this combined trend and, as with the active duty component, shows increasing rates over time, with the Army and Marine Corps having the highest combined rates.

Substance Use and Substance Use Disorders Among Military Dependents

The considerable information available on substance use among service members is in stark contrast to the limited empirical data on substance use among military spouses and children. One small study of military female spouses whose husbands were deployed (Padden et al., 2011) found that 3.9 percent reported illicit drug use, 12.4 percent reported binge drinking, and 27 percent reported tobacco use. Unfortunately, this was a small convenience sample of 105 spouses from a family readiness group, so the results are of limited generalizability.

Studies of military family members have tended to focus on the stress and mental health challenges they face. Indeed, the conflicts in Iraq and Afghanistan over the past decade have placed considerable strain on military families, who have had to cope with frequent and often lengthy separations due to the deployment of their service members. Not surprisingly, some of these deployment stressors, including fear for the safety of loved ones, single parent responsibilities, and marital strain, have had negative impacts on the spouses of military personnel (Schumm et al., 2000). Deployments have been associated with increased mental health diagnoses for spouses (Mansfield and Engel, 2011), with a higher likelihood of child maltreatment in military families (Gibbs et al., 2007), with poorer dietary behaviors, and with poorer stress management and rest (Padden et al., 2011). Eaton and colleagues (2008) found that rates of mental health problems among military spouses were similar to those among service members. However, spouses were more likely to seek mental health care and had less concern about the stigma of receiving that care relative to service members. Spouses also were an important influence on National Guard members who served in the Iraq and Afghanistan wars seeking care for their alcohol or mental health problems (Burnett-Zeigler et al., 2011).

Ahmadi and Green (2011) suggest that the stressors of military life, coupled with the fact that military personnel marry and have children earlier than their civilian counterparts, place service members at increased risk for substance abuse and for the development of adverse coping mechanisms. While this suggestion may have merit, the committee could identify no large-scale published studies examining substance use among military spouses and children. Mansfield and Engel (2011) suggest that this dearth of data with which to assess relationships between deployment stress and substance use points to the need for well-designed epidemiological studies to fill this information gap. The Millennium Cohort Study, an ongoing

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