomatology did not moderate the relationship between leaving the military and current drug use. CONCLUSIONS: Leaving the military in and of itself may result in increased drug use for some individuals, regardless of mental health symptomatology.

United States Army Reserve/National Guard soldiers' healthcare experiences, attitudes, and preferences: Differences based on deployment status.

Some United States Army Reserve/National Guard (USAR/NG) soldiers have substantial health needs, which may be service-related, but not necessarily resulting from deployment. However, most USAR/NG members need to have been deployed to qualify for Veterans Administration (VA) benefits. Therefore, many USAR/NG soldiers seek care from civilian healthcare providers (HCPs). Using a subset (N = 430 current/former soldiers) of Operation: SAFETY study data, we used regression models to examine differences in healthcare experiences, attitudes, and preferences by deployment status (never-deployed vs. previously-deployed). Final models controlled for age, sex, rank (enlisted vs. officer), military status (current vs. former military), and RAND SF-36 General Health Score. Over 40% of soldiers agreed that civilian HCPs should ask patients about their military service, but never-deployed soldiers were less likely to report being asked about their service (p < 0.05) or how their service affects their health (p < 0.10). Never-deployed soldiers were also less likely to attribute their health concerns to military service (p < 0.001). Although never-deployed soldiers were more likely to prefer receiving physical (p < 0.05) and mental (p < 0.05) healthcare outside of the VA than previously-deployed soldiers, never-deployed soldiers had low confidence in their HCP's understanding of their needs (49% thought that their civilian HCP did not understand them; 71% did not think that their civilian HCP could address military-related health concerns; 76% thought that their civilian HCP did not understand military culture). Findings demonstrate that although civilian HCPs may be the preferred (and only) choice for never-deployed USAR/NG soldiers, they may need additional support to provide care to this population.

Cannabis approval and perceived risk of use among minority U.S. Army Reservists.

This study examined how minoritized U.S. Army Reserve/National Guard service members perceive cannabis use amid a continuously evolving societal and legal landscape in the United States. Logistic regression analyses were conducted to examine relationships between cannabis perceptions and race while considering illicit drug use norms, posttraumatic stress disorder symptomatology, and current drug use. Non-Hispanic Black soldiers had lower odds of approval for medicinal cannabis use and Hispanic soldiers had higher odds of perceived risk of cannabis use, both of which persisted when considering key covariates. These findings may be partly explained by a confluence of societal and cultural factors.

Exploring Racial/Ethnic Disparities in Substance Dependence and Serious Psychological Distress among US Veterans.

OBJECTIVES: There are substantial racial/ethnic disparities in substance use and mental health among civilian populations, but few studies have examined these disparities in veterans using a nationally representative sample. Thus, we examined differences in substance dependence and serious psychological distress (SPD) by race/ethnicity among a national sample of US veterans. METHODS: We pooled cross-sectional data from the 2015-2019 waves of the National Survey on Drug Use and Health (N = 7,653 veterans aged 18-64 years). Regression models were utilized to examine racial/ethnic differences in DSM-IV substance dependence and SPD with a Benjamini-Hochberg correction applied. RESULTS: Compared to non-Hispanic White veterans: American Indian/Alaska Native veterans had significantly higher odds of past-year alcohol dependence (AOR = 2.55, 95% CI: 1.28, 5.08); Asian American veterans had significantly lower odds of past-year alcohol dependence (AOR = 0.12, 95% CI: 0.02, 0.62); non-Hispanic Black (AOR = 0.60, 95% CI: 0.48, 0.77), Hispanic (AOR = 0.47, 95% CI: 0.34, 0.65), and veterans of more than one race (AOR = 0.55, 95% CI: 0.36, 0.83) had significantly lower odds of past-month nicotine dependence; Asian American veterans had significantly lower odds of past-year illicit drug dependence (AOR = 0.05, 95% CI: 0.01, 0.35); and non-Hispanic Black veterans had significantly lower odds of past-year SPD (AOR = 0.69, 95% CI: 0.55, 0.85) after correction for multiple comparisons. CONCLUSION: Overall, racial/ethnic disparities in substance dependence and SPD among veterans are not as stark as in civilian populations, but some disparities remain.

Cannabis Use and Perceptions Among Current and Former Military Service Members.

