the effects of the military’s antidrug policies over the

Substance Use & Misuse, 48:837–853, 2013Copyright C© 2013 Informa Healthcare USA, Inc.ISSN: 1082-6084 print / 1532-2491 onlineDOI: 10.3109/10826084.2013.800120

ORIGINAL ARTICLE

The Effects of the Military’s Antidrug Policies over the Life Course: TheCase of Past-Year Hallucinogen Use

Richard A. Miech1, Andrew S. London2, Janet M. Wilmoth2 and Stephen Koester1

1Health and Behavior Sciences, University of Colorado at Denver, Denver, Colorado, USA; 2Department of Sociology,Syracuse University, Syracuse, New York, USA

We analyze long-term trends in past-year hallucino-gen use among veterans as compared to nonveterans.This topic is theoretically strategic because themilitaryadopted stringent and successful antidrug policies inthe mid-1980s, which serves as a natural experimentto examine the potential long-term impact of compre-hensive drug policies on illegal drug use. Drawing onself-reported data from the National Survey of DrugUse and Health in years 1985, 1988, and 1990–2010,the analysis uses age-period-cohort analysis to updatetrends in past-year hallucinogen use and to examinethe impact of veteran status. Results are consistentwith the hypothesis that a stringent antidrug policycan lead to a life-long reduction in hallucinogen use.Among birth cohorts who were young adults immedi-ately before the implementation of the antidrug poli-cies (those in the 1960–1964 birth cohort) odds of past-year hallucinogen use were twice as high for veteransas compared to nonveterans over the life course. Thisdifference disappeared among birth cohorts that wereyoung adults after the antidrug policies were imple-mented, when the prevalence of past-year hallucino-gen use would be expected to be higher for veterans be-cause of their significantly higher rates of illegal druguse in adolescence. After the drug-testing policies wereimplemented veterans actually had significantly lowerprevalence of past-year hallucinogen use in compari-son to nonveterans among the subgroup of respondentswho reported a history of illegal drug use before age18 (OR = .77, p < .01). These trends across veteransand nonveterans were not explained by trends in re-cruits’ tendencies for illegal drug use. These findingspoint to service in today’s armed forces as a turningpoint that, overall, leads to a lasting, lifelong reductionin substance use.

Address correspondence to Richard Miech, Health and Behavior Sciences, University of Colorado at Denver, Denver, Colorado, USA; E-mail:[email protected].

Keywords hallucinogens, veterans, age, period, cohort,NSDUH, life course, gateway

INTRODUCTION

Trends in substance use among US veterans as com-pared to nonveterans are largely unknown. This gap inour knowledge is problematic because veterans compriseabout 9% of the US population aged 18 years or older(US Census Bureau, 2010) and substance use among vet-erans has substantial policy relevance given that veteranshave access to an array of publicly funded U.S. Depart-ment of Veterans Affairs programs and services designedto compensate them for their service to their country. Al-though rates of participation in the armed services havedeclined over the past 50 years as the size of the mil-itary has contracted (U.S. Office of Personnel Manage-ment, 2012), military service remains a salient pathwayto adulthood (Kelty, Kleykamp, & Segal, 2010; Kelty &Segal, 2012), particularly for youth from socioeconomi-cally disadvantaged backgrounds (Bennett & McDonald,2012; Sampson & Laub, 1996). The US military is oneof the largest employers of young and, to a lesser extent,middle-aged adults; in 2010, there were 1,602,000 uni-formed military personnel (US Office of Personnel Man-agement, 2012). Thus, a substantial portion of adults areexposed to service-related contexts and military policiesthat have the potential to shape substance use—for betteror worse—during the formative years of young adulthood.

The impact of military service on substance use ap-pears to vary across historical era, providing a unique“natural experiment” to examine the potential long-termimpact of strict antidrug policies and programs. Militaryservice before the 1980s appears to have been a turningpoint that increased substance use over the life courseamong veterans relative to nonveterans, at least among

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838 R. A. MIECH ET AL.

Vietnam veterans (Wright, Carter, & Cullen, 2005). Af-ter the 1980s, military service has had a very different ef-fect as a result of the implementation of zero-tolerancedrug policies that include yearly, random urinalysis tests,and potential separation from service upon first failed test(discussed in more detail below). These policies substan-tially reduced illegal drug use among active duty person-nel (Bray & Hourani, 2007; Bray et al., 2010). Whetherthis reduction in use during the period of active duty qual-ifies as a “turning point” that has led to a lasting reduc-tion of substance use over the life course is not known; acomparison of illegal drug use prevalence among birth co-horts that served before and after the zero-tolerance poli-cies were implemented provides a unique opportunity toaddress this gap in knowledge. Such intercohort compar-isons are important for moving forward the literature onmilitary service and the life course (Wilmoth & London,2012a), as well as for adding to the emergent life courseliterature that focuses on identifying factors that affectdrug use over the life course and turning points in sub-stance use careers (Teruya & Hser, 2010; Wright et al.,2005).

Effects of military service on substance use early in thelife course have the potential to influence later-life trajec-tories and outcomes in various interconnected domains,including human capital development, socioeconomic at-tainment, marriage and family life, and health. Existinglife course research provides an intellectual frameworkto guide analyses of veteran status differences in sub-stance use (Elder & Johnson, 2002; Giele & Elder, 1998;Sampson & Laub, 1996; Teruya & Hser, 2010; Wilmoth& London, 2012b; Wright et al., 2005). While life courseanalysis can be used to study change in individual lives,it is also well-suited to examine population-level changes,such as the dramatic changes in substance use patterns thathave been observed in the US population in recent decades(Miech, Bohnert, Heard, & Boardman, 2013; Miech &Koester, 2012). Life course analysis goes beyond the in-dividual level to consider collective outcomes (Dannefer& Kelley-Moore, 2009); trends, and variation in them byveteran status, can be studied by focusing on intra- andintercohort variation.

