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. 2022 May 8;38(5):1045–1057. doi: 10.1002/smi.3156

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

Rachel A Hoopsick 1,✉, D Lynn Homish 2, Schuyler C Lawson 2, Gregory G Homish 2
PMCID: PMC9853315  NIHMSID: NIHMS1862783  PMID: 35500288

Abstract

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.

Keywords: illicit drug use, military, non‐deployment emotions, non‐medical use of prescription drugs, reserve soldiers, tobacco use

1. INTRODUCTION

The Reserve Component of the US Armed Forces constitutes more than one‐third of the US military, the greatest proportion of which are US Army Reserve/National Guard soldiers (USAR/NG; Defense Manpower Data Centre, 2019). These part‐time service members may be at greater risk for some substance use and other psychological sequelae than their active duty counterparts (Beckman et al., 2021; Cohen et al., 2015; Ursano et al., 2018). For example, recent data from the Health Related Behaviours Survey showed that reservists were significantly more likely to report current use of any drug than active duty service members (Beckman et al., 2021). Much of the substance use research in USAR/NG populations has focussed on those who have experienced deployment, yet a considerable proportion of these soldiers may never deploy within their military careers (Defense Manpower Data Center, 2019). However, growing research suggests that never‐deployed and previously‐deployed USAR/NG have similar or even greater rates of substance use. For example, national data show that reservists do not significantly differ from veterans in the prevalence of past‐month prescription drug misuse (2.4% vs. 1.3%) or dependence (0.5% vs. 0.2%) (Hoopsick et al., 2017). Additionally, prevalence estimates from the Ohio Army National Guard Mental Health Initiative suggest that 15.6% of National Guard soldiers experience a drug use disorder in their lifetime (Tamburrino et al., 2015), despite a strict, “zero tolerance” policy regarding illicit drug use by the US Armed Forces.

1.1. Non‐deployment

Although the majority of military‐related research on substance use has focussed on the context of deployment experiences and the post‐deployment period, several studies have demonstrated that never‐deployed service members have comparable problems with mental health and substance use as service members who were previously deployed (Hoopsick, Homish, et al., 2019; Trautmann et al., 2014; Wells et al., 2010). Notably, Tamburrino et al. (2015) found there was no significant difference in the lifetime prevalence of drug use disorder (sedative, hypnotic, anxiolytic, cannabis, or other drug abuse or dependence) between National Guard soldiers who were previously deployed (15.1%) and those who were never deployed (16.7%). There are a number of reasons why some service members may not be selected for deployment (e.g., health status, injury, life events, stateside needs, overseas needs for specific military occupational specialities, etc.). It remains unclear if not being deployed contributes to poor mental health or substance use or if service members' poor mental health and/or substance use results in a lower likelihood of being selected for deployment.

Emerging research demonstrates many never‐deployed USAR/NG soldiers experience negative emotions related to never having been deployed, including feelings of guilt, decreased value to their units, decreased camaraderie with their unit members, and decreased connectedness to their unit (Hoopsick, Homish, Bartone, et al., 2018). These negative non‐deployment emotions have been associated with a range of mental health problems, including anger, anxiety, depression, and posttraumatic stress symptomatology (Hoopsick, Homish, Bartone, et al., 2018). Cross‐sectional data show that more severe negative emotions related to never having been deployed were also associated with several measures of alcohol use behaviours, including hazardous drinking, the frequency of getting drunk, the typical number of drinks consumed during a drinking episode, and the percent of days in the last 12 months that included drinking (Hoopsick, Homish, Vest, et al., 2018). However, the relationship between these emotions and other substance use has not been explored.

These negative emotions related to non‐deployment may function through the related experiences of guilt and shame proposed by Lewis (1971). Guilt is characterised by tension, remorse, and regret that results in being preoccupied with thinking about how things could be different (Tangney & Dearing, 2002). Relatedly, shame is a painful emotion often accompanied by a sense of worthlessness (i.e., loss of value), powerlessness, and feeling exposed, regardless of whether or not others actually witness one's own perceived shortcomings. Some service members may feel a deep sense of guilt and internalized shame related to their non‐deployment. In turn, this may result in a desire to escape (Tangney & Dearing, 2002). Previous research has shown that greater shame‐proneness is associated with problematic substance use (Dearing et al., 2005) and other maladaptive coping strategies, such as self‐blaming and catastrophizing (Szentágotai‐Tătar & Miu, 2016).

It is also possible that the social components of these negative emotions, including a loss of connectedness and camaraderie with soldiers' units due to non‐deployment, may affect soldiers' psychosocial well‐being. Among USAR/NG soldiers who were deployed, greater perceived social support from their military unit members during the deployment period was associated with a lower likelihood of post‐deployment drug use (Hoopsick, Benson, et al., 2019). Social support from one's unit has also been associated with less mental health symptomatology among both previously‐deployed and never‐deployed USAR/NG (Hoopsick, Homish, Collins, et al., 2021). Thus, the loss of connectedness and camaraderie experienced through negative emotions related to non‐deployment might also act as an ecological stressor to affect never‐deployed soldiers' propensity for substance use.

