Substance Abuse in the Reserve and National Guard

Key Takeaways

• Substance misuse in the military, particularly among National Guard members, exceeds civilian rates, with over 10% of veterans diagnosed with SUDs.
• Factors contributing to substance misuse include deployment stress, reintegration challenges, and co-occurring disorders like PTSD.
• Deployment is a significant risk factor for substance misuse, with deployed personnel more likely to develop SUDs than non-deployed.
• Stigma and lack of access to healthcare services are barriers to treatment for Reserve and National Guard members.
• Alcohol use disorders are prevalent, with the National Guard having the highest suicide rate among military branches.
• Drug misuse poses risks to readiness and well-being, with the DoD conducting urinalysis to deter and detect drug misuse.
• Substance misuse can lead to personal, professional, and health consequences, including an increased risk of suicide.
• Prevention and treatment programs like ASAP and SAMHSA grants are crucial for addressing substance misuse in the military.
• The effectiveness of current programs within the Reserve and National Guard needs assessment, with a focus on tailored interventions.
• Strategies to reduce substance misuse include enhancing resiliency training, improving mental health services access, and addressing stigma.

Members of the Reserve and National Guard confront distinctive challenges that contribute to higher rates of substance misuse compared to their active-duty counterparts. Deployment, stigma, career transitions, and mental health challenges are just a few obstacles Reserve and National Guard personnel face when it comes to substance use.

Common Challenges Faced by Reserve and National Guard Personnel

• Deployment, which often involves exposure to combat and traumatic events, is a significant stressor that can lead to the development of substance use disorders (SUDs). Research indicates that those deployed to conflict zones such as Iraq and Afghanistan are 1.36 times more likely to develop an alcohol use disorder and 1.14 times more likely to develop a drug use disorder than those who were not deployed.
• The stigma associated with seeking help for SUDs is another barrier that can prevent Reserve and National Guard members from accessing necessary treatment. The perceived risk of career damage or other consequences for seeking help can deter individuals from utilizing available resources. 
• A lack of consistent access to military healthcare systems, which can impede their ability to receive evidence-based treatments for co-occurring conditions like PTSD and SUDs.
• The transition from military to civilian life presents additional hurdles as service members readjust to their communities and face the mental health challenges that come with reintegration. 

Understanding and addressing these unique challenges are crucial for developing effective prevention and treatment programs tailored to the needs of Reserve and National Guard members, ultimately supporting their health and well-being.

Deployment and Substance Abuse in Reserve and National Guard

Deployment has been identified as a significant risk factor for substance misuse among Reserve and National Guard members. Data from various studies, including Operation: SAFETY, indicate a troubling correlation between combat deployment and increased substance misuse. Members of the US Army Reserve/National Guard (USAR/NG) with combat experience exhibit higher incidences of substance use disorders (SUDs) compared to the general population. 

Nearly 30% of deployed Army National Guard soldiers reported heavy alcohol use shortly after returning from deployment, a rate that exceeds their non-deployed counterparts and other military branches.

Several factors contribute to this trend, including:

• The intense stress, trauma, and injuries military personnel face during deployment.
• Mental health issues like post-traumatic stress disorder (PTSD), which can further exacerbate substance use as a coping mechanism.
• The transition back to civilian life poses additional challenges, where the structure and strict substance use policies of military life give way to less regulated environments, potentially leading to increased drug use, with marijuana being the most commonly used substance.

Despite the availability of resources like the Suicide Prevention and Readiness Initiative for the National Guard and various Veterans Affairs (VA) programs, barriers to accessing treatment persist. Stigma, fear of career repercussions, and inadequate capacity for behavioral health services are significant obstacles that prevent many service members from seeking the help they need. As such, there is a critical need for improved screening, referral protocols, and evidence-based treatment options tailored to the unique experiences of Reserve and National Guard members post-deployment.

PTSD and Substance Abuse Among Reserve and National Guard Members

Reserve and National Guard members face a unique set of challenges that can contribute to the development of Post-Traumatic Stress Disorder (PTSD) and subsequent substance misuse. Substance misuse, particularly alcohol misuse, is prevalent among veterans, including those in the Reserve and National Guard. The National Guard has the highest suicide rate of any military branch, and a special initiative—the Suicide Prevention and Readiness Initiative for the National Guard—aims to identify risk factors and provide intervention techniques. 