Despite the potentially rich insights that can be gainedby using a life course perspective in drug use research,relatively few substance use researchers do so (Teruya &Hser, 2010). Similarly, few life course researchers who fo-cus on military service have systematically examined sub-stance use trajectories and outcomes (for an exception, seeWright et al., 2005) or how substance use influences veter-ans’ later-life human capital development, socioeconomicattainment, marriage and family life, and health (Wilmoth& London, 2012b). In our estimation, the relative lack oflife course research that focuses on the nexus of militaryservice and drug use is unfortunate. There is substantialpotential for the cross-fertilization of ideas and policy-relevant knowledge gains that could be achieved throughthe integration of currently divergent literatures and ad-ditional life course research. Therefore, in this paper, wepresent a case for integrating life course approaches in

general, and age-period-cohort (APC) analysis in particu-lar, into studies of military service and substance use. Af-ter explaining our conceptual framework, we provide anempirical APC analysis of veteran status and hallucinogenuse from 1985–2010 in order to demonstrate the utility ofthe approach we advocate. We then discuss the implica-tions of our findings for theory and policy.

LIFE COURSE PERSPECTIVES ON MILITARY SERVICEAND SUBSTANCE USE

Over the past 30 years, a growing body of research hasdrawn on life course perspectives to investigate the in-fluence of relatively early-life military service on vari-ous mid- and later-life outcomes (Wilmoth & London,2012b). This research has demonstrated the institutionalinfluence of the US military on educational, occupational,income, marital/family, health, and other life course tra-jectories and outcomes (Clipp & Elder, 1996; Dechter& Elder, 2004; Elder & Bailey, 1988; Elder & Clipp,1988, 1989; Elder, Clipp, Brown, Martin, & Firedman,2009; Elder, Gimbel, & Ivie, 1991; Elder, Shanahan, &Clipp, 1994, 1997; London & Wilmoth, 2006; MacLean& Elder, 2007; Mettler, 2005; Modell & Haggerty,1991; Pavalko & Elder, 1990; Settersten, 2006; Wilmoth,London, & Parker, 2010). It has also shown that the trans-formative potential of the military varies across individ-ual characteristics, such as sex, race/ethnicity, and socialclass, as well as historical periods (Angrist, 1990; Angrist& Krueger, 1994; Gimbel & Booth, 1994, 1996;Teachman, 2004, 2005; Teachman & Call, 1996; Teach-man & Tedrow, 2004; Wilmoth, London, & Parker, 2011).

Researchers who focus on military service and the lifecourse recognize the important role that military poli-cies play in shaping veterans’ lives, as well as how suchpolicies sometimes foreshadow subsequent social trendsthat influence the lives of both those who have and havenot served. The influence of the GI Bill on veterans’access to higher education, as well as home loans anda range of other resources, is well known (Bennett &McDonald, 2012; Mettler, 2005). Perhaps less well-known are the facts that: policies to compensate widowsfor the Civil War-related deaths of their husbands and pro-vide disabled Civil War veterans with pensions were theforerunners of various civilian social welfare programs(Skocpol, 1992, 1997); the racial integration of the mil-itary in 1948 preceded the racial integration of civilianlife in the United States (Lutz, 2012); and the “family-friendly policies” of the All-Volunteer Force era, cou-pled with racial integration and enforced, merit-based pay,and promotion schedules have eliminated racial differ-ences in marriage that remain evident in the civilian world(Lundquist, 2004). Although themilitary, as an institution,sometimes leads social trends, Kelty and Segal (2012: p.46) note that: “at other times the military follows the leadof civilian society (e.g., improved equality for women andhomosexuals)” (see also Brown, 2012).

In line with the growing antidrug sentiment that devel-oped in the United States during the 1980s (Jonnes, 1996),

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VETERANS AND HALLUCINOGENS USE 839

the military’s policy toward illicit drug use began to shiftfrom an emphasis on rehabilitation to a policy of zero tol-erance based on aggressive drug testing and punitive con-sequences (Institute of Medicine, 2012; Mehay & Pacula,1999). This change accelerated following a fatal aircraftaccident on the aircraft carrier Nimitz in 1981. Six of the14 Navy personnel killed in the accident had marijuanametabolites in their bodies. In December of 1981, the Sec-retary of Defense issued memorandum 62884 authoriz-ing punitive actions including separation from service andcourt martial for illicit drug use (Bray, Marsden, Herbold,& Peterson, 1992). Since then, the US military and thedifferent military services have issued a number of pol-icy directives aimed at updating the policy by includingadditional drugs, setting lower screening thresholds for apositive urinalysis, and detailing procedures for conduct-ing urinalyses and sanctioning personnel who test posi-tive. Over the past three decades, the overall trend of thesepolicy updates and directives has been toward stricter en-forcement of the zero tolerance policy (Department ofDefense, 2012b).

