Military service is a stressful task that influences the
life style of army personnel. Several factors can make soldiers less capable of
coping with stressful events; so they may try to start drug abuse or increase
in the amount or diversity of substance abuse. Understanding factors
responsible for this misbehavior among soldiers is crucial for their commanders
to modify these factors.
This study aimed to determine the predictors of change in
substance abuse status in soldiers.
This cross-sectional research was conducted to evaluate the
substance abuse status among Iranian soldiers in 2010. The target population
was the soldiers who had spent at least 3 months of their military service.
Cluster sampling was done from army service garrisons in 12 provinces in Iran.
A total of 3960 soldiers were selected with different levels of education and
age. Data gathering was done with demographic questionnaires, Texas Christian
university (TCU) drug screen II and ASI questionnaire (fifth edition). Four
types of dependent variables were defined: “improvement”, “without change”,
“deterioration”, and “severe deterioration”. Backward ordinal regression
analysis was done and P values, OR, and SE were calculated by SPSS19 software.
Totally, 6.7% of soldiers improved, 82% remained without
change, 6.1% deteriorated, and 5.2% severely deteriorated with regard to their
substance abuse. Modifiable predictors were distance from home lower than 200
km (OR =1.54), bad relationship with commanders (OR = 1.88), service place
dissatisfaction (OR = 1.39), and always feeling lonely (OR = 1.83).
Non-modifiable factors were alcohol use within family and friends (P = 0.000);
psychiatric drug use history (OR = 1.72); suicidal attempt history (OR = 1.31);
divorce, separation, and extramarital contact (P = 0.001); unemployment (P =
0.019); leisure time dissatisfaction (P = 0.004); living alone (OR = 2.43); and
substance abuse onset before age 15 (OR = 1.71).
Considering non-modifiable risk factors, leaders and
commanders may recognize more vulnerable soldiers and try to resolve modifiable
factors and decrease the risk of getting worse (with respect to substance
abuse) about 7.3 times...
...The aim of this study was to determine the predictors of change
in substance abuse status of soldiers during military service. In our study, it
is demonstrated that alcohol use in family and with friends, living alone,
psychiatric drug use history, suicidal attempt history, marital status, job
prior to military service, leisure time dissatisfaction and age of substance
abuse onset are non-modifiable factors of increasing the chance of progression
in substance abuse status from “improvement” to “no change”, “deterioration”,
and “severe deterioration”. Also distance from home, bad relationship with
commanders, service place dissatisfaction and always feeling lonely are the
modifiable risk factors of increasing 7.3 times the chance of mentioned
progression.
There is some evidence that having a parent who
abused substances play a crucial role in the etiology of illegal substance use
initiation and continuation (26-30). Also, Hofler et
al. in their study on 1228 teenager respondents showed that family history of
substance use disorders and peer group drug use predict the progression to
cannabis use from “no use”, to “one time only”, then “repeated use”, and
finally “regular use” (31). Many studies
demonstrated that parental and peer drinking predicted heavy drinking (32-34). Hayatbakhsh et
al. showed in two studies that maternal smoking and alcohol consumption were
strongly associated with young adult cannabis use, early onset of smoking, and
use disorder (28, 35). Our study
confirmed these findings.
Some studies have demonstrated that male gender is
an important etiology of illegal substance use initiation and continuation (27, 28, 30). Ferrier-Auerbach
et al. hypothesize that higher alcohol use in the military will be associated
with demographic variables, including younger age, male gender, lower levels of
education, and unmarried status (36). This finding
confirmed by Ansari-Moghadam et al. who indicated that male gender, single
life, low level of education act as facilitators for transition to use new drugs
(37). However, Maggs
et al. showed that greater academic performance predicted heavy drinking (34). Heinz et al.
demonstrated that social support has been indicated in improved substance-use
outcomes and the quality of social support in marital relationship (i.e.
functional social support) has been associated with substance-use outcomes in
important and meaningful ways (29). We did not
assess the gender variable in our study, but we showed that marital status and
job prior to military service are the important demographic predictors for
deterioration in substance abuse status. Lower level of education in univariate
analysis was associated by being in improvement type, but it was not known as
predictor in multivariate analysis.