Background: Research indicates separation from the military may result in increased risk of alcohol use. However, there is little data on cannabis use among military service members, particularly when examining the period after separation from military service. This research examines cannabis-related perceptions and use among U.S. Army Reserve/National Guard (USAR/NG) current and former soldiers. Methods: Data come from Operation: SAFETY (Soldiers And Families Excelling Through the Years), an ongoing study examining health among male and female USAR/NG soldiers. The current sample was comprised of 401 current and former USAR/NG soldiers. Logistic regression models examined the associations between past-year cannabis use, military status (i.e., current versus former), attitudes towards recreational cannabis, perceived ease of access, and perceived risk of cannabis use, while controlling for age, problematic alcohol use, and current cigarette smoking. Results: Overall, 7.4% of current and 20.3% of former military service members used cannabis in the past year. Favorable attitudes towards cannabis use and perceived ease of accessing cannabis were associated with increased odds of use among all soldiers. In adjusted models, former military members had greater odds (AOR = 5.28, 95% CI = 2.16, 12.87) of past-year cannabis use compared to current service members. Conclusions: Findings indicate that separation from the military may be an important risk factor to consider when assessing cannabis use in the military. Additional research is needed to examine socioenvironmental factors (e.g., access to post-deployment support services and healthcare, state legalization laws, other behavioral health conditions) that contribute to former service members' cannabis use.

Sex differences in the relation between military sexual trauma and risk for alcohol misuse among U.S. Army Reserve and National Guard soldiers.

BACKGROUND: Military sexual trauma (MST) is linked to a range of deleterious health outcomes. Extant literature has focused disproportionately on mental health sequelae of MST. Research is needed to better understand the extent to which MST contributes to alcohol misuse and related problems - key issues facing service members. Additionally, sex differences in the nature and prevalence of MST may impact sequelae. The present research examined (a) the prevalence of an MST history among female and male service members, (b) relations between MST history and risk for alcohol misuse and related problems, and (c) potential sex differences in these experiences and outcomes. METHODS: Data from current and previous service members (334 males and 70 females) were drawn from Operation: SAFETY (Soldiers and Families Excelling Through the Years), a longitudinal study of U.S. Army Reserve and National Guard (USAR/NG) soldiers and their partners. Analyses examined the prevalence and types of MST experienced, relations between MST history and three alcohol-related variables (total consumption, heavy drinking frequency, and alcohol-related problems), and differences by sex. RESULTS: Approximately one-third (33.7%) of service members reported an MST history. Females (61.4%) reported an MST history at more than twice the rate of males (27.8%). Interactions between MST and sex were significant for all alcohol-related variables. Among males, an MST history was related to 70% higher alcohol consumption, 86% higher heavy drinking frequency, and 45% higher alcohol problem scores. An MST history was unrelated to alcohol-related variables among females. CONCLUSION: Findings suggest a higher prevalence of MST among USAR/NG service members than is often reported in the literature, particularly among males. An MST history was associated with higher and more hazardous/harmful current alcohol consumption among male service members, highlighting the need for greater screening, prevention, and intervention among a population already at high risk for problematic alcohol use. Results underscore that MST is an important and prevalent experience requiring greater study alongside more traditional notions of service-connected trauma.

The Role of Military Identity in Substance Use and Mental Health Outcomes among U.S. Army Reserve and National Guard Soldiers.

We investigated how military identity (i.e., veteran identity centrality, the extent to which military service is central to an individual's sense of self) relates to substance use and mental health among U.S. Army Reserve and National Guard (USAR/NG) soldiers. Data were drawn from Operation: SAFETY, a longitudinal survey study of USAR/NG soldiers. Regression models (n=413 soldiers) examined relationships between military identity and substance use (i.e., alcohol problems, past 3-months non-medical use of prescription drugs (NMUPD), illicit drug use, tobacco use), and mental health (i.e., generalized anxiety, anger, depression, PTSD), controlling for sex, race, age, education, years of military service, military status (current/former), and deployment (ever/never). In adjusted models, stronger military identity was not related to alcohol, illicit drug, or tobacco use, but was associated with past 3-months NMUPD (OR: 1.40, 95% CI: 1.12, 1.75, p<.01) and greater symptoms of anger (IRR: 1.02, 95% CI: 1.01, 1.03, p<.01), generalized anxiety (IRR: 1.05, 95% CI: 1.01, 1.10, p<.01), depression (IRR: 1.06, 95% CI: 1.02, 1.10, p<.01), and PTSD (IRR: 1.07, 95% CI: 1.02, 1.12, p<.01). Findings demonstrate the importance of military identity for health-related outcomes. NMUPD suggests potential self-medication and an avoidance of help-seeking, as admitting difficulties may conflict with military identity.