1.2. Role of sex differences

Examinations of substance use and substance use disorders by sex have been mixed. There are complex biological and environmental factors that contribute to a greater prevalence of substance use and substance use disorders among men as compared to women (McHugh et al., 2018); however, these differences in substance use behaviours and sequelae have narrowed considerably over time (Keyes et al., 2008; Seedat et al., 2009; White, 2020). Although both men and women are at risk for problems with substance use, there are notable differences in substance‐specific prevalence estimates. Recent data from the National Survey on Drug Use and Health suggest there are sex‐based differences in the prevalence of past‐month tobacco use (28.3% for men, 17.3% for women) and illicit drug use (14.5% for men, 9.0% for women) among adults aged 26 years of age and older (SAMHSA, 2020). Conversely, women tend to have similar or higher rates of non‐medical use of prescription drugs than men, including past‐month non‐medical use of stimulants (0.4% for men, 0.4% for women) and tranquilizers/sedatives (0.6% for men, 0.7% for women).

Data from the Ohio Army National Guard Mental Health Initiative showed that there is no significant difference in the lifetime prevalence of drug use disorder between male (15.5%) and female (16.7%) National Guard soldiers (Tamburrino et al., 2015). Our previous work demonstrated that negative emotions related to non‐deployment are prevalent among both male and female soldiers who have never been deployed (Hoopsick, Homish, Bartone, et al., 2018), but were only associated with hazardous drinking behaviours among male USAR/NG soldiers (Hoopsick, Homish, Vest, et al., 2018). These findings, coupled with a high lifetime prevalence of drug use disorder among reservists (Tamburrino et al., 2015), warrant further examination of potential sex‐based differences in the relations between non‐deployment emotions and drug use. In particular, our previous cross‐sectional work could be strengthened by examining these relations over time. Specifically, longitudinal research allows for the examination of potential changes in substance use over time and whether or not these residual changes are associated with varying levels of negative emotions related to non‐deployment.

1.3. Current study

Given that preliminary evidence suggests that non‐deployment may act as a stressor, it is important to understand how never‐deployed soldiers' feelings of guilt, decreased value to their units, decreased camaraderie with their unit members, and decreased connectedness to their unit might contribute to drug use over time. The current study examined a subset of data from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing longitudinal survey‐based study of USAR/NG soldiers and their partners. Our primary objective was to examine how non‐deployment may affect current drug use (i.e., tobacco use non‐medical use of prescription drugs, cannabis use, other illicit drug use) over time. Our second objective was to determine whether there was a differential effect for male and female soldiers.

2. MATERIAL AND METHODS

2.1. Participants and procedure

Participants were recruited for the Operation: SAFETY study from 47 USAR/NG units across New York State over a 15‐month period (Summer 2014 ‐ Fall 2015). These participants consisted of adult couples who were married or living as if married at baseline, in which at least one member of the dyad was a current USAR/NG soldier. Eligible couples completed electronic surveys annually after giving informed consent to participate, with follow‐up surveys administered approximately 1 year after each participant's prior survey date. Each Operation: SAFETY participant received a check for $60 at baseline, $70 for each of the first two follow‐up surveys (i.e., year 1, year 2), and $80 for the third follow‐up (i.e., year 3). The study protocol was approved by the Institutional Review Board at the University at Buffalo, the Army Human Research Protections Office, the Office of the Chief, Army Reserve, and the Adjutant General of the National Guard. A total of 731 soldiers and partners were eligible for inclusion in Operation: SAFETY. Of those, 572 (78%) agreed to participate and 83% of these couples (N = 472 couples) completed some part of the survey. Surveys were included only if both partners completed follow‐up (N = 418 couples). Of the 418 couples enroled at baseline in Operation: SAFETY, only 18 couples (4.3%) did not complete the year 3 follow‐up survey (both partners were lost to follow‐up). We conducted sensitivity analyses and found that if a civilian partner screened for the study (n = 11 couples) the couple was less likely to enrol (p < 0.001) than if a soldier screened for the study. Further details regarding recruitment, eligibility, and procedures have been previously published (e.g., Devonish et al., 2017; Heavey et al., 2017).

The analytic sample for the current study includes USAR/NG soldiers without a history of deployment who completed a follow‐up survey at year 1, year 2, and/or year 3. Participants were asked at baseline and each follow‐up assessment if they had ever been deployed in their lifetime as a part of any military service and were subsequently asked if they had been deployed between assessments at each follow‐up assessment (i.e., year 1, year 2, year 3). A detailed participant flow chart of the analytic sample (N = 182 never‐deployed soldiers) drawn from the Operation: SAFETY study is presented in Figure 1. Most of these soldiers were male (67.0%), non‐Hispanic White (79.1%), and had at least some college education (86.8%). On average, they had served 5.3 years (SD: 6.0) in the military and the majority were in an enlisted rank (83.0%). Additional sample characteristics are presented in Table 1.

FIGURE 1.

FIGURE 1

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Never‐deployed soldier participant flow chart. Shaded boxes comprise analytic study sample, N = 182 never‐deployed soldiers

TABLE 1.

