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Military service and risk of subsequent drug use disorders among Swedish men

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Abstract

Purpose

Environmental factors contribute substantially to risk for drug use disorders (DUD). The current study applies multiple methods to empirically test whether military service is associated with subsequent DUD, as previous findings are inconsistent.

Methods

Longitudinal Swedish national registry data on a cohort of male conscripts born 1972–1987 (maximum N = 485,900) were used to test the association between military service and subsequent registration for DUD. Cox proportional hazard models were used in preliminary analyses, followed by three methods that enable causal inference: propensity score models, co-relative models, and instrumental variable analysis.

Results

Across all methods, military service was causally associated with lower risk of DUD. Hazard ratios ranged from HR = 0.43 (95% confidence intervals [CI] 0.37; 0.50) in the instrumental variable analysis to 0.77 (0.75; 0.79) in the multivariate propensity score matching analysis. This effect diminished across time. In the model including a propensity score, HRs remained below 1 across the observation period, while confidence intervals included 1 after ~ 11 years in the co-relative analysis and after ~ 21 years in the instrumental variable analysis.

Conclusions

In this cohort of Swedish men, complementary methods indicate that military service conferred substantial but time-limited protection against subsequent DUD. The observed effect could be due to reduced opportunity for substance use during service, social cohesion experienced during and after service, and/or socioeconomic advantages among veterans. Additional research is necessary to clarify these protective mechanisms and determine how other environmental contexts can provide similar benefits.

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Data availability

The data used in these analyses are available through Statistics Sweden. Restrictions apply to the availability of the data.

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Acknowledgements

This project was supported by NIH grants DA030005, AA023534, and AA027522; and by the Swedish Research Council as well as ALF funding from Region Skåne. The funders had no role in the conduct of the research; collection, analysis, or interpretation of data; the writing of the manuscript; or the decision to submit the manuscript for publication.

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Author notes

  1. Kenneth S. Kendler and Kristina Sundquist are joint senior authors.

Authors and Affiliations

  1. Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Box 980126, RichmondRichmond, VA, 23298-0126, USA

    Alexis C. Edwards & Kenneth S. Kendler

  2. Center for Primary Health Care Research, Lund University, Malmö, Sweden

    Henrik Ohlsson, Jan Sundquist & Kristina Sundquist

  3. Department of Psychiatry and Behavioral Sciences, State University of New York-Downstate, Brooklyn, NY, USA

    Peter B. Barr

  4. Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Jan Sundquist & Kristina Sundquist

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Correspondence to Alexis C. Edwards.

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We secured ethical approval for this study from the Regional Ethical Review Board in Lund and participant consent was not required (No. 2008/409 and later amendments) due to the pseudonymized nature of the data.

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Edwards, A.C., Ohlsson, H., Barr, P.B. et al. Military service and risk of subsequent drug use disorders among Swedish men. Soc Psychiatry Psychiatr Epidemiol 58, 1039–1048 (2023). https://doi.org/10.1007/s00127-023-02426-y

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