Problems With Sleep Are Common and Predict Increased Risk for Alcohol and Drug Use Among Reserve and National Guard Soldiers.

OBJECTIVE: Sleep problems are common among military members and may increase substance use risk. This study examines longitudinal associations between sleep problems and substance use among U.S. Army Reserve and National Guard (USAR/NG) soldiers as well as differences between current and former soldiers. METHOD: Data are drawn from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing prospective study of the health and well-being of USAR/NG soldiers and their spouses. We used generalized estimating equation models (N = 485 soldiers; 79.8% male) to examine residual change in substance use (alcohol problems, heavy drinking, current use of any drug, nonmedical use of prescription drugs [NMUPD], and illicit drugs) associated with sleep problems (globally and particular dimensions) over 3 years, controlling for probable post-traumatic stress disorder, age, sex, and substance use at the prior time point. Interaction models examined differences by military status (current vs. former soldier). RESULTS: Sleep problems were associated with increased risk of heavy drinking (p < .05), any current drug use (p < .05), current NMUPD (p < .01), and current illicit use (p < .05). There were significant interactions between sleep quality and military status on any current drug use (p < .01) and current illicit use (p < .05) and between sleep duration and military status on current NMUPD (p < .05), such that the risk of substance use was greater for former compared with current soldiers. CONCLUSIONS: Sleep problems are prevalent among USAR/NG soldiers and are longitudinally associated with alcohol and drug use. This risk may increase for soldiers who have separated from the military. These findings support routine screening for sleep problems among soldiers and predischarge education around substance use risks related to unaddressed sleep problems.

Lifetime trauma exposure profiles and alcohol use over time among U.S. Reserve and National Guard soldiers.

Although trauma exposure is a recognized risk factor for alcohol use, research on military populations has emphasized combat exposure, with minimal consideration of exposure to other potentially traumatic events (PTEs). We aimed to (a) identify, characterize, and quantify subgroups of service members based on PTE patterns; (b) examine associations between trauma exposure subgroups and alcohol use; and (c) examine these associations longitudinally. Data were drawn from Operation: SAFETY, a longitudinal study of health and well-being among U.S. Army Reserve/National Guard soldiers (N = 478). Exposure to 15 PTEs, including childhood maltreatment, noninterpersonal events (e.g., natural disasters, accidents), interpersonal trauma, and military-related exposures, was assessed at baseline. Latent profile analysis was conducted to characterize mutually exclusive trauma profiles; profile membership was used to longitudinally predict alcohol use in generalized estimating equation models. Four exposure profiles were identified: intimate partner violence (IPV)/combat trauma (8.4%, n = 40), combat trauma (24.7%, n = 118), childhood trauma (8.4%, n = 40), and low trauma (58.6%, n = 280). In adjusted models, compared to the low trauma profile, IPV/combat profile membership was longitudinally associated with alcohol problems, OR = 2.44, p =.005. Membership in other trauma profiles was not associated with alcohol use. Within the IPV/combat profile, men had a higher risk of frequent heavy drinking than women. Results suggest a need to comprehensively screen for lifetime PTE exposure, particularly IPV, in military populations. Given the high prevalence of nonmilitary PTEs, an inclusive, trauma-informed approach to health care and service provision is warranted.

Drug use over time among never-deployed US Army Reserve and National Guard soldiers: The longitudinal effects of non-deployment emotions and sex.

Some US military service members who have never been deployed experience negative emotions related to never having been deployed, and some work shows these non-deployment emotions (NDE) are cross-sectionally associated with hazardous drinking for male, but not female, US Army Reserve/National Guard (USAR/NG) soldiers. However, it is not known if these effects extend to drug use or persist longitudinally, which is the focus of the current study. We conducted a longitudinal residual change analysis of a subset of data (N = 182 never-deployed soldiers) from Operation: SAFETY, an ongoing survey-based study of USAR/NG soldiers recruited from units across New York State. Outcome measures included current tobacco use, non-medical use of prescription drugs (NMUPD), current cannabis use, and other current illicit drug use (excluding cannabis) at four time points over a 3-year period. Results from bootstrapped residual change generalized estimating equation (GEE) models show that more negative NDE were longitudinally associated with a greater likelihood of current NMUPD among male, but not female, soldiers (p < 0.05). NDE were not longitudinally associated with current tobacco use, cannabis use, or other illicit drug use among male or female soldiers (ps > 0.05). NDE may contribute to ongoing NMUPD among male USAR/NG soldiers who have never been deployed. Never-deployed soldiers, especially those with negative emotions related to never having been deployed, should not be overlooked in military screening and intervention efforts.