Additionally, after leaving military service, the rates of drug use, especially marijuana, tend to increase among service members. The co-occurrence of substance use disorders (SUDs) and mental health disorders is common, highlighting the need for comprehensive care that addresses both issues simultaneously.

Lack of Continuous Health Care

Unlike their active-duty counterparts, these service members often lack continuous access to military health care services, which could impact their ability to receive timely and effective treatment for PTSD. Studies have shown that following deployment, United States Army Reserve/National Guard (USAR/NG) soldiers report higher rates of mental health problems and treatment needs for PTSD, depression, and substance misuse than active-duty members.

Recent Policy Updates

Recent legislative efforts, such as the introduction of the 2024 National Defense Authorization Act (NDAA) and the Douglas Mike Day Psychedelic Therapy to Save Lives Act, indicate a growing awareness and willingness to explore alternative treatments, including psychedelic therapy, for conditions like PTSD affecting military personnel. These developments, along with existing programs and policies, underscore the importance of addressing the mental health and substance misuse challenges faced by Reserve and National Guard members in a holistic and supportive manner.

Substance Abuse Rates in the Reserve and National Guard

Substance misuse among members of the Reserve and National Guard is a significant concern, with evidence indicating higher instances of substance use disorders (SUDs) compared to the civilian population. 

Key Statistics

Research highlights that individuals deployed in recent conflicts, such as those in Iraq and Afghanistan, are notably more susceptible to SUD diagnoses. In 2013, approximately 44% of returning service members faced challenges with substance use behaviors during their transition back to civilian life, a statistic that underscores the acute need for targeted intervention and support.

Studies have also revealed that Reserve and National Guard personnel report higher rates of mental health issues and treatment needs for conditions like post-traumatic stress disorder (PTSD), depression, and substance misuse than their active-duty counterparts. The National Survey on Drug Use and Health (NSDUH), while not including active-duty military, does capture data on current reserve soldiers, providing valuable insights into this group’s substance use trends. The 2018 Health Related Behaviors Survey (HRBS) found that 13.3% of reserve component members reported being current cigarette smokers, a figure that is above the Healthy People 2020 target of 12% for US adults.

These statistics and findings highlight an urgent need for comprehensive strategies to address substance misuse within the Reserve and National Guard, including the development of effective prevention and treatment programs that are sensitive to the unique challenges faced by this population.

Alcohol Abuse Among Reserve and National Guard Members

Alcohol misuse within the Reserve and National Guard is a pressing concern, with studies indicating a notable prevalence of alcohol use disorders among these service members. Research highlights the unique challenges faced by these individuals, including:

• The stress of deployment
• The transition back to civilian life

These challenges contribute to higher rates of substance misuse compared to the general population. 

Post-Deployment Alcohol Use

A study published in the Journal of Studies on Alcohol and Drugs reported significant post-deployment alcohol use among Army National Guard personnel, suggesting a need for targeted interventions.

Suicide Rates and Alcohol Misuse

The National Guard has been identified as having the highest suicide rate among military branches, with alcohol misuse potentially being a contributing factor. This alarming statistic underscores the importance of the Suicide Prevention and Readiness Initiative for the National Guard, which aims to provide effective intervention techniques. 

Influence of Military Culture

The Northern Hub for Veterans and Military Families Research has documented the intricate relationship between military service, alcohol use, and mental health, emphasizing the role of military culture and social norms in influencing drinking behaviors.

Transition Risks and Support Systems

Despite stringent military policies against illicit drug use, alcohol remains a substance that is frequently misused, particularly after service members leave the military. The transition period poses significant risks, as evidenced by the RAND Corporation’s findings on the culture of alcohol in the US Military and its correlation with problematic drinking. Veterans Affairs and other support systems must address this issue comprehensively, offering support and treatment for those struggling with alcohol misuse.

Drug Abuse Among Reserve and National Guard Members

Drug misuse within the Reserve and National Guard is a significant concern, as it poses risks to the readiness and well-being of service members. The Department of Defense (DoD) has been conducting urinalysis testing for over 30 years to deter and detect drug misuse among service members. Maintaining a drug-free military is crucial for ensuring a safe and effective US Armed Forces. 

Factors Influencing Drug Abuse Among Reserve and National Guard Personnel

Studies have revealed that non-deployment emotions (NDE), which are negative feelings experienced by some service members who have never been deployed, are associated with hazardous drinking behaviors, especially in male US Army Reserve/National Guard (USAR/NG) soldiers.