Baseline characteristics of study sample, N = 182 never‐deployed soldiers

Mean (SD) or % (n)
Sex ‐‐
Male 67.0% (122)
Female 33.0% (60)
Age, years 28.9 (6.3)
Race/Ethnicity ‐‐
Non‐hispanic white 79.1% (144)
Non‐hispanic black 6.0% (11)
Hispanic 7.1% (13)
Other 6.0% (11)
Education ‐‐
High school 13.2% (24)
Some college 53.9% (98)
College degree 33.0% (60)
Median family income category $40,000 ‐ $59,999
Military service, years 5.3 (3.9)
Rank ‐‐
Enlisted 83.0% (151)
Officer 13.2% (24)
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2.2. Measures

2.2.1. Non‐Deployment emotions

We added a measure of negative emotions related to never having been deployed to the Operation: SAFETY study after baseline recruitment had begun. Thus, the first follow‐up survey (year 1) represents the earliest time point that included the collection of data related to non‐deployment emotions, the Non‐Deployment Emotions (NDE) Questionnaire (Hoopsick, Homish, Bartone, et al., 2018). The addition of this measure was approved by University at Buffalo's Institutional Review Board and was included in all subsequent follow‐up interviews of never‐deployed soldiers (year 1, year 2, year 3). The NDE assesses constructs of guilt, value, camaraderie, and connectedness using a series of 4 questions: ‘Do/Did you feel guilty for not having been deployed?“; ‘Do/Did you feel less valuable as a member of your unit because you have not been deployed?“; “Do/Did you feel less camaraderie with your unit because you have not been deployed?“; and “Do/Did you feel less connected with your unit because you have not been deployed?” Each question is scored 0–4 on a Likert scale with responses ranging from “Not at all” to “Extremely.” Summary NDE scores range from 0 to 16, with higher scores indicating more negative emotions related to never having been deployed. Previous psychometric testing of this instrument has demonstrated that all constructs are positively correlated with each other and that the NDE Questionnaire can well‐discriminate between soldiers that have low, moderate, and highly negative non‐deployment emotions (Hoopsick, Homish, Bartone, et al., 2018). The NDE had high reliability in our sample (year 1 αmen = 0.90, αwomen = 0.93).

2.2.2. Current tobacco use

We assessed current tobacco use at each time point (baseline, year 1, year 2, year 3) with the following questions: “In your lifetime have you smoked at least 100 cigarettes, and do you currently smoke cigarettes?”; “Do you currently use e‐cigarettes or a vaping device?”; “Do you currently smoke cigars?”; and “Do you currently use smokeless tobacco?” A response of “Yes” to any of these questions was considered a positive screen for current tobacco use. For the focal analyses, we dichotomised current tobacco use (no/yes). Among those who reported current tobacco use, we also quantified the severity of nicotine dependence using the Heaviness of Smoking Index (Kozlowski et al., 1994).

2.2.3. Current non‐medical use of prescription drugs

We assessed soldiers' current non‐medical use of prescription drugs (NMUPD) at each time point (baseline, year 1, year 2, year 3) with the National Institute on Drug Abuse (NIDA) Modified Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), which was vigorously tested to examine and ensure reliability and validity across diverse settings and cultures (WHO ASSIST Working Group, 2002). NMUPD was defined as using prescription stimulants, sedatives, opioids, or other prescriptions ‘on your own, that is either without a doctor's prescription, in greater amounts, more often, or longer than prescribed, or for a reason other than a doctor said you should use them.” NMUPD was assessed with the following question: “In the past 3 months, how often have you used (substance)?” Any use in the past 3 months was considered a positive screen for current NMUPD and was dichotomised (no/yes) for the set of focal analyses. Among those reporting current NMUPD, we also report on the substance‐specific involvement scores captured by the NIDA Modified ASSIST.

2.2.4. Current cannabis use and other illicit drug use

Current cannabis use and other illicit drug use were also assessed at each time point (baseline, year 1, year 2, year 3) using the NIDA Modified Assist (WHO ASSIST Working Group, 2002). Given that cannabis has been decriminalised in many U.S. states for medical and recreational purposes (though remains federally illegal and recreational cannabis was illegal in the state of New York at the time of data collection), cannabis use was examined separately from other illicit drug use, including cocaine or crack, stimulants, inhalants, sedatives, hallucinogens, and street opioids. Current use was assessed at each time point (baseline, year 1, year 2, year 3) with the following question: “In the past 3 months, how often have you used (substance)?” Any use of the substance in the past 3 months was considered a positive screen for current use. We dichotomised current cannabis use and other current illicit drug use (no/yes) in the focal analyses. We also report on the substance‐specific involvement scores captured by the NIDA Modified ASSIST for those who endorsed current use.

2.2.5. Sex

Soldiers self‐reported their sex upon enrolment into the Operation: SAFETY study.

2.3. Covariates

Age. Soldiers reported their date of birth at baseline and age was calculated at each time point based on the survey date. Given that substance use tends to decrease with age, we included age as a time‐varying covariate in our adjusted models.

Family income. Soldiers reported their total family income category at each time point (Less than $19,999; $20,0000 to $39,999; $40,000 to $59,999; $60,0000 to $79,999; $80,000 to $99,999; $100,000 to $119,999; $120,000 or more). Given the established associations between socioeconomic status and different types of substance use, we included family income as a time‐varying covariate in our final models.

