Influence Substance Use Research Articles

The Influence of Substance Use on Intimate Partner Homicide: Evidence from a Norwegian National 22-year Cohort

Intimate partner homicides (IPH) are fatal violent attacks perpetrated by intimate partners. Research has indicated that substance use can co-occur in IPH. This study investigates the role of substance influence at the time of the crime and the prevalence of substance use in these cases. All IPHs in Norway from 1990–2012 (N = 177) were included. Quantitative data were extracted from court documents. Information concerning risk factors was drawn from three validated risk assessment instruments. Multivariate logistic regression analyses were conducted. For IPH committed by a substance-influenced perpetrator, there was an increased risk of the victim being substance influenced as well (OR = 11.697, CI = 4.259 – 31.631). Similarly, there was an association between perpetrators’ type of influence at the time of the crime and perpetrators’ substance misuse in general. Blood alcohol or other toxins were present in half of the perpetrators and 41% of the victims. Our results point to an association between IPH and substance use which needs to be established. Hence, this will have clinical and policy implications.

How Social Relationships Influence Substance Use Disorder Recovery: A Collaborative Narrative Study.

Individuals with a substance use disorder (SUD) often have fewer social support network resources than those without SUDs. This qualitative study examined the role of social relationships in achieving and maintaining stable recovery after many years of SUD. Semi-structured interviews were conducted with 18 participants, each of whom had been diagnosed with a SUD and each of whom had been abstinent for at least 5 years. A resource group of peer consultants in long-term recovery from SUDs contributed to the study planning, preparation, and initial analyses. The relationship that most participants described as helpful for initiating abstinence was recognition by a peer or a caring relationship with a service provider or sibling. These findings suggest that, to reach and maintain abstinence, it is important to maintain positive relationships and to engage self-agency to protect oneself from the influences of negative relationships. Substance use disorder service providers should increase the extent to which they involve the social networks of clients when designing new treatment approaches. Service providers should also focus more on individualizing services to meet their clients on a personal level, without neglecting professionalism or treatment strategies.

Effects of DRD2 splicing-regulatory polymorphism and DRD4 48bp VNTR on crack cocaine addiction.

There is evidence that dopamine receptors D2 (DRD2) and D4 (DRD4) polymorphisms may influence substance use disorders (SUD) susceptibility both individually and through their influence in the formation of DRD2-DRD4 heteromers. The dopaminergic role on the vulnerability to addiction appears to be influenced by sex. A cross-sectional study with 307 crack cocaine addicts and 770 controls was conducted. The influence of DRD2 rs2283265 and DRD4 48bp VNTR in exon 3 variants, as well as their interaction on crack cocaine addiction susceptibility and severity were evaluated in women and men separately. An association between the DRD2 T allele and crack cocaine addiction was found in women. In this same group, interaction analysis demonstrated that the presence of DRD2-T allele and concomitant absence of DRD4-7R allele were associated with risk for crack cocaine addiction. No influence of DRD2 and DRD4 variants was observed in men regarding addiction severity. This study reinforces the role of dopaminergic genes in externalizing behaviors, especially the influence of DRD2-DRD4 interaction on SUD. This is the fourth sample that independently associated the DRD2-DRD4 interaction with SUD itself or related disorders. In addition, our findings point out to a potential difference of dopaminergic neurotransmission across sex influencing addiction susceptibility.

Toxoplasma gondii seropositivity and substance use in US adults.

The intracellular parasite Toxoplasma gondii (Nicolle et Manceaux, 1908) infects humans resulting in acute toxoplasmosis, an infection that in immunocompetent people is typically mild but results in persistent latent toxoplasmosis. In that T. gondii appears to affect dopamine synthesis and because addicting drugs affect midbrain dopamine transmission, latent toxoplasmosis could influence substance use. Using both the third and continuous National Health and Nutrition Examination Surveys from the US Centers for Disease Control and Prevention, we used logistic regression to test for associations between T. gondii seropositivity and subject self-report of having ever used tobacco, alcohol, marijuana, cocaine, heroin, or methamphetamine. In the third NHANES dataset, which included data for tobacco, alcohol, marijuana and cocaine, T. gondii seropositivity was associated with a reduced likelihood of self-reported marijuana (OR = 0.71 [95% CI: 0.58; 0.87]; p = 0.001) and cocaine use (OR = 0.72 [95% CI: 0.56; 0.91]; p = 0.006). In the continuous National Health and Nutrition Examination Surveys dataset, which included data for all six substances, T. gondii seropositivity was associated with a reduced likelihood of self-reported tobacco (OR = 0.87 [95% CI: 0.76; 1.00]; p = 0.044), marijuana (OR = 0.60 [95% CI: 0.50; 0.72]; p < 0.001), heroin (OR = 0.60 [95% CI: 0.42; 0.85]; p = 0.005) and methamphetamine use (OR = 0.54 [95% CI: 0.38; 0.77]; p = 0.001). We observed interactions between sex and T. gondii seropositivity in the prediction of self-reported use of tobacco and alcohol. Further, T. gondii seropositivity appeared to remove the protective effect of education and economic status against self-reported cigarette smoking. These findings suggest that T. gondii seropositivity may be inversely associated with some but not all types of substance use in US adults.