Resiliency factors, which are protective elements that help guard against post-deployment drug use, are also being examined to better understand and prevent substance misuse. The prevalence of current drug use among male USAR/NG soldiers was found to be 9.2%, with 6.6% reporting illicit drug use and 3.5% reporting non-medical use of prescription drugs (NMUPD). 

These findings highlight the need for targeted prevention and treatment strategies to address the unique challenges faced by Reserve and National Guard members, including the higher rates of mental health problems and substance misuse treatment needs compared to their active-duty counterparts.

Consequences of Substance Abuse Among Reserve and National Guard Members

The impact of substance misuse on Reserve and National Guard members is multifaceted, affecting their personal lives, professional duties, and overall health. According to a report by the Institute of Medicine (IOM), substance use disorders (SUDs) represent a public health crisis within the armed forces, which includes Reserve and National Guard members. Several challenges contribute to substance misuse among these service members, such as:

• Deployment stress
• Witnessing traumatic events
• The culture of drinking in the military 

Personal and Professional Consequences of Substance Misuse

Substance misuse can lead to a range of personal consequences, including strained relationships with family and friends, financial difficulties, and legal problems. Professionally, it can result in decreased job performance, disciplinary actions, and even discharge from service. Health-wise, substance misuse can lead to chronic diseases, mental health disorders, and an increased risk of suicide, as indicated by the high suicide rates within the National Guard. The 2018 Health Related Behaviors Survey found that 20.2% of reservists agreed with statements related to support of drinking in military culture, highlighting the normalization of substance use.

Barriers to Substance Abuse Treatment in the Reserve and National Guard

Moreover, research from Brandeis University and the University at Buffalo suggests that military identity is closely tied to substance use and mental health outcomes. A stronger military identity was associated with non-medical use of prescription drugs (NMUPD) and greater symptoms of anger, anxiety, depression, and PTSD. Despite the availability of counseling and treatment programs, barriers such as stigma and perceived career harm from seeking help persist, resulting in the underutilization of these services by Reserve and National Guard members.

Substance Abuse Prevention and Treatment in the Reserve and National Guard

The Reserve and National Guard face unique challenges when it comes to substance misuse, necessitating tailored prevention and treatment programs. 

Army Substance Abuse Program

The Army Substance Abuse Program (ASAP) provides crucial support for active Army Soldiers, Reservists, and National Guard personnel. The program offers a comprehensive approach that includes prevention, drug testing, and Employee Assistance Program (EAP) services, with dedicated contact numbers for each branch of service.

Substance Abuse and Mental Health Services Administration

Further bolstering these efforts, the Substance Abuse and Mental Health Services Administration (SAMHSA) has introduced funding opportunities for grants aimed at preventing substance misuse and treating substance use disorders (SUDs) nationwide. This initiative aligns with the National Guard’s amplification of substance misuse prevention through the Department of Defense’s Prevention, Treatment, and Outreach (PT&O) initiative, currently being tested in 12 pilot states.

Comprehensive Soldier Fitness Program

Programs such as the Comprehensive Soldier Fitness (CSF) program, which includes resilience training and self-development modules, play a pivotal role in addressing substance misuse among military personnel. 

The National Guard has also implemented Substance Abuse Prevention and Drug Deterrence programs across all states and territories, focusing on enhancing Soldiers’ overall fitness and combat readiness.

Military OneSource

For immediate assistance, service members can access resources such as Military OneSource, which offers guidance on mental health and substance misuse, as well as crisis intervention services. These comprehensive prevention and treatment programs underscore the military’s commitment to the health and well-being of its members, aiming to provide equitable access to care and foster recovery.

Assessing the Effectiveness of Current Substance Abuse Prevention and Treatment Programs

Recent initiatives and funding strategies highlight the ongoing efforts to combat substance misuse within the Reserve and National Guard. 