Military friends in the social network. Consistent with other social network studies and research regarding non‐deployment emotions (Homish & Leonard, 2008; Hoopsick, Homish, Vest, et al., 2018; Hoopsick, Homish, Vest, et al., 2021), military social network friends were identified as those currently serving in any branch of the military and who the participant defined as someone who provided them with emotional support, someone with whom they socialized regularly, someone who helped them with practical or financial problems, and/or someone who was important to them. The number of military friends in the social network was included as a time‐varying covariate in adjusted models.

Clinical depression. Preliminary research showed that greater NDE were associated with greater depression symptomatology (Hoopsick, Homish, Bartone, et al., 2018). Given the overlap between symptoms of clinical depression (e.g., feelings of worthlessness or excessive or inappropriate guilt; American Psychological Association, 2001) and NDE, as well as the co‐occurring nature of depression and substance use (Davis et al., 2008; Hunt et al., 2020), we included clinically significant depression symptomatology as a covariate in our final models. We assessed depression symptomatology with the PHQ‐8 (Kroenke et al., 2009). This measure assesses the frequency of depression symptoms over the last 2 weeks, such as ‘Feeling down, depressed, or hopeless” and ‘Feeling bad about yourself.” We included the PHQ‐8 score as an ordinal variable in our analyses using clinical cut points (i.e., None, Mild, Moderate, Moderately Severe, Severe; Kroenke et al., 2009). The PHQ‐8 had high internal consistency in our sample (baseline αmen = 0.90, αwomen = 0.91).

Military status. Leaving the military may contribute to an increased risk of substance use (Golub & Bennett, 2014; Hoopsick et al., 2017; Vest et al., 2018). It is also possible that how soldiers feel about never having been deployed might also affect their decision to remain in the military and/or leaving the military might affect the severity of NDE. Given that leaving the military appears to be an independent risk factor for substance use and may be related to NDE (perhaps bidirectionally), it is also likely to confound the relationship between NDE and substance use. To account for potential confounding effects of military status, we included it as a time‐varying covariate (current vs. former soldier), given that some study participants separated from the military during the longitudinal Operation: SAFETY study.

2.4. Analysis

We used descriptive statistics to characterise the sample at baseline and to describe our time‐varying variables at each follow‐up assessment (year 1, year 2, and year 3). Next, we used empirical growth models to examine longitudinal changes in drug use over time, including time as the only predictor in each generalized estimating equation (GEE) model. To examine the longitudinal effects of NDE on residual changes in drug use (i.e., current tobacco use, current NMUPD, current cannabis use, other illicit drug use) over a 3‐year follow‐up period, we used separate GEE models. Given that all drug use outcomes were dichotomised at each time point (no/yes), all GEE models used a logit link function, and odds ratios (ORs) with 95% confidence intervals (CIs) were reported. NDE score was included in all models as our primary time‐varying predictor.

Adjusted GEE models controlled for the effect of the focal drug use outcome at the prior time point. Using a residual change approach, these models examined the relation between NDE at wave i and drug use measures at wave i, statistically controlling for drug use (matched to the outcome) at the prior wave (i ‐ 1). Therefore, any significant effects of NDE represent the prediction of residual change in drug use over the prior year. Controlling for drug use at the prior time point also addresses the within‐person autocorrelation of drug use across all time points. We also included age in years, family income category, number of military friends in the social network, clinical depression category as indicated by PHQ‐8 score (None, Mild, Moderate, Moderately Severe, Severe), and military status (current service member vs. former service member) as time‐varying covariates in adjusted models and reported adjusted odds ratios (AORs) with 95% CIs. Time (year 1, year 2, year 3) was also included in each model.

To examine for differences in the longitudinal relations between NDE and each of the drug use outcomes by sex, we then added an interaction term (cross product of NDE and sex) to each adjusted model with sex as a time‐invariant variable. Finally, we plotted the predictive margins of significant interactions to further examine and explain the effects of NDE on drug use. All GEE models were bootstrapped with 1000 replications to enhance the accuracy of inferences made with these data. We used Stata version 17.0 (College Station, TX) for all analyses.

3. RESULTS

3.1. Descriptive results

Non‐deployment emotions. The distributions of Non‐Deployment Emotions Questionnaire responses at each time point and other key variables of interest at each time point are presented in Table 2. Approximately three‐quarters of the sample reported having some negative feelings related to never being deployed at each time point (Figure S1). The mean NDE score was 4.2 (SD: 4.2) in year 1 and increased to 4.9 (SD: 4.8) in year 3, consistent with moderately negative non‐deployment emotions (Hoopsick, Homish, Bartone, et al., 2018).

TABLE 2.