Military personnel who test positive for illicit drugs aresubject to discharge under Article 635–200 of theUniformCode of Military Justice. Generally, officers and noncom-missioned officers are processed for separation from themilitary for a single drug-positive urinalysis or drug of-fense. Enlisted personnel were given the opportunity tochange their drug using behavior. If, however, they com-mitted a second drug offense they were processed for sep-aration. Although all branches of the Armed Forces ini-tiated these zero tolerance policies they were not applieduniformly. In 1995, however, all branches of the militaryinstituted policies for drug testing and disciplinary actionthat were consistent (Mehay & Pacula, 1999).

Currently, all active duty military personnel are re-quired to have at least one random urinalysis (UA) test ayear. The Department of Defense conducts 60,000 urinal-ysis tests per month. All UAs test for marijuana, cocaine,and amphetamines including ecstasy. Tests for otherdrugs such as LSD (lysergic acid diethylamide), opiates,barbiturates, and PCP (phencyclidine) are done on everysample at some labs and randomly at others. The Depart-ment of Defense keeps testing up to date and adds newtests to detect new drugs and drops tests for drugs with ex-ceedingly low prevalence; for example, the military addedtests for the then-new drug of ecstasy in 1997 and droppedtesting for LSD in 2006 as a result of its near-zero preva-lence. Details of specific drugs tested and the assays totest them are available in annual reports of the militarydrug testing programs (Office of the Under Secretary ofDefense for Personnel and Readiness, 2009, 2010, 2011,2012). A positive urinalysis begins the administrative pro-cess of “separation from service” (Rhem, 2012).

The antidrug policies and programs implemented bythe military had their intended effect and dramatically re-duced the prevalence of illegal drug use among active-duty personnel. Prevalence of past-month illegal drug useamong active-duty personnel dropped more than eight-fold, from 27.6% in 1980 to 3.4% in 2002 (Bray &

Hourani, 2007). This decline started in the 1980s, withthe commencement of the new zero-tolerance policies inthe military, and plateaued at around 3% starting in 1992,when the policies were more fully implemented.

The long-term impact of the military’s drug screen-ing program on veterans’ drug use behaviors over thelife course is not known. On the one hand, it is possiblethat the drug testing policies may have created a “turningpoint” in the lives of young military personnel; exposureto such policies may have produced a lifelong reductionin use. Such a finding would be consistent with a centralpremise of “gateway theory” (Fergusson, Boden, & Hor-wood, 2006; Kandel, Davies, Karus, &Yamaguchi, 1986),which posits that illegal drug use in young adulthood is acausal factor for use in later years and that reducing and/oreliminating use in young adulthood should, therefore, leadto a lifelong reduction in use over the life course. Sucha finding would also be consistent with the notion of aturning point in the life course, which Teruya and Hser(2010: p. 189) define in the context of drug use researchas: “a particular event, experience, or awareness that re-sults in changes in the direction of a pathway or persistenttrajectory over the long-term.” On the other hand, drugtesting policies may have no lasting effect. Such a find-ing might emerge if illegal drug use in adulthood is drivenby an underlying, individual proclivity for substance use(see Lynskey et al., 2003) that remains unaltered by ex-posure to the military’s antidrug policies and programsduring young adulthood. While exposure to the military’sdrug screening program temporarily reduces use, it is pos-sible that drug use resumes once individuals are no longersubject to those policies.

A life course perspective is especially well-suited toguide an examination of the potential lifelong effects ofthe military’s antidrug policies on substance use. Trajec-tories of substance use for birth cohorts follow age-gradedpatterns, and the structure of these patterns can vary overdifferent historical eras. To analyze the effects of veteranstatus within this dynamic context, we use an APC ana-lytic approach.

Figure 1 presents a conceptual model that summarizesthe APC approach to studying substance use that we em-ploy in this study. Trends in an outcome (such as substanceuse) represent the sum effect of three factors, which to-gether account for 100% of the variance in time trends.Cohort effects are represented by Path a in Figure 1 andrefer to the unique prevalence of an outcome that followsa birth cohort as it ages through historical time. For exam-ple, the Baby Boom cohort has a uniquely high prevalenceof past-year marijuana use, and as it has aged, its preva-lence of marijuana use has remained significantly higherthan other birth cohorts when they were at the same age(Miech & Koester, 2012).

Path b and Path c denote the possibility that birth co-hort effects may act differently for veterans in compar-ison to their effects for nonveterans. If military serviceacts a turning point in young adulthood, then it is pos-sible that birth cohort effects may be moderated by vet-eran status. The potential effect of veteran status may

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FIGURE 1. Conceptual framework for age-period-cohort analysis of hallucinogen use.

differ in relation to the military antidrug policies that wereimplemented staring in the 1980s. Before the antidrugpolicies were implemented, veterans may have had higherrates of substance use over the life course than nonveter-ans. Such an effect would result in a significant and pos-itive effect for Path b. After the antidrug policies wereimplemented, veterans may have had lower rates of sub-stance use over the life course than nonveterans—an ef-fect that would result in a significant and negative effectfor Path c.

In order to correctly identify cohort effects, it is nec-essary to adjust for potential historical period and agingeffects. Historical period effects are represented by Pathd in Figure 1 and refer to changes over time in the preva-lence of an outcome that occur across all ages and cohortssimultaneously. For example, historical period effects area major contributor to the rapid increase in the nonmed-ical use of prescription pain medications since the 1990s(Miech et al., 2013). The rapid increase in the availabilityof prescription pain medications, as well as their reputa-tion as safe (Miech et al., 2013), has led to higher rates ofprescription pain misuse across people of all ages and co-horts in comparison to past eras. Third, aging effects arerepresented by Path e in Figure 1 and refer to the chang-ing prevalence of an outcome as people age. The preva-lence of almost all illegal drug use declines systematicallywith advancing age for all cohorts and in all time periods;APC analysis in the context of substance use controls ag-ing effects so that period and cohort effects are correctlyspecified.