Effects of Social Network Characteristics on Mental Health Outcomes Among United States Army Reserve and National Guard Soldiers.

We sought to examine the relative salience of multiple social network structural characteristics (e.g., size, composition, quality, substance use) for understanding soldiers' mental health symptoms (anger, anxiety, depression, PTSD). Data are drawn from soldiers (N = 421) participating in the Operation: SAFETY study. Negative binomial regression models examined the relationship between ten social network characteristics and mental health outcomes, controlling for age, sex, years of military service, and deployment history. Greater number of close network ties was associated with fewer symptoms of anger, anxiety, and depression (ps < 0.05), but not PTSD. Having more illicit drug-using network ties was associated with greater severity of anxiety symptoms (p < 0.05). Finally, more days spent drinking with network members was related to higher levels of anger (p < 0.05). Interpersonal relationships that entail substance use are associated with greater anxiety and anger while a greater number of close ties is associated with fewer anger, anxiety, and depression symptoms.

Mental and physical health factors related to dual use of veterans affairs and non-veterans affairs healthcare among U.S. reserve soldiers.

This study examined the association between mental and physical health factors and dual use of Veterans' Affairs (VA) and non-VA healthcare among previously deployed male Reserve/National Guard (R/NG) soldiers (N = 214). Participants completed online annual surveys on a range of topics, including validated measures of mental and physical health, as well as questions about past-year healthcare utilization. Multinomial logistic regression models separately examined the association between mental health symptoms (PTSD, anxiety, depression, emotional role limitations), physical health symptoms (bodily pain, physical role limitations), and healthcare use (single use and dual use compared to no use), controlling for geography, trust in the VA, age, and race. Anxiety (aRR: 1.13; 95% Confidence Interval (CI): 1.02, 1.26; p<.05), depression (aRR: 1.23; 95% CI: 1.06, 1.43; p<.01), and PTSD (aRR: 1.05; 95% CI: 1.01, 1.10; p<.05) symptoms were all related to past year dual use of VA and non-VA healthcare, even after controlling for known demographic factors. Bodily pain and emotional and physical role limitations were not related to healthcare outcomes. This suggests that mental health symptoms themselves may be a primary factor driving healthcare use. Further study is needed to examine whether dual use of VA and non-VA healthcare is duplicative or complementary.

Differences in alcohol screening and alcohol problems among United States veterans based on military service history.

Military deployment is a risk factor for alcohol problems, and postdeployment alcohol problems are more prevalent among part-time reservists than full-time active duty service members. However, emerging research suggests that reservists who never experience deployment are also at risk. We examined if never-deployed/activated reserve veterans differed from active duty/deployed veterans in alcohol screening and misuse. Using pooled cross-sectional data from the National Survey on Drug Use and Health (NSDUH; 2015-2019), we estimated the prevalence of past-year self-reported alcohol screening by a health care provider and measured DSM-IV alcohol abuse and alcohol dependence among U.S. veterans aged 18-49 years with at least one health care visit in the past year (N = 4,148). We used regression models to examine for differences in these outcomes between never-deployed/activated reserve veterans and active duty/deployed veterans. Overall, 15% of veterans reported not being screened for alcohol use, despite 1 in 11 meeting DSM-IV criteria for alcohol abuse/dependence. Active duty/deployed veterans were more likely to have been screened for alcohol use than never-deployed/activated reserve veterans (p < .05). However, there was no difference in past-year alcohol abuse (p > .05) or dependence (p > .05) between never-deployed/activated reserve veterans and veterans with a history of active duty service/activation. Never-deployed/activated reserve veterans are less likely to be screened for alcohol use than active duty/deployed veterans, despite no significant difference in meeting alcohol abuse/dependence criteria. Providers may not recognize never-deployed reservists as veterans. We recommend systematic screening for military service history and alcohol use for all veterans, regardless of deployment/active duty service. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Resilience to Hazardous Drinking Among Never-Deployed Male United States Army Reserve and National Guard Soldiers.