Descriptive statistics of time‐varying variables for analytic sample

Baseline, N = 182 Year 1, N = 171 Year 2, N = 164 Year 3, N = 145
Mean (SD) or % (n) Mean (SD) or % (n) Mean (SD) or % (n) Mean (SD) or % (n)
Age 28.9 (6.3) 29.9 (6.4) 30.6 (6.3) 33.3 (6.4)
Median family income category $40,000 ‐ $59,999 $40,000 ‐ $59,999 $60,000 ‐ $79,999 $80,000 ‐ $99,999
Military friends in social network 0.8 (0.9) 0.7 (1.0) 0.7 (0.9) 0.6 (0.8)
Clinical depression ‐‐ ‐‐ ‐‐ ‐‐
None 73.1% (133) 78.4% (134) 76.8% (126) 69.7% (101)
Mild 18.1% (33) 15.8% (27) 13.4% (22) 17.9% (26)
Moderate 4.4% (8) 4.1% (7) 3.7% (6) 7.6% (11)
Moderately severe 2.8% (5) 0.6% (1) 3.1% (5) 2.8% (4)
Severe 1.7% (3) 1.2% (2) 3.1% (5) 2.1% (3)
Military status ‐‐ ‐‐ ‐‐ ‐‐
Current service member 88.5% (161) 87.7% (150) 78.1% (128) 57.9% (84)
Former service member 11.5% (21) 12.3% (21) 22.0% (36) 42.1% (61)
Total NDE score NA 4.2 (4.2) 4.9 (4.6) 4.9 (4.8)
NDE item 1: Do/Did you feel guilty for not having been deployed? NA ‐‐ ‐‐ ‐‐
Not at all 35.7% (61) 25.6% (42) 29.0% (42)
A little bit 28.7% (49) 32.9% (54) 29.0% (42)
Moderately 15.8% (27) 11.6% (19) 16.6% (24)
Quite a bit 15.2% (26) 18.3% (30) 15.2% (22)
Extremely 4.7% (8) 11.6% (19) 10.3% (15)
NDE item 2: Do/Did you feel less valuable as a member of your unit because you have not been deployed? NA ‐‐ ‐‐ ‐‐
Not at all 40.9% (70) 34.8% (57) 38.6% (56)
A little bit 28.7% (49) 26.2% (43) 25.5% (37)
Moderately 13.5% (23) 18.3% (30) 25.5% (37)
Quite a bit 11.7% (20) 11.0% (18) 11.7% (17)
Extremely 5.3% (9) 9.8% (16) 11.0% (16)
NDE Item 3: Do/Did you feel less camaraderie with your unit because you have not been deployed? NA ‐‐ ‐‐ ‐‐
Not at all 51.5% (88) 48.8% (80) 46.9% (68)
A little bit 24.0% (41) 22.0% (36) 22.8% (33)
Moderately 9.9% (17) 14.0% (23) 14.5% (21)
Quite a bit 11.1% (19) 9.8% (16) 9.0% (13)
Extremely 3.5% (6) 5.5% (9) 6.9% (10)
NDE item 4: Do/Did you feel less connected with your unit because you have not been deployed? NA ‐‐ ‐‐ ‐‐
Not at all 49.7% (85) 52.4% (86) 47.6% (69)
A little bit 25.2% (43) 20.1% (33) 23.5% (34)
Moderately 11.7% (20) 12.8% (21) 14.5% (21)
Quite a bit 9.4% (16) 10.4% (17) 6.9% (10)
Extremely 4.1% (7) 4.3% (7) 7.6% (11)
Current tobacco use ‐‐ ‐‐ ‐‐ ‐‐
No 69.2% (126) 61.4% (105) 68.3% (112) 75.2% (109)
Yes 30.8% (56) 37.4% (64) 29.9% (49) 24.8% (36)
Current NMUPD ‐‐ ‐‐ ‐‐ ‐‐
No 93.4% (170) 94.7% (162) 93.3% (153) 97.2% (141)
Yes 6.6% (12) 5.3% (9) 6.7% (11) 2.8% (4)
Current cannabis use ‐‐ ‐‐ ‐‐ ‐‐
No 94.0% (171) 95.3% (163) 92.7% (152) 89.7% (130)
Yes 6.0% (11) 4.7% (8) 7.3% (12) 10.3% (15)
Other current illicit drug use ‐‐ ‐‐ ‐‐ ‐‐
No 98.4% (179) 98.3% (168) 98.2% (161) 97.9% (142)
Yes 1.7% (3) 1.8% (3) 1.8% (3) 2.1% (3)
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Abbreviations: NDE, non‐deployment emotions; NMUPD, non‐medical use of prescription drugs; PHQ‐8, Patient Health Questionnaire.

Drug use. At baseline, 30.8% of the sample reported current use of tobacco, decreasing to just 1 in 4 soldiers reporting tobacco use by year 3. The baseline mean (±SD) Heaviness of Smoking Index scores for men (1.6 ± 1.2) and women (1.0 ± 1.1) were indicative of a low level of addiction (Kozlowski et al., 1994). The prevalence of current NMUPD varied across the time points and was as high as 6.7% (in year 2). Among soldiers who reported current NMUPD, 44.4% reported non‐medical use of prescription stimulants, 55.6% reported non‐medical use of prescription sedatives, and 66.7% reported non‐medical use of prescription opioids. The baseline substance use involvement scores for non‐medical use of prescription sedatives were indicative of moderate risk for both men (4.0 ± 5.1) and women (6.5 ± 6.2), while mean scores for non‐medical use of stimulants were suggestive of low risk (men: 1.0 ± 2.6, women: 0.6 ± 1.3). Baseline substance use involvement scores for non‐medical use of prescription opioids were indicative of moderate risk among men (4.1 ± 7.6) and low risk among women (0.9 ± 1.5).