AN EMPIRICAL EXAMPLE: TRENDS INHALLUCINOGEN USE BY VETERAN STATUS

We demonstrate the utility of this conceptual modelwith an APC analysis of past-year hallucinogen use.Hallucinogens are psychoactive substances that inducehallucinations, and include LSD, ecstasy, certain typesof mushrooms, PCP, and peyote. Use of hallucinogens

occurs primarily among youth less than 30 years ofage, and among this group its prevalence has followed aU-shaped curve over historical time. Among 18-year-oldrespondents in the National Survey on Drug Use andHealth (NSDUH), past-year prevalence was at its highest(15%) in the first year of the study (1979), declined to5% in the early 1990s, then nearly doubled to 9% by thelate 1990s (Golub, Johnson, Sifaneck, Chesluk, & Parker,2001). From the late 1990s onward, the prevalence ofpast-year hallucinogen use has remained at about 8%for young adults (Table 7.8b: Center for BehavioralHealth Statistics and Quality, 2012). To our knowledge,analyses of long-term hallucinogen trends have not yetused an APC approach, and therefore, the relative impactof different birth cohort and historical period on overalltrends is unknown. Similarly, no study of which weare aware has examined veteran status differences inhallucinogen use using an APC approach.

Our empirical example study consists of two mainparts. First, we build on the existing literature on trendsin past-year hallucinogen use and (a) update trends forthe US population to the year 2010, and (b) disaggre-gate these trends in age, period, and cohort components.An updated analysis of long-term hallucinogen trends iswarranted given that the last published study to focus onthe topic in detail was published more than a decade ago(Golub et al., 2001). Second, we compare the hallucino-gen use of veterans to that of nonveterans amongmembersof birth cohorts who were in young adulthood before andafter the implementation of themilitary’s antidrug policiesof the mid-1980s.

We expect that birth cohorts, and not historical periodeffects, drove the increase in past-year hallucinogen usesince the 1990s. The rationale for expecting a “cohort”rather than a “historical period” explanation for the ob-served trends is based primarily on the prevalence of firstuse of hallucinogens amongmiddle-aged and older adults.A “cohort” explanation rests on the proposition that thisprevalence is low to zero. It posits that young adults of

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different eras develop different levels of hallucinogen useand each cohort then maintains its relative standing as itages, when overall hallucinogen use declines. In this sce-nario adults who use hallucinogens in middle age or laterare not new users, but rather adults who continue a be-havior they first established during young adulthood. Incontrast, a “historical period” explanation would requirea substantial prevalence of new hallucinogen users in mid-dle age and later, as well an increase among young adults.It rests on the proposition that a social contextual fac-tor increases the prevalence of past-year hallucinogen useacross adults of all ages. Given that first-time use of hallu-cinogens among middle age and older adults is extremelyrare (Golub et al., 2001), our expectation is that cohortsprimarily drove the trends in hallucinogen use that havebeen documented. We, therefore, postulate:

Hypothesis 1: Overall trends in past-year hallucinogen useare driven primarily by birth cohorts, and not historicalperiod effects.

We also expect that veteran status differences in hal-lucinogen use vary before and after the antidrug policiesof the military were implemented, as indicated by Pathb and Path c in Figure 1. Reports from the military dur-ing the early 1980s portrayed fears that illegal drug usewas rampant and that military service could be acting asan incubator of illegal drug use (Bray et al., 1992). Themilitary brings together large numbers of young peopleand provides them with discretionary income and recre-ational time, which together create an opportunity struc-ture that has the potential to foster illegal drug use ifleft unchecked. To the extent that fears about military-incubated illegal drug use were grounded in reality andthe screening programs implemented by the military wereeffective, we expect that the prevalence of illegal drug usewas higher among veterans as compared to nonveteransbefore the antidrug policies were set into place. Thus, oursecond hypothesis is:

Hypothesis 2: The prevalence of hallucinogen use washigher among veterans as compared to nonveteransamong cohorts who were young adults before the im-plementation of antidrug policies in the mid-1980s.

The successful reduction of illegal substance useamong active-duty service members after the mid-1980sshould theoretically lead to a lifelong reduction in hal-lucinogen use according to “gateway theory” (Fergussonet al., 2006; Kandel et al., 1986). This theory posits acausal sequence in which illegal drug use in adolescenceand young adulthood makes individuals more likely to useillegal drugs later in the life course (Swift et al., 2012), andleads to escalating use of other illegal drugs, such as hal-lucinogens. If true, it follows that reduction of drug useduring young adulthood, a time when most veterans arein the service, should break this causal chain and therebylead to a lifelong, lasting reduction of illegal drug use overthe life course. Such a finding would also be consistentwith the notion that military service during specific his-

torical periods (i.e., after the implementation of system-atic drug screening) serves as a positive turning point inthe life course because it reduced or eliminated illicit druguse in later life (Teruya & Hser, 2010). Because the mil-itary as an institution changes over time, service per sewould not produce a turning point in drug use trajecto-ries; it is only among those cohorts that were exposed tothe military’s antidrug policies that we would expect tosee such a turning point.