Adolescents, parents and teachers\u2019 perceptions of risk and protective factors of substance use in Moroccan adolescents: a qualitative study

BackgroundSubstance use in adolescents is a global public health concern that continues to draw attention from academics, policy experts, and government officials. In Morocco, few studies have investigated the influencing factors of substance use in adolescents. Here, we aimed to fill this gap and to better understand factors that protect or influence substance use in adolescents.MethodsWe conducted a qualitative study using focus group discussions. The semi-structured interview guides were based on the socio-ecological model as a theoretical framework to explore perceptions of students, parents, and teachers regarding substance use risks and protective factors in adolescents. Data from each group were audio-recorded, transcribed, and analyzed using thematic analysis.ResultsFrom May to July 2016, 17 focus group discussions were conducted at two middle schools in Taza city, Morocco, which included 8 groups of 7 adolescents (28 boys and 28 girls) aged 14 to 16 years, 5 groups of parents (5 females and 21 males), and 4 groups of teachers (13 males and 5 females). Thematic analysis resulted in six common themes that represented the most salient perceived risk and protective factors regarding substance use among adolescents: perceived benefits of substance use, awareness and beliefs, family influence, peer influence, easy accessibility of substances, and social norms.ConclusionsOur results demonstrate that multilevel prevention programs in adolescents should address influencing factors from the individual to the societal level, including social norms and the government’s policy toward substance use. Health education programs included as part of the school curriculum can contribute to promoting awareness and reducing risky behaviors of Moroccan adolescents.

Prevalence of youth gambling and potential influence of substance use and other risk factors throughout 33 European countries: first results from the 2015 ESPAD study.

Although generally prohibited by national regulations, underage gambling has become popular in Europe, with relevant cross-country prevalence variability. This study aimed to estimate the prevalence of underage gambling in Europe stratified by type of game and on-/off-line mode and to examine the association with individual and family characteristics and substance use. Our study used data from the 2015 European School Survey Project on Alcohol and Other Drugs (ESPAD) cross-sectional study, a survey using self-administered anonymous questionnaires. Thirty-three European countries. Sixteen-year-old-year-old students (n=93 875; F=50.8%). The primary outcome measure was prevalence of past-year gambling activity. Key predictors comprised individual behaviours, substance use and parenting (regulation, monitoring and caring). A total of 22.6% of 16-year-old students in Europe gambled in the past year: 16.2% on-line, 18.5% off-line. High prevalence variability was observed throughout countries both for mode and types of game. With the exception of cannabis, substance use shows a higher association with gambling, particularly binge drinking [odds ratio (OR)=1.46, 95% confidence interval (CI)=1.39-1.53), life-time use of inhalants (OR=1.57, 95% CI=1.47-1.68) and other substances (OR=1.78, 95% CI=1.65-1.92)]. Among life habits, the following showed a positive association: truancy at school (OR=1.26, 95% CI=1.18-1.35), going out at night (OR=1.32, 95% CI=1.26-1.38), participating in sports (OR=1.30, 95% CI=1.24-1.37). A negative association was found with reading books for leisure (OR=0.82%, 95% CI=0.79-0.86), parents' monitoring of Saturday night activities (OR=0.81, 95% CI=0.77-0.86) and restrictions on money provided by parents as a gift (OR=0.89, 95% CI=0.84-0.94). Underage gambling in Europe appears to be associated positively with alcohol, tobacco and other substance use (but not cannabis), as well as with other individual behaviours such as truancy, going out at night and active participation in sports, and is associated negatively with reading for pleasure, parental monitoring of evening activities and parental restriction of money.