The percentage of never‐deployed soldiers reporting current cannabis use increased over time, from 6.0% at baseline to 10.3% at year 3. Baseline substance use involvement scores for cannabis were suggestive of relatively low risk for both men (1.0 ± 3.4) and women (1.2 ± 2.4) but ranged from 0 to 22, suggesting that some soldiers were at moderate risk. Illicit drug use (excluding cannabis) remained low across all time points and substance use involvement scores were suggestive of low risk. Despite some variability in the prevalence of drug use across time points, empirical growth models suggest that there were no statistically significant changes from baseline to year 3 in current tobacco use (OR = 0.94, 95% CI: 0.85, 1.03; p = 0.170), NMUPD (OR = 0.84, 95% CI: 0.62, 1.14; p = 0.261), or illicit drug use (OR = 1.17, 95% CI: 0.77, 1.80; p = 0.460). The increase in cannabis use over time was significant at a trend level (OR = 1.28, 95% CI: 0.99, 1.64; p = 0.060).

3.2. Main effects of non‐deployment emotions on drug use

As shown in Table 3, NDE were not significantly associated with current tobacco use in unadjusted (OR = 1.04, 95% CI: 0.99, 1.09; p = 0.144) or adjusted models (AOR = 1.04, 95% CI: 0.98, 1.10; p = 0.238). Greater NDE was longitudinally associated with current NMUPD (OR = 1.12, 95% CI: 1.01, 1.26; p = 0.047), but this effect was no longer significant after controlling for the effects of clinical and sociodemographic covariates (AOR = 1.07, 95% CI: 0.95, 1.20; p = 0.270). NDE were not associated with current cannabis use or other current illicit drug use in unadjusted or adjusted models (ps > 0.10).

TABLE 3.

Longitudinal effects of non‐deployment emotions on drug use

Current tobacco use Current NMUPD Current cannabis use Other current illicit drug use
OR AOR OR AOR OR AOR OR AOR
(95% CI) (95%) (95% CI) (95% CI) (95% CI) (95% CI) (95% CI) (95%)
Non‐deployment emotions 1.04 1.04 1.12 a 1.07 1.05 1.00 1.17 1.11
(0.99, 1.09) (0.98, 1.10) (1.01, 1.26) (0.95, 1.20) (0.98, 1.12) (0.91, 1.09) (0.94, 1.46) (0.80, 1.54)
Open in a new tab

Note: Unadjusted models include the effect of time. Adjusted models include the effects of time, age in years, family income category, number of military friends in the social network, clinical depression category as indicated by PHQ‐8 score (None, Mild, Moderate, Moderately Severe, Severe), military status (current service member vs. former service member), and the focal substance use variable (i.e., current tobacco use, current NMUPD, current cannabis use, or other current illicit drug use) at the previous time point.

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; NMUPD, non‐medical use of prescription drugs; OR, odds ratio.

a

p < 0.05.

3.3. Interaction effects of non‐deployment emotions and sex on drug use

There was a significant interaction between NDE and sex on current NMUPD over time (AOR = 0.77, 95% CI: 0.60, 0.98; p = 0.037; Table 4), such that greater NDE was longitudinally associated with a higher likelihood of current NMUPD among male, but not female soldiers (Figure 2). There was no significant interaction between NDE and sex on current tobacco use (AOR = 1.05, 95% CI: 0.92, 1.19; p = 0.494), current cannabis use (AOR = 0.98, 95% CI: 0.79, 1.20; p = 0.813), or other current illicit drug use (AOR = 1.15, 95% CI: 0.70, 1.87; p = 0.586).

TABLE 4.

Interaction effects of sex and non‐deployment emotions on drug use

Current tobacco use Current NMUPD Current cannabis use Other current illicit drug use
AOR AOR AOR AOR
(95%) (95% CI) (95% CI) (95% CI)
Non‐deployment emotions X sex 1.05 0.77 a 0.98 1.15
(0.92, 1.19) (0.60, 0.98) a (0.79, 1.20) (0.70, 1.87)
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Note: In addition to the interaction term, models include the effects of non‐deployment emotions, sex, time, age in years, family income category, number of military friends in the social network, clinical depression category as indicated by PHQ‐8 score (None, Mild, Moderate, Moderately Severe, Severe), military status (current service member vs. former service member), and the focal substance use variable (i.e., current tobacco use, current NMUPD, current cannabis use, or other current illicit drug use) at the previous time point.

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; NMUPD, non‐medical use of prescription drugs; OR, odds ratio.

a

p < 0.05.

FIGURE 2.

