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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards
Services distinguish several degrees of severity of drug and alcohol abuse, and there are some important differences among the branches.
Alcohol consumption dropped significantly between 1980 and 1993, from a high of over 70 percent to a low of about 50 percent. It has fluctuated only slightly since that time and stood at about 47 percent in 2003. For both males and females, white youth have the highest rates of alcohol consumption and black youth the lowest. Hispanic youth are in between but are closer to whites than blacks in their consumption rates.
Marijuana usage also shows a steep drop between 1978 and 1992, from a maximum of 37 percent to a low of 12 percent. The rate began rising again in the early 1990s and reached a more recent maximum of just under 25 percent in 1997, and it has remained at about that level since that time. The use of other illicit drugs is about half the level of marijuana, and it shows a similar pattern but with somewhat less pronounced swings. Total illicit drug use among men differs very little by race; however, differences are found by gender. Black women have rates that are consistently 10 points below white women.
Substance Abuse and Military Performance
The primary outcome for evaluating moral character standards is attrition. Serious substance abusers are ineligible for enlistment in the first place (e.g., chronic alcoholism, illicit drug dependence), and very few waivers are granted for those who test positive at the MEPS for alcohol or illicit drugs other than marijuana. The main question therefore concerns waivers granted for positive tests for marijuana. Since a history of occasional use of marijuana no longer requires a waiver, we were restricted to evaluating attrition of enlistees who enter with a waiver for marijuana. Such waivers range from 2,000 to 3,000 per year, which is about 1.5 percent of total accessions.
At 12 months, attrition is elevated for marijuana waivers by only 3 percent; female rates are more elevated, but very few women receive these waivers. Attrition rates at 24 months are more elevated (6 to 9 percent), but even this difference is modest. Finally, 36-month attrition is elevated by 10 percentage points. On one hand, it is not clear whether these elevated rates would justify changes in the waiver policy; the longer persons stay in the Service past 12 months (the maximum length of most training periods), the more likely they are to repay the initial training investment. On the other hand, there are relatively few of these waivers, which means excluding them would not have much impact on recruiting costs. A formal cost-performance trade-off analysis would be required to test whether stricter standards for marijuana waivers would be cost-effective.