Getting to Zero: We Can't Do It Without Addressing Substance Use.

HIV elimination by 2030 cannot occur without attention to substance use. It cuts across risk groups and affects sexual risk behavior, treatment adherence, and systemic processes such as immunity and inflammation. There continues to be often limited attention to non-injection drug use and the syndemic character of HIV and substance use. There is a need for a more comprehensive approach that addresses the multiple influences of substance use on HIV prevention and care, integrating this into evidence-based services and building on the successes of comprehensive Seek, Test, Treat, and Retain approaches to substantially reducing new HIV cases among drug users.

The prevalence of substance use among Russian, Somali and Kurdish migrants in Finland: a population-based study

BackgroundSubstance use is a well-known public health problem, but population-based research on migrants’ substance use in Europe is limited. Factors related to the cultural background and current life situation might influence substance use among migrants. Here, the prevalence of substance use in Russian, Somali and Kurdish migrants in Finland is reported in comparison with the general population, and the associations between substance use and socio-economic and migration-related background factors among migrants are analysed.MethodsCross-sectional data from the Finnish Migrant Health and Wellbeing Study (Maamu) and comparison group data of the general Finnish population (n = 1165) from the Health 2011 Survey were used. The survey participants were of Russian (n = 702), Somali (n = 512), and Kurdish (n = 632) origin. Substance use included self-reported alcohol use within previous 12 months (AUDIT-C questionnaire), current and lifetime daily smoking and lifetime use of cannabis and intravenous drugs.ResultsBinge drinking was less prevalent among all migrant groups than in the general Finnish population (Russian men 65%, p < 0.01; Russian women 30%, p < 0.01, Somali men 2%, p < 0.01, Kurdish men 27%, p < 0.01, Kurdish women 6%, p < 0.01, general population men 87% and women 72%). Current daily smoking was more prevalent among Russian (28%, p = 0.04) and Kurdish (29%, p < 0.01) migrant men compared with the reference group (20%). Younger age and employment were associated with binge drinking among migrants. Socio-economic disadvantage increased the odds for daily smoking in Russian, Somali and Kurdish migrant men. Several migration-related factors, such as age at migration and language proficiency, were associated with substance use.ConclusionsBinge drinking is less common among migrants than in the Finnish general population. However, current daily smoking was more prevalent among Russian and Kurdish migrant men compared with the general population. Younger age, level of education, employment, duration of residence in Finland and language proficiency were associated with binge drinking and daily smoking with varying patterns of association depending on the migrant group and gender. These findings draw attention to the variation in substance use habits among migrant populations.

Marijuana Promotion Online: an Investigation of Dispensary Practices

Marijuana product advertising will become more common, as the use of medical and/or recreational marijuana becomes increasingly legal in the USA. In this study, we investigate the marketing tactics being used on marijuana dispensary websites in the USA that could influence substance use behaviors. One hundred dispensary websites were randomly selected from 10 states that allowed the legal use of medical or recreational marijuana and had at least 10 operational dispensaries. Three dispensaries were excluded due to non-functioning websites, leaving a sample of 97 dispensaries. Content analysis was conducted on these dispensaries' websites, with the primary areas of focus including website age verification, marijuana effects, warnings, and promotional tactics. Among the 97 dispensaries, 75% did not include age verification. Roughly 30% offered online ordering and 21% offered delivery services. Sixty-seven percent made health claims pertaining to medical conditions that could be treated by their marijuana products, with moderate or conclusive evidence to support their claims. Less than half of the dispensaries (45%) advised consumers of possible side effects, and only 18% included warnings about contraindications. Nearly half (44%) offered reduced prices or coupons, 19% offered "buy one get one free" offers, and 16% provided giveaways or free samples. Our findings indicate that marijuana dispensary websites are easily accessible to youth. In addition, only a small amount of the websites advised consumers about possible side effects or contraindications. This study suggests the need for surveillance of marijuana commercialization and online advertising especially in the context of state policy reforms.