FIGURE 2

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Predicted probability of current non‐medical use of prescription drugs by Non‐Deployment Emotions score and sex

4. DISCUSSION

The findings of the current study can be contextualised with the Bioecological Model of Deployment Risk and Resilience, a military‐informed ecological framework for understanding the relations between stressors, adversity, and life events on the psychosocial outcomes of military service members (Wooten, 2013). In this model, service members are “physically, socially, psychosocially, and environmentally embedded in multiple systems of influence in the military context” (p. 705). Wooten's multiphasic framework posits that service members affect and are affected by the ecological environment, and that stressors, adversity, and life events may originate across different contexts and points in time, resulting in disruptions to the biopsychosocial ‘homoeostatic state” or state of equilibrium in which individuals are able to actively adjust and adapt to life circumstances and develop coping mechanisms (Wooten, 2013). This model has primarily been used to understand military‐connected experiences and outcomes through the lens of deployment, but this framework has also been used to examine a heterogenous group of service members, including those who have never experienced deployment (Hoopsick, Homish, Collins, et al., 2021). Specifically, this framework has previously been used to understand social and environmental influences on service members' mental health symptomatology and may also be particularly useful to contextualise substance use in this population. It is possible that non‐deployment may act as a stressor within Wooten's ecological framework, resulting in an interruption to the biopsychosocial homoeostatic state, which may affect the likelihood of engaging in substance use.

It is important to note that deployment and group membership are central components of the reserve identity within US military populations (Griffith, 2011). While those that are deployed might serve a year or more with their unit (Adler et al., 2005), never‐deployed USAR/NG spend limited time with their units consisting of only 39 days of military service annually, participating in monthly weekend drills, and attending several days of training (Griffith, 2010). Thus, it is possible that non‐deployment may contribute to additional stress and isolation for never‐deployed soldiers. The data collection period of the current study coincided with several US military operations in the Middle East, and our results show that greater NDE are longitudinally associated with a higher likelihood of current NMUPD among male, but not female, USAR/NG soldiers who have never been deployed. These findings mirror our earlier cross‐sectional research that examined the relationship between negative emotions related to never having been deployed and hazardous drinking, which demonstrated a similar effect of NDE for male, but not female, USAR/NG soldiers (Hoopsick, Homish, Vest, et al., 2018). Preliminary research suggests that USAR/NG soldiers' identity centrality (i.e., the degree to which serving in the military is central to an individual's sense of self) may be related to the likelihood of engaging in NMUPD (Vest et al., 2021) and differs according to deployment status (Vest, 2013). It is possible that soldiers' identity may also differ by sex and be closely related to their propensity for negative emotions related to never having been deployed. Additional research is needed to understand if there are sex‐based differences in the reserve identity (Griffith, 2011) or other factors that might explain the observed effect of NDE on NMUPD among male, but not female, USAR/NG soldiers.

Within the context of guilt and shame as described by Lewis (1971), one possible explanation for our findings is that male USAR/NG soldiers who experience NDE may be preoccupied with thoughts about never being deployed and may also experience shame‐related feelings of worthlessness (i.e., less value to military unit), perhaps resulting in a desire to escape through drug use. Across a variety of samples, prior research has shown that greater shame‐proneness is associated with a greater likelihood of problems with substance use (Dearing et al., 2005) and higher use of maladaptive emotion regulation strategies, such as self‐blaming and catastrophizing (Szentágotai‐Tătar & Miu, 2016). It is also possible that the social components of NDE, including a loss of connectedness and camaraderie with soldiers' military units may, in part, drive the risk of substance use. Recent research in adolescent populations has shown that a lower sense of belonging is associated with greater approval and use of substances (Bakhtiari et al., 2020). Further, our prior work showed that soldiers with greater perceived social support from their military units were less likely to report post‐deployment drug use (Hoopsick, Benson, et al., 2019) and problems with mental health (Hoopsick, Homish, Collins, et al., 2021). Taken together with the findings of the current study, it is possible that non‐deployment might act as an ecological stressor to affect never‐deployed soldiers' propensity for substance use. Further research is needed to examine proneness to guilt and shame, their relations to social group dynamics, and how these phenomenological experiences might result in differential effects for men and women.

Although greater NDE were longitudinally associated with residual changes in current NMUPD among male USAR/NG soldiers, it is important to contextualise these findings. Our prior research among previously deployed USAR/NG soldiers showed that NMUPD buffered the harmful effects of combat exposure on multiple indicators of quality of life, suggesting that some service members may have been self‐medicating untreated or undertreated physical and psychological conditions (Hoopsick, Vest, et al., 2018). Given that never‐deployed service members identify barriers to accessing healthcare and are less likely to seek psychiatric care than their previously deployed counterparts (Chapman et al., 2014), we speculate that our findings may also be an indicator of similar untreated or undertreated conditions among these never‐deployed USAR/NG soldiers. At year baseline, 8.8% of never‐deployed soldiers reported moderate or worse depression symptomatology. By follow‐up year 3, 12.4%of these never‐deployed soldiers reported moderate or worse depression symptomatology ‐‐ nearly double the 7.0% of US adults sampled in the National Health Interview Survey who reported current symptoms of moderate or worse depression (Villarroel & Terlizzi, 2020).

In addition to our focal analyses, the prevalence of drug use in this community sample is notable. The prevalence of tobacco use among these never‐deployed soldiers ranged from 24.8% to 37.4% over the study period, which is considerably higher than the 22.6% of US adults aged 26 and older who report past‐month tobacco use (SAMHSA, 2020). Current NMUPD ranged from 2.8%–6.7% over the 3‐year follow‐up period. This is also much higher than the prevalence estimates from the National Survey on Drug Use and Health for current non‐medical use of prescription opioids (1.0%), stimulants (0.4%), and tranquilizers/sedatives (0.7%) reported by adults aged 26 and older (SAMHSA, 2020). Notably, the prevalence of any current illicit drug use (including cannabis and other illicit drugs) in this sample of never‐deployed soldiers was 10.3% at year 3, which is similar to the prevalence of current illicit drug use among the general population aged 26 or older (11.6%; SAMHSA, 2020). This contrasts with previous literature demonstrating significantly lower rates of illicit drug use among soldiers compared to civilian populations (Platteborze et al., 2013). Although the majority of this drug use was cannabis, this is an important finding given that cannabis remains federally illegal, and its use has potential career ramifications for currently serving USAR/NG.