Veterans who entered military service with a prior his-tory of adolescent illegal drug use are of particular inter-est. Illegal drug use in adolescence is one of the strongestpredictors of subsequent use at older ages (Swift et al.,2012), and few population-level interventions or policieshave demonstrated the capacity to redirect this trajectory.A focus on veterans with a history of adolescent substanceabuse is both a stringent, conservative test of gateway the-ory, and also offers the potential to test the effectiveness ofa social policy on one of the most intractable predictors ofdrug use. At least among current recruits, levels of preen-listment illegal drug use are substantial, with one study ofnaval recruits reporting that 31% engaged in illegal druguse one year before basic training began (Ames, Cunradi,& Moore, 2002).

These considerations lead to our third and final hypoth-esis and a subsidiary to it (hypothesis 3a):

Hypothesis 3: Veterans who were young adults after themilitary implemented anti-drug policies will have sub-stantially lower prevalence of past-year hallucinogenuse compared to nonveterans over the life course.

Hypothesis 3a: This effect will also be present amongthe subsample of respondents who used illegal drugsin adolescence, before they were eligible to enter thearmed services.

This third hypothesis and it subsidiary come with twoimportant, competing counterhypotheses. First, the “per-sonal propensity” hypothesis directly contradicts gatewaytheory and posits that illegal drug use in adolescence isnot a causal influence on later illegal drug use. Instead,the reason the two co-occur is that both are driven by anunderlying predisposition for illegal drug use in some in-dividuals, which may have a genetic basis (discussed inHall & Lynskey, 2005; Lynskey et al., 2003). This per-spective predicts that people with high levels of personalpropensity will use illegal drugs later in life whether or nottheir use in young adulthood was reduced due to an exoge-nous constraint on use, such as the military’s drug screen-ing program for active-duty personnel. Consequently, anyreduction of illegal drug use during young adulthood thatresulted from the military’s antidrug policies would be ex-pected to be specific to the time when veterans were in themilitary and would not have a lasting effect. A null findingfor Hypothesis 3, and especially its subsidiary, would beconsistent with this “personal propensity” hypothesis.

A second competing hypothesis focuses on self-selection. This hypothesis is a variation of the “per-sonal propensity” hypothesis and posits that antidrug

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policies of the military led potential recruits with a highpropensity for illegal drug use to self-select away frommilitary service. In its strong form, this hypothesis pre-dicts that any lower prevalence of hallucinogens amongveterans as compared to nonveterans results from a dispro-portionate selection of early users away from military ser-vice, and not a causal effect of antidrug policies on illegaldrug trajectories. As with the counterhypothesis above, anull finding for Hypothesis 3would support the contentionthat the antidrug policies do not alter trajectories of illegaldrug use. Further, to the extent that adolescent illegal druguse before age 18 years is a measure of propensity for il-legal drug use, support for this counterhypothesis wouldcome from the finding that levels of adolescent, illegaldrug use among veterans as compared to nonveterans havedeclined in recent years.

DATA AND METHODS

DataData for the analysis come from the national survey ondrug use and health (NSDUH), a series of annual, na-tionally representative, cross-sectional surveys of the UScivilian, noninstitutionalized population. This study usesthe years 1985, 1988, and every year from 1990 to 2010inclusive.

The NSDUH was designed to provide estimates of theprevalence of illegal and legal drugs in the household pop-ulation of the United States. These surveys use a multi-stage probability sample, with minor variation in the sam-pling frame over the years from 1985 to the present. Theanalyses we present in this paper are based on respondentswho were aged 20–59 years at the time they were sur-veyed. The pooled sample includes 485,254 respondents.

The survey has undergone some methodological im-provement over time, which has led to higher, and presum-ably more accurate, estimates of drug use. The two majorimprovements were: (1) a shift from paper-and-pencil tocomputer-assisted surveys in 1999 and (2) the introduc-tion of respondent incentives in 2002 (Kennet & Gfroerer,2005). These improvements affected respondents of allages in the specific years that they were implemented.Therefore, in the analyses that follow, their effects willaffect the estimates of “historical period” effects and not“cohort” effects.

Interviews were conducted in the home by trainedinterviewers. To maximize the validity of responsesand to minimize under-reporting, respondents answeredquestions about possible sensitive issues, such as il-legal drug use, using a self-administered format. Re-sponse rates were typically 80% or higher. All in-formation is self-reported. More detailed informationabout the survey is available at the SAMHSA website:http://www.oas.samhsa.gov/nhsda.htm.

MeasuresThe dependent variable in our analyses is past-year useof hallucinogens. To assess hallucinogen use, the surveyasked respondents about LSD, PCP, peyote, mescaline,psilocybin (mushrooms), and ecstasy. The survey also

provided the opportunity for respondents to list any otherhallucinogens that they used. Respondents are coded posi-tive for past-year hallucinogen use if they report past-yearuse of any hallucinogen.

The focal independent variables measure veteran sta-tus, year of age, birth cohort, and historical period. Addi-tionally, for some analyses self-reported illegal drug useprior to age 18 years is taken into account. Multivariateanalyses control for sex and race/ethnicity.