BACKGROUND: Negative emotions related to never having been deployed to active duty are associated with an increased risk of hazardous drinking among United States Army Reserve/National Guard (USAR/NG) soldiers. Resiliency factors are known to buffer the effects of combat on hazardous drinking among service members who have been deployed, but it is not known whether these factors are protective for never-deployed service members, or which domains of hazardous drinking might be affected. Therefore, we examined the effects of a range of resiliency factors (i.e., marital satisfaction, psychological hardiness, intrinsic religiosity) on the relation between nondeployment emotions (NDE) and domains of hazardous drinking. METHODS: We drew a subset of data from Operation: Soldiers and Families Excelling Through the Years (N = 112 never-deployed male soldiers), an ongoing study of USAR/NG soldiers. Regression models examined the main effects of NDE on each of the domains of hazardous drinking (i.e., total Alcohol Use Disorders Identification Test [AUDIT] score, consumption subscale, dependence subscale, alcohol-related problems subscale) and effect modification of each of the resiliency factors on the relations between NDE and the domains of hazardous drinking, separately. Final models controlled for years of military service, rank (enlisted vs. officer), number of military friends in the social network, and depression. RESULTS: Greater NDE were associated with a higher total AUDIT score, alcohol consumption, and alcohol dependence (ps < 0.05), but not alcohol-related problems (p > 0.05). Marital satisfaction and psychological hardiness buffered the effects of NDE on total AUDIT score and alcohol dependence (p < 0.05). Intrinsic religiosity only modified the effect of NDE on total AUDIT score. None of the resiliency factors modified the effects of NDE on alcohol consumption or alcohol-related problems. CONCLUSIONS: Soldiers with greater NDE had a greater risk of hazardous drinking in the presence of low resilience. Interventions to promote resiliency are an important consideration for protecting USAR/NG soldiers from hazardous drinking, regardless of their deployment history.

Resilience to mental health problems and the role of deployment status among U.S. Army Reserve and National Guard Soldiers.

PURPOSE: Research suggests that interpersonal and intrapersonal resiliency factors protect against poor post-deployment mental health outcomes among Reserve/Guard soldiers who have been deployed. There is increasing awareness that never-deployed soldiers are also at risk. The purpose of this study was to examine the relationships between resiliency factors and a range of mental health outcomes among a sample of United States Army Reserve and National Guard (USAR/NG) soldiers who have and have not experienced deployment. METHODS: A subset of data was drawn from Operation: SAFETY (N = 360), an ongoing study examining the health and well-being of USAR/NG soldiers. We used a multivariate path analysis approach to examine the simultaneous effects of unit support, marital satisfaction, and psychological hardiness on the following mental health outcomes, concurrently: anger, anxiety, depression, and posttraumatic stress disorder (PTSD) symptomatology. We also examined interaction effects between resiliency factors and deployment status on mental health outcomes. RESULTS: Greater unit support (ps < 0.01), marital satisfaction (ps < 0.001), and psychological hardiness (ps < 0.001) were associated with less anger, anxiety, depression, and PTSD symptomatology. Psychological hardiness had significant interactions with deployment status on anxiety, depression, and PTSD, such that the protective effects of psychological hardiness were even stronger among never-deployed soldiers than previously deployed solders. CONCLUSION: Resiliency factors can be targeted for intervention to prevent poor mental health outcomes among USAR/NG soldiers, regardless of deployment status. Further, psychological hardiness may be an even more important protective factor among soldiers who have never been deployed.

Hardiness protects against problematic alcohol use in male, but not female, soldiers.

Military service members are at high risk for problematic substance use compared with the general population; deployment and combat exposure further increases this risk. It is thus critical to identify resiliency factors that can buffer the negative effects of military experiences and potentially prevent problematic alcohol use. The current research examines the extent to which psychological hardiness predicts lower risk of problematic alcohol use and explores potential sex differences in this association. Data are from Operation: SAFETY, an ongoing study of U.S. Army Reserve/National Guard soldiers. Negative binomial regression models examined the relation between baseline hardiness, assessed by the 15-item Dispositional Resiliency Scale, and problematic alcohol use at the 1-year follow-up, assessed by the Alcohol Use Disorders Identification Test (N = 260), controlling for baseline combat exposure (Combat Exposure subscale, Deployment Risk and Resilience Inventory-2) and baseline quantity and frequency of alcohol use. To examine the impact of hardiness on men and women, models were stratified by sex. In final, adjusted models, hardiness predicted lower risk of problematic alcohol use (adjusted risk ratio = 0.98; p < .05) for male soldiers and was unrelated to alcohol use for female soldiers (adjusted risk ratio = 1.01; p > .05). Post hoc analyses explored the impact of each dimension of hardiness (i.e., commitment, control, and challenge) on problematic alcohol use. Hardiness assessment may complement existing screening tools to identify high-risk populations; interventions to promote hardiness may help in preventing problematic alcohol use, particularly among male soldiers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Lower levels of bodily pain increase risk for non-medical use of prescription drugs among current US reserve soldiers.