4.1. Limitations

As with all research, the findings of the current study must be considered within the context of its limitations. First, all survey‐based research is subject to social response bias (i.e., participants responding in a way that is more likely to be perceived as socially desirable); however, confidential computer‐assisted interviewing has been shown to produce valid assessments of substance use in various settings and populations (e.g., McNeely et al., 2016; Wolff & Shi, 2015). Second, all soldiers were from a single US state and partnered (married or living as if married) at baseline, which may limit the generalisability of this study. However, military units sampled for Operation: SAFETY were diverse in terms of military occupational specialities and included combat, engineer, medical, logistics, and support roles, and the sample was consistent with national estimates in terms of race/ethnicity and sex (Office of the Deputy Assistant Secretary of Defense, 2019). Additionally, national data show that more than half of US service members are married (Office of the Deputy Assistant Secretary of Defense, 2019), which lends confidence to the external validity of our findings. Third, our sample size may have limited our statistical power to detect some effects, but all models were bootstrapped with 1000 replications to improve the accuracy of inferences made. Fourth, the dichotomous measurement of drug use among this community sample of service members significantly limits the clinical implications of our findings. However, never‐deployed soldiers remain at risk for substance use, and results from the current study suggest that non‐deployment might act as an ecological stressor to affect never‐deployed soldiers' propensity for use. Lastly, due to the observational nature of these data, we are limited in our ability to make causal inferences about the relations between NDE and substance use. There may be additional factors that might explain the relationship observed between NDE and NMUPD among male soldiers in our study.

4.2. Strengths

The current study has important strengths that should also be noted. First, these findings add to our understanding of two highly understudied and overlapping populations that are at risk for problems with drug use: USAR/NG soldiers and never‐deployed military service members. Second, our study focussed on sex‐based differences and included female soldiers who are frequently excluded from military research. Further, the overall Operation: SAFETY study sample is consistent with the national demographic and military characteristics of Reserve and Guard soldiers, including the proportion of female service members (Office of the Deputy Assistant Secretary of Defense, 2019). Third, the current study utilised data from four time points over a 3‐year period, allowing for longitudinal analyses that demonstrate the ongoing nature of negative emotions related to never having been deployed and its potential effect on drug use among never‐deployed USAR/NG soldiers.

4.3. Conclusions and future directions

Our findings provide compelling evidence that never‐deployed male USAR/NG soldiers are at increased risk for NMUPD in the presence of more negative emotions related to never having been deployed. Coupled with previous findings regarding NDE and hazardous drinking (Hoopsick, Homish, Vest, et al., 2018) and mental health symptomatology (Hoopsick, Homish, Bartone, et al., 2018), the current study suggests that the NDE Questionnaire may complement existing screening tools used to identify high‐risk military populations. Moreover, our findings suggest that tailored interventions to reduce the risk of NMUPD may be warranted for never‐deployed male service members and veterans. Additional research is needed to examine the clinical utility of the NDE Questionnaire and to explore the role of NDE among other branches of the US military and active duty US service members who may also experience negative emotions related to never having been deployed. To enhance generalisability, future research should also examine the prevalence and effects of NDE among military populations from other countries and among clinical samples. The examination of clinical samples would also allow for a more nuanced examination of the effects of NDE on the severity of substance use. Future work should also examine NDE among larger samples, which would increase statistical power to examine more complex trajectories of substance use over time. Additionally, subsequent research regarding non‐deployment should specifically examine the role of NDE as a disruptor of the homoeostatic state within the Bioecological Model of Deployment Risk and Resilience (Wooten, 2013). This work highlights the need for universal screening and prevention efforts among military service members, regardless of deployment status.

FUNDING

This research was supported by the National Institute on Drug Abuse award number R01DA034072 to Gregory G. Homish and by the National Centre for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001412 to the University at Buffalo. This research was also supported the National Institute of Health's Initiative for Maximising Student Development award number 5R25GM095459‐10 in support of Schuyler C. Lawson (PI: Margarita L. Dubocovich).

CONFLICT OF INTEREST

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Hoopsick, R. A. , Homish, D. L. , Lawson, S. C. , & Homish, G. G. (2022). Drug use over time among never‐deployed US Army Reserve and National Guard soldiers: The longitudinal effects of non‐deployment emotions and sex. Stress and Health, 38(5), 1045–1057. 10.1002/smi.3156

DATA AVAILABILITY STATEMENT

The data that support the findings of this study will be available on request from the corresponding author after the conclusion of the parent study. The data are not publicly available due to the ongoing nature of this longitudinal study.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study will be available on request from the corresponding author after the conclusion of the parent study. The data are not publicly available due to the ongoing nature of this longitudinal study.

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