Studies have shown that parent's educational
degree and lower levels of parental verbal reasoning are associated with
illegal substance use initiation and continuation (27-30). Also
single-parent household and less harmonious family relationships predicted
heavy drinking (33, 34, 38) and changes in
maternal marital status were strong early life predictors of young adult
cannabis use and disorder (28). In our study,
living alone was a predictor for getting worse in substance abuse situation,
which can be due to instability of family or individual reasons.
Brady and Sinha showed in their study that
patients with anxiety or mood disorders are more prone to use substances for
alleviating distressing symptoms (38). There is some
evidence that early onset of drug use, more thought problems, weak social
problem solving skills, and use of legal substances at baseline play a pivotal
role in the etiology of illegal substance use initiation and continuation (27, 30, 39). Also one study
indicated that early onset of substance use and type of first used drug act as
facilitators for transition to new drugs (37). Kaplow et al.
showed that overactivity is a predictor of early-onset substance use (30). Hofler et al. in
their study on 1228 teenager respondents showed that self-esteem and
competence, unconditional commitment to not using drugs, immediate availability
of drugs, and previous history of nicotine dependence and alcohol use disorders
predict the progression to cannabis use from “no use”, to “one time only”, then
“repeated use”, and finally “regular use” (31). Risk taking, use
of cigarettes and marijuana, higher social maladjustment, greater academic
performance, less internalizing problems, more truancy, and earlier
school-leaving plans predicted heavy drinking (32-34, 38). Ferrier-Auerbach
et al. also hypothesize that higher alcohol use in the military will be
associated with personality disorders, including higher levels of negative
emotionality and disconstraint; as well as pre-deployment mental health
problems such as higher levels of PTSD and depression (36). Early life
course predictors of cannabis use were studied. In this regard, school
performance, childhood sexual abuse, early adolescence smoking and alcohol
consumption, as well as adolescent aggression/delinquency were strongly
associated with young adult cannabis use and substance use disorder (28). One study
identified patients with substance use disorders who deteriorated during
treatment, and examined baseline predictors of deterioration. Deterioration was
predicted by not having close friends. Patients who had both alcohol and drug
dependency, personality disorder diagnosis, and those who had a shorter episode
of care and fewer outpatient-mental-health visits, were more likely to
deteriorate (40). Child
externalizing (at age 5) significantly predicted the early onset of smoking (35).
Our study demonstrated that psychiatric drug use
history, self-mutilation or suicide history, leisure time dissatisfaction, bad
relationship with commanders, service place dissatisfaction, and feeling always
lonely are factors of increasing in the chance of progression in substance
abuse status from “improvement” to “no change”, “deterioration” and finally
“severe deterioration”. We also showed that distance from home (less than 200
km) is a predictor of getting worse, which can be due to maintaining access to
substances. Age of substance abuse onset was associated significantly to
getting in worse type, which confirms other studies. In our study, exemption
from combat was significantly associated with improving in substance abuse
status but in multivariate analysis it was not a predictor.
One of the study limitations was the information
bias due to incorrect responses of some participants. To ease this problem,
participants were assured of the privacy of information. The other limitation
was lack of specific assessment in each stratum due to executive problems,
which lead to non-specific generalizability. Substance abuse information was
collected only subjectively with its own limitation of validity. Also in this
study, dependent variables were defined totally for all substances, which may
lower the specificity of results for each group of substance abusers. The
strength of this study was its target sample from a wide area of the country
and its important setting, the military service. The other strength of this
study is defining subtypes of ‘change’ in substance abuse situation.
Alcohol use in family and with friends, living
without family, psychiatric drug use history, suicidal attempt history,
divorce, separation, extramarital contact, unemployment, leisure time
dissatisfaction, distance from home less than 200 km, bad relationship with
commanders, service place dissatisfaction, always feeling lonely, and age of
substance abuse onset all contributed significantly to the final model,
predicting the progression to the substance abuse status from ‘improvement’ to
‘no change’, then ‘deterioration’ and finally ‘severe deterioration’.
Considering non-modifiable risk factors, commanders may recognize more
vulnerable soldiers and try to resolve modifiable ones and decrease the risk of
getting worse as much as 7.3 times...
1Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