Year of age is provided in the public release NSDUHdata in years up to 1998, but in later surveys a variableto indicate year of age is not provided. Instead, in thelater survey years the age variables indicate only whetherrespondents’ age falls within broad categories, such as35–49 or 50–64. However, additional information on ageis available from the alcohol section of the survey, whichasks respondents both their age when they first drank alco-hol and also the calendar year when they first drank alco-hol. From this information it is possible to calculate thebirth year of the respondents and, consequently, age ofrespondent at the time of the survey. Ninety-one percentof the respondents in years 1999 and later reported everdrinking alcohol and also the information from which todeduce their year of age. For people who reported neverdrinking alcohol, we assumed they also never used hal-lucinogens and randomly assigned them to an age withintheir broad age category in the public release.

In analyses not shown, we evaluated how well thismethod to deduce age in the public release data worked.We obtained special permission from NSDUH to run anAPC analysis of past-year marijuana use with the nonpub-lic data, for which exact year of age is available. For eachdemographic subgroup this analysis produced 29 coeffi-cients and 29 standard errors. We then ran the same analy-sis using the public release data and the deductive method.The correlations of the estimated coefficients across thetwo methods were high: among women, the correlationwas .998887, among men it was .999939, and among His-panics it was .998989. The correlations of the estimatedstandard errors across the two methods were also high andwere all above .99. Further, the high correlations were notspecific to the outcome of past-year marijuana use and weran the same procedure for the outcome of binge drink-ing (for which we also received one-time permission touse the nonpublic data) and found similar, high levels ofcorrelation that were never below .99.

MethodsPast-year hallucinogen use is expressed as the function:

Logit(Yik) = a + Ck + Pj + A + eik (1)

where the effect of the k-th cohort is given byCk, the effectof the j-th period by Pj, and the effect of age is given byA; where α is a constant and eij is random disturbance.Age is a continuous variable centered at age 30 years.Cohort consists of 13 5-year periods starting at 1930. Thefirst three 5-year cohorts (1930–1934, 1935–1939, and1940–1944) are combined into one group because small

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numbers prevented independent estimation of these 5-yeargroup effects. The combination of these cohorts into onegroup also aids in the identification of the model. His-torical period consists of five 5-year periods starting in1985–1989.

This model is estimated using logistic regression. Allanalyses are weighted to take into account the complexsurvey design. Data from all surveys were pooled anddata from each survey were assigned unique strata num-bers to adjust standard errors for design effects (Korn &Graubard, 1999).

RESULTS

Sample Description and the Prevalenceof Hallucinogen UseTable 1 presents descriptive statistics for the analytic sam-ple of persons aged 20–59 years from 1985 to 2010, andthey conform to expectations. The overall prevalence ofpast-year hallucinogen use for all survey years combinedis low: 0.89% for veterans and 1.5% for nonveterans. Vet-erans comprise 9% of the overall sample.

Table 1 shows substantial variation in past-year hallu-cinogen use by demographic groups. Consistent with pre-vious studies, men have higher prevalence than women.Further, non-HispanicWhites have higher prevalence thanHispanics, who have higher prevalence than non-HispanicBlacks. Table 1 also shows, as expected, that early use ofany illegal drug use is strongly associated with later use inadulthood. While the prevalence was still relatively low,respondents who reported use of any illegal drug duringadolescence had a prevalence of past-year hallucinogenuse that was ten times higher than the prevalence amongthose who did not report drug use in adolescence (4.1%vs. 0.41%).

The prevalence of past-year hallucinogen use decreasesdramatically with age, and is 38 times higher for re-spondents aged 20–29 years (4.2%) than for those aged50–59 years (0.11%). Across historical time, the over-all prevalence of past-year hallucinogen use follows a U-shaped curve: for the combined group of all ages it was1.6% in 1985–1989, fell to 1.1% in 1990–1994, and thenreturned to 1.6% in 2000–2004 and 2005–2010. Preva-lence also varies by birth cohort, but these levels are dif-ficult to interpret directly because more-recent cohorts

TABLE 1. Descriptive statistics of analysis pool (n = 485,254)

Percentage past-year hallucinogenPercentage past-year use among respondents who used

Variable Percentage of sample hallucinogen use illegal drugs before age 18

VeteranYes 9.9 0.89 2.6No 90.1 1.5∗ 4.2∗

Age20–29† 25.5 4.2 8.830–39 27.9 0.94∗ 2.1∗

40–49 26.4 0.30∗ 0.77∗

50–59 20.2 0.11∗ 0.83∗

Year1985–1989† 7.3 1.6 6.11990–1994 20.1 1.1∗ 3.8∗

1995–1999 21.1 1.3 4.0∗

2000–2004 22.8 1.6 4.2∗

2005–2010 28.7 1.6 3.8∗

Birth cohort1935–1944† 9.6 0.11 2.21945–1964 52.0 0.53∗ 1.61965–1974 23.2 1.7∗ 3.8∗

1975–1989 15.2 4.9∗ 10.5Sex

Female 51.4 0.88 2.8Male 48.6 2.0∗ 5.0∗

Race/ethnicityWhite† 71.2 1.6 4.2Black 11.7 0.84∗ 2.8∗

Hispanic 11.9 1.0∗ 4.0Illegal drug use before age 18

Yes 28.0 4.1 4.1No 72.0 0.41∗ –

†Reference category for tests of statistical significance.∗Significantly differs from reference category in bivariate analysis, p < .05.

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are relatively younger, and youth confers a substantiallyheightened risk of past-year hallucinogen use. Interpreta-tion of hallucinogen levels across cohorts requires con-trols for age and historical period, which is accomplishedwith the formal APC analysis that we present below.

