2018 Department of Defense Health Related Behaviors Survey (HRBS)
Apr 28, 2021
Substance Use Among the Active Component
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The Health Related Behaviors Survey (HRBS) is the U.S. Department of Defense's (DoD's) flagship survey for understanding the health, health-related behaviors, and well-being of service members. Fielded periodically for more than 30 years, the HRBS includes content areas that might affect military readiness or the ability to meet the demands of military life. The Defense Health Agency asked the RAND Corporation to revise and field the 2018 HRBS among members of both the active component and the reserve component. This brief discusses findings for the active component.
In this brief, results for substance use, particularly use of alcohol, tobacco and nicotine products, and illicit and prescription drugs, are reviewed. Some results are also compared with Healthy People 2020 (HP2020) objectives established by the U.S. Department of Health and Human Services for the general U.S. population. Because the military differs notably from the general population (for example, service members are more likely to be young and male than is the general population), these comparisons are offered only as a benchmark of interest.
Heavy drinking is a leading preventable cause of death both in the United States and worldwide and has been linked to numerous problems, such as substance use disorders, occupational problems, relationship difficulties, and poor physical and mental health.
The 2018 HRBS measured binge drinking (defined as consuming five or more drinks on the same occasion for men and four or more drinks for women at least once in the past 30 days) and heavy drinking (defined as reporting binge drinking at least one day each week in the past 30 days).
The survey found that
|Total||Air Force||Army||Marine Corps||Navy||Coast Guard||HP2020 goal (not to exceed)|
|Military culture supportive of drinking||28.2%||27.3%||26.8%||34.0%||29.0%||19.1%||NA|
In the 2018 HRBS, 6.2 percent (CI: 5.6–6.9) of active component service members reported serious consequences (e.g., finding it harder to handle problems, receiving military punishment, being arrested, hitting a spouse or significant other, getting into a fight) from drinking in the past 12 months. In addition, 4.9 percent (CI: 4.3–5.5) reported risky drinking and driving—that is, driving when having had too much to drink or being a passenger with a driver who had too much to drink—in the past 12 months. Finally, 5.7 percent (CI: 5.1–6.3) reported productivity loss from drinking in the past 12 months.
The 2018 HRBS asked service members about their perceptions of military alcohol culture—that is, whether respondents found it hard to "fit in" with their command if they did not drink, believed that drinking was part of being in one's unit, believed that everyone was encouraged to drink at social events, or believed that leaders were tolerant of drunkenness when personnel were off-duty. Altogether, 28.2 percent (CI: 27.1–29.4) of active component service members agreed with at least one of these statements that military culture supports drinking, though Coast Guard respondents were least likely to agree.
Tobacco is the single-most preventable cause of disease and death in the United States. Although rates of smoking have decreased over the past decade, smoking remains the cause of six in seven lung cancer deaths, one in three of all cancer deaths, and more than three in four cases of chronic obstructive pulmonary disease. Although use of smokeless tobacco receives less attention, it has been associated with increased risk of cancer and stroke. Traditional tobacco products are not the only concern; the use of e-cigarettes has increased rapidly in recent years, with mounting evidence that their use may increase risk of cardiovascular and lung disease. These products are typically used more by young adults, who make up a large proportion of the active component.
|Total||Air Force||Army||Marine Corps||Navy||Coast Guard||HP2020 goal (not to exceed)*|
|Any current tobacco/nicotine use||37.8%||31.2%||36.2%||49.0%||40.6%||35.4%||NA|
* HP2020 goals for cigars and smokeless tobacco are each less than 0.5 percent. HP2020 does not have goals for e-cigarette or pipe or hookah use.
Findings from the 2018 HRBS include the following (Figure 2):
Among current smokers in the 2018 HRBS, 46.5 percent (CI: 43.2–49.7) reported attempting to quit smoking in the past 12 months.
The 2018 HRBS measured use among service members in the past 12 months and past 30 days for several types of drugs: marijuana or hashish, synthetic cannabis, inhalants to get high, synthetic stimulants, nonprescription cough or cold medicine, nonprescription anabolic steroids, and drugs other than marijuana and synthetic cannabis (these included cocaine [including crack], lysergic acid diethylamide [LSD], phencyclidine [PCP], 3,4-methylenedioxy-methamphetamine [MDMA, commonly called ecstasy], methamphetamine, heroin, and gamma hydroxybutyrate [GHB]). Findings include the following:
|Total||Air Force||Army||Marine Corps||Navy||Coast Guard|
The 2018 HRBS asked respondents about three types of prescription medication. These were stimulants or attention enhancers (e.g., Adderall, amphetamines, Ritalin, prescription diet pills), sedatives (e.g., Ambien, Valium, Xanax, Rohypnol, phenobarbital, ketamine), and pain relievers (e.g., OxyContin/Oxycodone, Percocet, codeine, methadone, hydrocodone, Vicodin). Findings include the following (Figure 3):
The 2018 HRBS also asked respondents about any misuse of prescription stimulants, sedatives, or pain relievers. Misuse is use of a prescription drug in any way not directed by a doctor. This could include use without a prescription of one's own or use in greater amounts, more often, or for longer than prescribed. Across all services, 1.4 percent (CI: 1.0–1.7) reported any prescription drug misuse. Among the three types of prescriptions asked in the survey, misuse was highest for prescription pain relievers, at 0.9 percent (CI: 0.7–1.2).
More than one-third of service members reported binge drinking in the past 30 days, and nearly one in ten were heavy drinkers. Prevention and intervention efforts could be targeted toward at-risk groups, but more than one in four service members reported that military culture was supportive of drinking. This indicates that prevention and intervention efforts would likely need to address military culture at a systemic level. DoD and the Coast Guard must better understand the culture and climate surrounding alcohol use and then take steps to shift the culture away from excessive use.
More than one in three service members reported tobacco or nicotine use in some form. Reducing this level of use is a high priority given its long-term health consequences. Intervention and prevention approaches will likely need to be informed by current evidence-based approaches used with civilians and target beliefs related to e-cigarettes as a replacement to traditional combustible cigarettes.
The rate of prescription drug use and misuse is low, especially compared with other substances. Nevertheless, given the potential for greater misuse, monitoring of prescription drug availability in the military is warranted. This might include monitoring the most common sources of prescription drugs among service members, as well as monitoring prescribing practices among military prescribers.
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