The Green Sheep: Exploring the Perceived Risks and Benefits of Cannabis Among Young Military Members and Veterans

Medical and recreational cannabis are becoming more accessible and socially accepted across the United States. Emerging adults (EAs; 18 to 29) are the largest group of cannabis users. Studies have found that veterans are more likely to report cannabis use compared to nonveterans. While research exists on the use levels of cannabis, limited knowledge is available on the perceived risks and benefits of using cannabis among EA military and veteran populations. Helping professionals encounter veterans who use cannabis and must consider military cultural factors and attitudes towards cannabis that may influence or exacerbate cannabis use. We conducted a qualitative study with 23 EA veteran and military members with high-risk substance use and asked about their thoughts on the acceptability, risks, and perceived benefits associated with cannabis. Two qualitative coders used NVivo to find themes following the six steps of thematic analysis. Results provide in-depth understanding of EA military members and veterans' perceptions of cannabis. Overall, we found participants were receptive to using cannabis for pain ailments, mental health issues, and as an alternative to benzodiazepines, opioids, and alcohol. However, they acknowledged restrictions are needed to moderate cannabis use and mitigate negative outcomes. Lastly, participants recognized the incongruence of cannabis use with military job responsibilities and expectations. These findings shed light on potential risk and protective factors related to using cannabis for recreational or medical reasons and should be considered when consulting EA military members and veterans.

Cannabis use in civilian college students and college student service members/veterans: the moderating effect of anxiety

Background: Cannabis is the most commonly used illicit drug on college campuses. Research suggests that Student Service Members/Veterans (SSM/V) may be more likely to use alcohol than civilian students, but little research has focused on cannabis use in these two samples. Objectives: The purpose of the current study was to compare cannabis use frequency, cannabis use disorder (CUD) symptoms, and cannabis-related problems between civilian students and SSM/V. A second aim was to determine if group differences in these outcomes were moderated by symptoms of depression, stress, or anxiety. Methods: The sample included 164 college SSM/V (80.4% female, 19.6% male) and 456 civilian (78% female, 22% male) college students. Participants completed an online survey assessing demographics, number of days of past month cannabis use, cannabis-related problems, CUD symptoms, and a measure of anxiety, depression, and stress. Results: Negative binomial regressions indicated no significant differences in number of days of past-month cannabis use or past-year cannabis-related problems between civilian students and SSM/V, although SSM/V reported more past-year CUD symptoms. Moderation analyses revealed that at elevated levels of anxiety, SSM/V students used cannabis more frequently than civilian students. Conclusion: These findings indicate that when experiencing elevated levels of anxiety, SSM/V use cannabis more frequently than civilian students, suggesting that anxiety may be a more prominent risk factor for frequency of cannabis use for SSM/V compared to civilian students. Education, prevention, and intervention efforts specifically addressing anxiety in this demographic are needed.

Alcohol screening and brief intervention in a representative sample of veterans receiving primary care services

AIMS

Unhealthy alcohol use is common among adults, and in particular, Veterans. Routine alcohol screening followed by brief intervention is recommended and considered a prevention priority in primary care settings. While previous studies have found that Veterans enrolled in the Veteran's Health Administration (VA) receive high rates of screening and brief intervention, less than 50% of Veterans receive VA health care. No study has evaluated receipt of these services in a general sample of Veterans. Therefore, in a nationally-representative sample, we examine whether Veteran status was associated with receiving alcohol screening and brief intervention in primary care.

METHODS

Using the Centers for Disease Control and Prevention's 2014 Behavioral Risk Factor Surveillance System data, we identified adults who endorsed visiting a doctor for routine checkup at least once in the past two years and responded to an optional module assessing alcohol-related care (N = 92,206; 14.1% Veterans). Multivariable logistic regression was used to assess the association between Veteran status and screening and brief intervention outcomes. We also evaluate differences in alcohol-related care across Veteran status stratified by gender. Models were adjusted for sociodemographic and clinical characteristics likely to confound the association.

RESULTS

Overall, Veterans were more likely than non-Veterans to be screened for alcohol quantity and heavy episodic drinking (ps < 0.05), and more likely to endorse receiving brief intervention advice about alcohol's harmful effects (p < .001). Veteran status predicted an increased likelihood of being screened and receipt of advice about alcohol's harmful effects, but did not predict the likelihood of receiving advice to reduce or abstain from drinking (AOR = 1.00, 95% C.I. [0.80-1.26]). Analyses stratified by gender indicated a similar pattern of results for males as the overall sample. Results among females indicated Veteran status predicted the likelihood of being asked about heavy episodic drinking (AOR = 1.47, 95% C.I. [1.09-1.99]) and being offered advice about the harmful effects of alcohol (AOR = 1.62, 95% C.I. [1.06-2.48]). Female Veterans were not more likely than female non-Veterans to be advised to reduce and/or abstain from drinking.

CONCLUSIONS

Screening about any alcohol use was common while report of screening for quantity and heavy episodic drinking occurrence and report of brief intervention were less common. Veterans were more likely than non-Veterans to report receiving recommended care, though rates of advice to reduce or abstain from drinking did not differ across groups. Persistent gaps in delivery of recommended alcohol-related care, especially for particularly vulnerable subpopulations such as women Veterans, suggest a need for quality improvement.