Age-Period-Cohort Analysis of Past-YearHallucinogen UseTable 2 and Figure 2 present the results of our formalAPC analysis of past-year hallucinogen use. The resultssupport Hypothesis 1 and indicate that cohort effects, andnot historical period effects, are the main drivers of trendsin past-year hallucinogen use. The cohort results indicatethat at all ages, the cohort born in 1955–1959 had oddsof past-year hallucinogen use that are 34% (e.291 = 1.34)higher than the reference cohort of 1960–1964. After the1960–1964 cohort, the prevalence of past-year hallucino-gen use returned to higher levels with the 1975–1979birth cohort, which had 59% (e.461 = 1.59) higher oddsof past-year hallucinogen use than the reference cohort,and these rates stayed high for the birth cohorts that fol-lowed. Historical period influences did not have a strongeffect on past-year hallucinogen prevalence. The coef-ficients that indicate the impact of historical period are

small and none differ significantly from the reference cat-egory of 1985–1989.

For the purposes of this investigation, age is included asa control for the correct specification of cohort and histori-cal period effects. As expected, past-year hallucinogen usedeclined abruptly and monotonically with advancing age.The effect of age reaches a floor at older ages, such thatthe effect of age is captured with a quadratic, curvilinearfunction. Compared to the reference group of respondentsaged 30 years, those aged 20 years have odds of past-yearhallucinogen use that are 4.83 times higher (because it iscentered at age 30 years, age has a value of −10 for re-spondents age 20, and e(−.141)(−10)+(.00165)(−10)(−10) = 4.83).Respondents aged 59 years have odds of past-year hallu-cinogen use that are only 0.067 times the odds of thoseaged 30 years (e(−.141)(29)+(.00165)(29)(29) = 0.067). Over theentire age range of the sample, the odds of past-year hal-lucinogen use are 72 (4.83/0.067) times higher for theyoungest (20-years-old) as compared to the oldest (59-years-old) respondents.

The controls acted as expected. Controlling age, pe-riod, and cohort effects, the odds of past-year hal-lucinogen prevalence for women were about half theodds for men (e−.838 = 0.43), and both Hispanics and

TABLE 2. Results of age-period-cohort model of past-year hallucinogen use; unexponentiated coefficients from logistic regression model

Variable Coefficient Standard error Wald chi-square

CohortCohort 1930–1944 −0.163 0.556Cohort 1945–1949 −0.681∗ 0.336Cohort 1950–1954 0.299 0.195Cohort 1955–1959 0.291∗ 0.139Cohort 1960–1964 ReferentCohort 1965–1969 −0.0421 0.107Cohort 1970–1974 0.171 0.13Cohort 1975–1979 0.461∗∗ 0.167Cohort 1980–1984 0.365 0.203Cohort 1985–1989 0.408 0.235 F(9,1012) = 7.61∗∗

AgeAge1 −0.141∗∗ 0.0103Age squared1 0.00165∗∗ 0.000339 F(2,1019) = 115.17∗∗

PeriodYears 1985–1989 ReferentYears 1990–1994 −0.254 0.141Years 1995–1999 −0.177 0.177Years 2000–2004 0.00487 0.204Years 2005–2010 −0.0228 0.239 F(4,1017) = 4.08∗∗

ControlsSex

Male ReferentFemale −0.838∗∗ 0.0328 F(1,1020) = 651.73∗∗

Race/ethnicityWhite ReferentBlack −0.781∗∗ 0.0548Hispanic −0.749∗∗ 0.046 F(2,1019) = 217.94∗∗

Constant −3.72∗∗ 0.136

∗p < .05.∗∗p < .01.1Age centered at 30.

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FIGURE 2. Age, period, and cohort effects for past-year hallucinogen use. ∗Note. Age effects are centered at age 30 years.

non-Hispanic Blacks had odds that were about half thoseof non-Hispanic Whites.

Veteran Status and Past-Year Hallucinogen UseFigure 3 presents observed,mean levels of past-year hallu-cinogen use by veteran status and historical period. PanelA of Figure 3 presents results for all men aged 25–29 yearsover the historical periods covered by the survey. PanelsB and C present the same information for men with andwithout a history of illegal drug use before age 18 years.We focus on the age range 25–29 years because the preva-lence of hallucinogen use drops to such low levels at olderages.

Consistent with Hypothesis 2, veteran men who wereyoung adults before the implementation of the military’santidrug policies have significantly higher rates of past-year hallucinogen use in comparison to nonveteran men.

Panel A of Figure 3 indicates that in 1985 the prevalencewas more than twice as high among veteran men as com-pared to nonveteranmen (1.1% vs. 0.5%), a difference thatis statistically significant. These male veterans were allin the service prior to 1986, before the antidrug policiesin general, and screening for hallucinogens in particular,were put fully into place. Panel A indicates that male vet-erans maintained this higher prevalence in 1990, althoughin this year the difference across veterans and nonveteransis not statistically significant.

Panel A of Figure 3 does not provide conclusive evi-dence to support or contradict Hypothesis 3, which pre-dicts that veterans who were young adults after the mil-itary implemented the antidrug policies will have lowerprevalence of past-year hallucinogen use in comparisonto nonveterans. On the one hand, the prevalence amongveterans is lower than it is among nonveterans in the year

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Panel A: Entire Population

Panel B: Population That Used Illegal Drugs Before Age 18

Panel C: Population That Did Not Use Illegal Drugs Before Age 18

*

† † *

VeteranNonveteran

FIGURE 3. Past-year hallucinogen prevalence among population age 25–29 by veteran status and year. ∗p ≤ .05, prevalence significantlydiffers across veterans and nonveterans in two-tailed, bivariate test. †p ≤ .05, prevalence significantly differs across veterans and nonveteransin two-tailed, bivariate test when years 1985 and 1990 combined into one analysis pool.