Effect of socio-economic status, family smoking and mental health through social network on the substance use potential in adolescents: a mediation analysis

ObjectivesUnderstanding pathways that influence substance use potential (SUP) can help with effective substance use prevention interventions among adolescents. The aim of the present study is to contribute to a better understanding of the SUP of adolescents by examining the mediating role of social network quality in the SUP of Iranian adolescents. Study designA cross-sectional study. MethodsStructural equation modeling was conducted to assess the hypothesized model that social network quality would mediate the association of family socio-economic status, a mental health disorder, and family smoking with addiction potential. ResultsThe model shows a good fit to the data. Social network quality mediated the effect of family smoking on the SUP for boys. A mental health disorder had a positive significant direct effect on addiction potential for both girls and boys. ConclusionsSocial network quality mediates the effect of family smoking on boys' addiction potential in the context of Iran. Educational programs based on local societal ways and cultural norms are recommended to change tobacco smoking behavior among family members. In addition, to prevent subsequent substance use among adolescents, more effort is needed to improve their mental health.

A qualitative investigation of the perceived role of peers in influencing substance use among youth in Monrovia, Liberia

ABSTRACTSubstance use and abuse has become an issue for adolescents globally. While multiple factors contribute to substance use, peer influence is particularly important. As such, this study aimed to examine students’ beliefs related to substance use, including the role peers have on substance use behaviors in Monrovia, Liberia. Nine focus groups were conducted with a total of 72 public school students in Monrovia. All focus groups were recorded, transcribed verbatim, and analyzed by a team of trained, qualitative coders. Per student report, peers both directly and indirectly influenced decisions related to substance use. Direct influence from peers included peer pressure, bullying and taunts, and putting drugs or alcohol into food and drinks to be consumed by peers without their knowledge. Indirect influence occurred when peers witnessed the substance use behaviors of others. Despite this, there was a subset of individuals who refused peer pressure, citing a number of reasons, including future negative outcomes. Given the central role that peers play in the substance use behaviors of adolescents in the Liberian cultural context, public health policies and interventions should target these interactions.

Substance Use and Professional Identity

Processes of professional socialization influence types of substances used, patterns of use, and estimation of normalization. This project explores psychoactive substance use among professionals and students in professional programs in Canada, rationales for use, strategies to manage use and potential consequences, and factors within professional education and culture that influence decisions about use. The intent of this study is to uncover social processes through which professional contexts influence substance use. The researchers sought to explore how professionals and professional students described their own decision-making about substance use and their perceptions of professional influences. The mixed methods pilot study involved ecological momentary assessment (EMA), using an app designed for the study, and qualitative interviews. Participants completed a brief survey on the app each time they used a substance during a 4-week period, reporting what substance was used, how much, where, who with, and anticipated or delayed effects. Thirty-four participants were involved in the EMA component, 20 of whom engaged in interviews. The findings suggest a certain amount of substance use is expected, accepted, and even promoted in professional fields. Thematic analysis revealed novel understandings about (i) deliberate decisions, (ii) disclosure and use, (iii) stigmatized substance use, (iv) normative substance use, and (v) the professional context. This study demonstrates potential advantages of undertaking research to explore substance use, as distinct from substance abuse, problematic use, dependence, or addiction. Conceptualizing substance use more broadly can help to identify factors that both encourage use (e.g., performance demands, social norms) and constrain use (e.g., responsibility, role modeling). This can expand approaches to address substance use that look beyond the individual to social and institutional contexts, acknowledging that responsibility is a collective process.

Factors influencing substance use among adolescent slum dwellers of Guwahati City, Assam

Introduction: Humans have been using substances in one form or the other for centuries. Adolescents seem to be the most vulnerable group, and the slum dwellers are particularly at risk because of the prevailing environment. Objectives: The objective of this study is to study the prevalence of substance use among adolescents of slums of Guwahati city and to find out various factors influencing substance use among them. Materials and Methods: A cross-sectional study was conducted among the adolescents living in slums of Guwahati, Assam, from February to May 2014. Using cluster sampling method, 23 slums were selected, and desired clusters were obtained by applying probability proportionate to size method. From each slum, equal number of boys and girls were interviewed to get a total of 414 study subjects. Statistical Analysis: Proportions, Chi-square test, and binary logistic regression were used. Results: The prevalence of ever users was 37.68% and 35.02% were current users. Gutkha was the most common substance used. The mean age of initiation of abusive substances was around 12 years for both boys and girls. Age, sex, religion, caste, schooling status, occupation, living status of parents and respondents, peer usage, and relationship with the family members showed significant association with substance use. Binary logistic regression concluded that age group, sex, and peer usage were the most significant factors influencing substance use behavior. Conclusion: As increasing age and peer usage influenced the substance usage, peer group counseling, recreational activities, and skill development programs in the early years hold promising in curbing the problem.

