Substance use in Military Personnel: Associations with Combat Exposure, Moral Injury, Posttraumatic Stress Disorder and Pain

BackgroundPrior research suggests that military personnel endorse higher rates of prescription drug misuse, cannabis, and heavy alcohol use than civilians. Factors related to substance use may differ for military personnel compared to civilians. In the present study, we examined whether combat exposure, moral injury, posttraumatic stress disorder (PTSD), and pain were associated with military personnel's self-reports of misuse of prescription opiates, prescription sedatives, both prescription opiates and sedatives, cannabis use, and hazardous alcohol consumption.MethodParticipants were a community sample of 238 U.S. military personnel who had deployed one or more times (71.0% males; <i>M</i> = 33.3 years; <i>SD</i> = 3.2).ResultsIn our sample, rates of past week misuse were as follows: 21.0% prescription opiates, 25.6% prescription sedatives, 16.4% both prescription opiates and sedative medications. With respect to cannabis use and alcohol consumption, 14.7% reported past-week cannabis use and 46.2% participants reported hazardous alcohol consumption above suggested clinical cut-offs. In multivariable multinomial logistic regression analyses, combat exposure and moral injury were uniquely associated with a greater likelihood of misusing prescription opiates, sedatives, and both opiates and sedatives versus no misuse. Higher PTSD symptoms scores were uniquely associated with past week cannabis use versus no use. Further, greater combat exposure was uniquely associated with a greater likelihood of engaging in hazardous alcohol use.ConclusionsThese results suggest that distinct psychosocial factors may differentially impact substance use among military personnel. Findings indicate the importance of assessing combat exposure, moral injury, PTSD, and pain to better understand substance use and treatment of military personnel.