BACKGROUND: Military populations have a higher prevalence of pain compared to their civilian counterparts and are also at increased risk for substance use. The link between clinically significant pain and substance use has been established, but it is unclear if lower levels of pain relate to risk. The goal of this inquiry was to determine if level of bodily pain was associated with increased risk of current substance use over time among a community sample of U.S. Army Reserve/National Guard (USAR/NG) soldiers. METHODS: Data were drawn from an ongoing study of USAR/NG soldiers. We used generalized estimating equations to examine the longitudinal impact of baseline bodily pain level (modeled in standard deviations from the mean pain score) on current drug use (illicit and non-medical use of prescription drugs [NMUPD]) among soldiers (n = 387) over two-years. Final models controlled for baseline post-traumatic stress disorder (PTSD), anxiety, and depression symptomatology, history of deployment (yes/no), years of military service, and substance use norms. RESULTS: Bodily pain was longitudinally associated with increased odds of current NMUPD (AOR: 1.49, p < .05), but not with the current use of illicit drugs (AOR: 1.18, p > .05), controlling for symptoms of PTSD, anxiety, depression, deployment, years of service, and substance use norms. CONCLUSIONS: Overall, our findings indicate that bodily pain is longitudinally associated with NMUPD among male soldiers, but not with illicit drugs. Significantly, our results stem from a non-clinical sample of soldiers with overall lower levels of pain. This indicates that pain may be important, even at lower levels, and underscores the importance of early non-pharmacologic interventions for pain.

Problems with social acceptance and social victimization predict substance use among U.S. Reserve/Guard soldiers.

The effects of negative social interactions/experiences on substance use have largely been studied in civilian populations, but less is known about United States Army Reserve/National Guard (USAR/NG) soldiers-a high-risk group. We examined the associations between problems with social acceptance, social victimization, and substance use among USAR/NG soldiers, and examined potential differences by deployment history. The sample consisted of soldiers who completed baseline and 1-year follow-up assessments (N = 445) of Operation: SAFETY, an ongoing study of USAR/NG soldiers. We examined the effects of baseline problems with social acceptance/social victimization on nonmedical use of prescription drugs (NMUPD), illicit drug use, frequent heavy drinking (FHD), and alcohol problems at follow-up. Significant effects were small in magnitude but consistent in direction. Greater problems with social acceptance were associated with higher odds of NMUPD and illicit drug use. Greater social victimization was associated with higher odds of NMUPD and illicit drug use. There were no differences by deployment history. Problems with social acceptance/social victimization were not associated with FHD or alcohol problems. Problems with social acceptance/social victimization may contribute to drug use among USAR/NG soldiers. Intervention programs should address social issues, regardless of deployment history.

Mental health and educational outcomes among current and former National Guard and Reserve soldiers.

Objective: This study examined the relationships between mental health and educational outcomes among student service members and veterans (SSM/Vs). Participants: Current/former Reserve and National Guard (R/NG) soldiers who were enrolled in school, college, or university in the past year (n = 130). Data were collected in 2014-2016. Methods: Exact logistic regression models separately examined the impact of anxiety, depression, anger, and PTSD on quitting/flunking in the past year. Final models controlled for sex and deployment status. Results: In final models, anxiety [OR: 1.14; 95% confidence interval (CI): 1.05, 1.23; p<.01], anger (OR: 1.12; 95% CI: 1.04, 1.21; p<.01), and PTSD (OR: 1.06; 95% CI: 1.02, 1.10; p<.01) were associated with a higher odds of quitting/flunking school, college or university. Depression was not associated with quitting/flunking. Conclusion: Anxiety, anger, and PTSD are associated with quitting/flunking among SSM/Vs. Interventions tailored to this population that address mental health needs may improve the likelihood of academic success.