Adherence to gender-typical behavior and high frequency substance use from adolescence into young adulthood.

Substance use is prevalent among adolescents in the U.S., especially males. Understanding the cross-sectional and longitudinal associations between gender norms and substance use is necessary to tailor substance use prevention messages and efforts appropriately. This study investigates the relationship between adherence to gender-typical behavior (AGB) and substance use from adolescence into young adulthood. Participants in the National Longitudinal Study of Adolescent to Adult Health completed self-report measures on the frequency of binge drinking, cigarette smoking and marijuana use as well as various behaviors and emotional states that captured the latent construct of AGB. Sex-stratified logistic regression models revealed cross-sectional and longitudinal relationships between AGB and high frequency substance use. For example, an adolescent male who is more gender-adherent, compared to less adherent males, has 75% higher odds of high frequency binge drinking in adolescence and 22% higher odds of high frequency binge drinking in young adulthood. Sex-stratified multinomial logistic regression models also revealed cross-sectional and longitudinal relationships between AGB and patterns of use. For example, a more gender-adherent adolescent male, compared to one who is less adherent, is 256% more likely to use all three substances in adolescence and 66% more likely to use all three in young adulthood. Cross-sectional and longitudinal results for females indicate greater gender-adherence is associated with lower odds of high frequency substance use. These findings indicate adherence to gender norms may influence substance use behaviors across the developmental trajectory, and inform strategies for prevention efforts.

Commentary on: Factors influencing substance use among adolescent slum dwellers of Guwahati City, Assam

Adolescent being at risk for substance use has become a cause of concern. Hence, there arises a need to highlight the predictors and to address the range of problems caused by substance use. Here is a brief commentary on adolescent substance use.

Same-Sex Friendship, School Gender Composition, and Substance Use: A Social Network Study of 50 European Schools

ABSTRACTBackground: Other-sex friendship (girls with boy friends, boys with girl friends) has been associated with substance use, but how the gender composition of schools influences substance use has not been known. Objectives: We analyzed the influence of other-sex friendship on substance use and took into account the proportion of each gender group at the schools, and hypothesized that other-sex friendship is associated with higher levels of substance use and that schools with a majority of males have higher levels of use than female-majority schools. Methods: In 2013, a social network survey was carried out in six European cities. In each city, schools were selected and 11,015 adolescents (aged 14-16) were recruited (participation rate = 79.4%). We collected data on smoking, binge drinking, cannabis use, and peer group composition. Results: Other-sex friendship was associated with smoking, binge drinking, and cannabis use for girls and with smoking for boys. Substance use was more frequent in schools with a majority of males. Conclusions/Importance: Adolescent girls are best protected from substance use if they are in gender-balanced schools, but in same-sex friendship. This offers new perspectives on gender mixing at school. In schools with a majority of boys, more attention should be paid to girls, and gender-specific health promotion programs should be implemented. This European study is the first to take into account both individual (other-sex friendship) and contextual (gender composition of schools) gender interactions. It confirms previous studies on other-sex friendship, while shedding light on the influence of gender-normative contexts on substance use.

Patterns of adverse childhood experiences and substance use among young adults: A latent class analysis

IntroductionAdverse childhood experiences (ACEs) have been strongly linked with subsequent substance use. The aim of this study was to investigate how different patterns of ACEs influence substance use in young adulthood. MethodsUsing a community sample of young individuals (N=336; ages 18–25), we performed latent class analyses (LCA) to identify homogenous groups of young people with similar patterns of ACEs. Exposure to ACEs incorporates 13 childhood adversities including childhood maltreatment, household dysfunction, and community violence. Multiple linear and logistic regression models were used in an effort to examine the associations between ACEs classes and four young adult outcomes such as alcohol-related problems, current tobacco use, drug dependence symptoms, and psychological distress. ResultsLCA identified four heterogeneous classes of young people distinguished by different patterns of ACEs exposure: Low ACEs (56%), Household Dysfunction/Community Violence (14%), Emotional ACEs (14%), and High/Multiple ACEs (16%). Multiple regression analyses found that compared to those in the Low ACEs class, young adults in the High/Multiple ACEs class reported more alcohol-related problems, current tobacco use, and psychological symptoms, controlling for sociodemographic characteristics and common risk factors for substance use such as peer substance use. ConclusionsOur findings confirm that for many young people, ACEs occur as multiple rather than single experiences. The results of this research suggest that exposure to poly-victimization during childhood is particularly related to substance use during young adulthood.