• NIH HEAL Initiative: The NIH HEAL Initiative‘s progress is notable, with the development of novel treatments for pain and opioid use disorder aiming to reduce dependency on opioids. Their research has also shed light on the pervasive stigma surrounding substance use disorders, a significant barrier to treatment. 
• Proposed Renaming of Institutes: The proposed renaming of institutes by the FY 2024 President’s Budget to focus on “Drugs and Addiction” and “Alcohol Effects and Alcohol-Associated Disorders” reflects a shift towards a more comprehensive understanding of substance use and its consequences. 
• SAMHSA Budget Proposal: SAMHSA’s request for a substantial budget increase underscores the commitment to improving mental health and substance use services. SAMHSA’s Community Harm Reduction and Engagement Initiative is a promising step towards bridging harm reduction with accessible treatment for opioid use disorder.

Impact and Challenges of Current Substance Abuse Prevention Programs

While these programs and initiatives indicate a strong federal response to substance misuse, assessing the effectiveness of these efforts in the following areas within the Reserve and National Guard is crucial. 

• The impact on service members’ lives
• The adaptability of these programs to their unique challenges
• The successful integration of such programs into military settings

Continued research, targeted funding, and the development of tailored interventions are necessary to ensure that these programs meet the specific needs of Reserve and National Guard members.

Enhancing Prevention and Treatment Programs for Substance Use Disorders

Recent initiatives and policy shifts highlight the need for continuous improvement in prevention and treatment programs for substance use disorders (SUDs), particularly within the Reserve and National Guard. 

SAMHSA Budget and Language Updates

The Substance Abuse and Mental Health Services Administration (SAMHSA) has proposed a fiscal year 2024 budget with a focus on expanding crisis care systems, such as the 988 Suicide & Crisis Lifeline, and increasing access to Community Mental Health Centers (CMHCs). This approach emphasizes a multidimensional strategy to address behavioral health challenges and aims to reduce stigma by proposing a change in terminology from ‘Abuse’ to ‘Use’ in agency names. 

Biden-Harris Administration Proposals

Improvements to current programs can also be inspired by the Biden-Harris Administration’s actions to lower barriers to treatment and increase support for individuals affected by opioid use. This includes updating Opioid Treatment Program (OTP) regulations and making permanent COVID-19 flexibilities that have positively impacted recovery. Furthermore, the introduction of a new Community Harm Reduction and Engagement Initiative represents an innovative approach to bridge harm reduction and low-threshold treatment for opioid use disorder. SAMHSA’s proposed rule updates are a testament to the evolving landscape of SUD treatment.

Areas for Future Improvement

Potential improvements for the Reserve and National Guard could include tailored approaches that consider the unique stressors and experiences of service members. Integrating evidence-based treatments, like medication-assisted treatment (MAT), into existing military health systems and ensuring that these services are readily accessible upon return from deployment could significantly enhance the effectiveness of prevention and treatment programs. 

Additionally, fostering partnerships with Federally Qualified Health Centers (FQHCs) could facilitate a more integrated care model sensitive to military personnel’s needs. These enhancements, grounded in recent policy developments and research, could lead to more comprehensive and effective SUD treatment for Reserve and National Guard members.

Strategies for Reducing Substance Abuse in the Reserve and National Guard

The Reserve and National Guard face unique challenges that contribute to substance misuse issues, including the stress of deployment and reintegration into civilian life. Policy recommendations for reducing substance misuse within these service branches can draw from various strategies that address individual needs and systemic factors.

Key recommendations include:

• Enhancing resiliency training programs to provide service members with coping strategies for stress and trauma, potentially reducing the risk of substance misuse.
• Improving access to mental health services, especially for conditions like PTSD and depression, which are often associated with substance misuse.
• Implementing comprehensive screening and referral protocols to identify substance misuse issues early and connect service members with appropriate treatment.
• Addressing stigma associated with seeking help for substance misuse or mental health issues, which can deter service members from accessing necessary services.
• Ensuring the availability of evidence-based treatment protocols and programs tailored to the unique experiences of Reserve and National Guard members.
• Continuing mandatory, random drug testing to deter use while also providing support for those who test positive.
• Expanding education and awareness campaigns that inform service members about the risks of substance misuse and the resources available for help.

Incorporating these recommendations into military policies and programs could reduce substance misuse rates among Reserve and National Guard members, ultimately improving their overall health and readiness.

Substance Abuse Treatment for Veterans

If you’re a military veteran seeking addiction treatment, The Recovery Village Cherry Hill at Cooper is here to help. We are a part of the VA Community Care Network, and we offer a trauma-informed program designed for veterans and first responders. Contact a Veteran Advocate today to learn more or to get started with treatment.