Combat exposure, posttraumatic stress disorder, and moral injury as predictors of substance use in military personnel


Journal article


Michelle L. Kelley, Jeff M. Gabelmann, Megan Strowger, John Hearton, Folly Folivi, Adrian J. Bravo, Jinjoo Noh, Kristin Kuskeye, William Haber, Adam P. McGuire
Journal of Drug Education: Substance Abuse Research and Prevention, 2025

DOI: https://doi: 10.1177/00472379251394435

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APA   Click to copy
Kelley, M. L., Gabelmann, J. M., Strowger, M., Hearton, J., Folivi, F., Bravo, A. J., … McGuire, A. P. (2025). Combat exposure, posttraumatic stress disorder, and moral injury as predictors of substance use in military personnel. Journal of Drug Education: Substance Abuse Research and Prevention. https://doi.org/https://doi: 10.1177/00472379251394435


Chicago/Turabian   Click to copy
Kelley, Michelle L., Jeff M. Gabelmann, Megan Strowger, John Hearton, Folly Folivi, Adrian J. Bravo, Jinjoo Noh, Kristin Kuskeye, William Haber, and Adam P. McGuire. “Combat Exposure, Posttraumatic Stress Disorder, and Moral Injury as Predictors of Substance Use in Military Personnel.” Journal of Drug Education: Substance Abuse Research and Prevention (2025).


MLA   Click to copy
Kelley, Michelle L., et al. “Combat Exposure, Posttraumatic Stress Disorder, and Moral Injury as Predictors of Substance Use in Military Personnel.” Journal of Drug Education: Substance Abuse Research and Prevention, 2025, doi:https://doi: 10.1177/00472379251394435 .


BibTeX   Click to copy

@article{michelle2025a,
  title = {Combat exposure, posttraumatic stress disorder, and moral injury as predictors of substance use in military personnel},
  year = {2025},
  journal = {Journal of Drug Education: Substance Abuse Research and Prevention},
  doi = {https://doi: 10.1177/00472379251394435 },
  author = {Kelley, Michelle L. and Gabelmann, Jeff M. and Strowger, Megan and Hearton, John and Folivi, Folly and Bravo, Adrian J. and Noh, Jinjoo and Kuskeye, Kristin and Haber, William and McGuire, Adam P.}
}

Abstract

Background: Prior 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. Method: Participants were a community sample of 238 U.S. military personnel who had deployed one or more times (71.0% males; M =33.3 years; SD=3.2). Results: In 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. Conclusions: These 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.