Treatment Outcomes for Women with Substance Use Disorders: a Critical Review of the Literature (2010–2016)

This review critically examines recent literature (2010–2016) on substance use outcomes in women-only treatment studies and gender differences in treatment outcomes in mixed-gender studies. We then focus on outcomes in three areas salient to women with substance use disorders (SUDs): treatment of comorbid post-traumatic stress disorder (PTSD), pregnancy and parenting interventions, and treatment for women in the criminal justice system. Favorable results were found for behavioral treatments for women including couples therapy and gender-responsive group therapy. When gender differences were observed in mixed-gender behavioral treatment, outcomes were more favorable in women than in men. However, when gender differences were observed in pharmacotherapy trial results, outcomes were worse for women. With regard to the three subgroups that we reviewed, most recent research on co-occurring PTSD and SUD has been secondary analysis studies which suggest that factors such as group attendance and co-occurring psychiatric disorders influence substance use outcomes. In contrast to the other two subgroups examined, behavioral treatments for pregnant women did not show superior outcomes when compared to control groups. However, buprenorphine was found to be safe and effective for use with pregnant women with an opioid use disorder. Finally, studies of treatment outcomes for women in the criminal justice system found preliminary evidence of efficacy for several behavioral treatments. Consistent with findings of previous reviews, gender alone did not necessarily predict treatment response; rather, interaction of gender and other factors affected outcomes. Evidence showing worse outcomes for women in pharmacotherapy trials, with the exception of buprenorphine with pregnant women, further reinforces the need for research to evaluate differential treatment outcomes for men and women.

During, After, or Both? Isolating the Effect of Religious Support on Recidivism During Reentry.

To examine the independent and interdependent roles of baseline religious support during incarceration and within-individual changes in religious support on recidivism during the prisoner reentry process. Using data from the Serious and Violent Offender Reentry Initiative, cross-lagged dynamic panel models are used to examine the respective roles of baseline differences and within-individual changes in religious support on two variety indices encompassing substance use and criminal offending while simultaneously controlling for pre-incarceration levels of substance use and offending. Findings show that within-individual increases in religious support protect against substance use post-release, while baseline levels of religious support do not significantly influence substance use. Additionally, baseline levels of religious support fail to condition this relationship. Findings assessing criminal offending demonstrate that baseline religious support and within-individual changes in religious support fail to relate to offending independently. However, an interaction term reveals that the combination of the two relates to significantly lower levels of offending post-release. Findings offer encouragement for those involved in the work of providing religious support to ex-offenders in the community, reaffirming that tailoring support programs to the religious or spiritual ways individuals make meaning in their lives can improve reentry outcomes. Methodologically, failing to distinguish between baseline levels of religious support and post-release changes in religious support fails to capture the complexity of religiosity on the reentry process.

Psychological Model of Military Aggressive Behavior: Findings From Population-Based Surveys

The U.S. military has expressed concern about the influence of deployment and combat exposure on the criminal behavior of personnel returning from Iraq and Afghanistan. This study examines the role of behavioral health risk and protective factors associated with combat exposure and criminal and aggressive behavior in active duty Army and Naval personnel. Data from this cross-sectional study are based on two large anonymous, population-based health-related behavior surveys. Findings show that the proportion of all active duty Army and Naval service personnel who reported encounters with law enforcement or committed one or more aggressive acts in the past year increased from 19.41% in 2005 to 22.58% in 2008. Substance use, especially illicit drug use, and mental health problems were significant correlates of criminal and aggressive behavior, as were younger age, male sex, high impulsivity, and work/family stress. Path modeling suggested that several variables, notably combat exposure and history of childhood abuse, appeared to manifest their influence on criminal or aggressive behavior through increases in substance use and mental health problems. The potential mediating influence of substance use and mental health on combat and other trauma experiences has significant implications for preventing criminal and aggressive behavior among U.S. active duty military personnel.