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1995 and all later years. On the other hand, these differ-ences are not statistically significant and could be due tosampling error.

Panel B presents results for men who reported illegaldrug use before age 18 years and provides support for Hy-potheses 2 and 3a. Among this group, the prevalence ofpast-year hallucinogen use was higher for male veteransas compared to male nonveterans in the years 1985 and1990, and this difference is statistically significant whenthe data from the years 1985 and 1990 are combined intoone group. This result directly supports Hypothesis 2. Inaddition, among males the prevalence of past-year hallu-cinogen use was lower for veterans and nonveterans in theyears after the military implemented its antidrug policies.The difference across veterans and nonveterans is statis-tically significant in 2005, a finding that provides directsupport for Hypotheses 3 and 3a.

Panel C of Figure 3 presents results for men who re-ported no illegal drug use before age 18 years. For thisgroup, the prevalence of past-year hallucinogen use isvery low (it is never over 0.03%) and the results indicateno significant difference between veterans and nonveter-ans in any of the survey years. To examine these differ-encesmore formally, and to control factors such as sex andrace/ethnicity, the analysis turned next to anAPC analysis.

Table 3 presents results from an analysis that takes vet-eran status into account in a formal APC analysis of past-year hallucinogen use. This analysis uses the full sampleand is a comprehensive model of the trends outlined inFigure 3. Results are presented both for the full sampleand also for the subgroup of respondents who reported il-legal drug use before age 18 years. The analysis builds onthe results in Table 2 by adding an indicator for veteranstatus and interactions of veteran status with birth cohort.Analyses not shown tested the potential interaction of vet-eran status with age and historical period indicators; theseinteractions did not significantly contribute to the model,either individually or as a group, and therefore, are notincluded in the final model.

The results in Table 3 provide support for both Hy-potheses 2 and 3. Support for Hypothesis 2 comes fromthe “veteran” coefficient, which in the context of the inter-actions in the model refers to veterans in the 1960–1964birth cohort. The positive, significant coefficient indicatesthat veterans in this birth cohort had odds of past-year hal-lucinogen use that were 2.25 (e.811 = 2.25) higher thannonveterans in the full sample. In the sample restrictedto respondents who had used illegal drugs before age18 years, the odds ratio is slightly smaller at 1.90 (e.642

= 1.90), but is still statistically significant. Veterans inthe 1960–1964 cohort were aged 20 years in 1980–1984,before the antidrug policies of the military were fullyimplemented.

The higher odds of past-year hallucinogen use amongveterans as compared to nonveterans is specific to veter-ans born in the 1960–1964 birth cohort. In the full sample,veterans in the 1955–1959 birth cohort had odds of past-year hallucinogen that were only 24% higher than thoseof nonveterans (e.811−.593 = 1.24), a difference that is not

statistically significant (p= 0.55, from postestimation testof the hypothesis that 0.811–0.593 = 0). Similarly, in thefull sample, the odds of past-year hallucinogen use acrossveterans and nonveterans did not differ for any of the co-horts born prior to 1955–1959. In the sample constrainedto those who had used illegal drugs before age 18 years,veterans in the 1955–59 cohort actually had odds of past-year hallucinogen use that were slightly lower than non-veterans (e.642−.671 = 0.97), although this difference is notstatistically significant. Among the earliest cohorts born1930–1944 and 1945–1949, the odds of past-year hallu-cinogen use were actually significantly lower (p< .01) forveterans as compared to nonveterans. Taken as a whole,these results indicate that a higher prevalence of hallucino-gens among veterans as compared to nonveterans is a dif-ference that emerged around 1980 (when the 1960–1964birth cohort was age 20), immediately before the imple-mentation of the antidrug policies and program in themilitary.

Support for Hypothesis 3 and Hypothesis 3a comesfrom the analysis of the sample that is restricted to thosewho reported illegal drug use before age 18 years, butsupport for Hypothesis 3 is not found in the full sample.Consistent with the findings reported in Panel B of Fig-ure 3, in the restricted sample, the lower odds of past-year hallucinogen use among veterans relative to non-veterans become apparent around the 1975–1979 cohort,which was 20 years old in 1995–1999. For example, inthe 1975–1979 cohort, the odds of past-year hallucino-gen use are lower for veterans as compared to nonvet-erans by a multiple of 0.82 (e−.841+.642 = 0.82), and forthe 1980–1984 and 1985–1989 cohorts, the correspondingmultiples are 0.72 and 0.80. In an analysis that combinedthe 1975–1989 cohorts into one group (not shown), theodds of past-year hallucinogen use for veterans averagedto 0.77 (p < .01) those of nonveterans.

Analysis of the full sample does not support Hypoth-esis 3. In all cohorts born in 1965 or later, the odds ofpast-year hallucinogen use are opposite the predicted di-rection and are slightly higher for veterans as comparedto nonveterans, although these differences are not statis-tically significant. For example, a veteran in the 1965 co-hort receives a value of 1 for both the “veteran” coeffi-cient (which has a value of .811) and the interaction “VetX Cohort 1965–1969” (which has a value of −.626), andtherefore, the odds for veterans as compared to nonveter-ans in this cohort are the addition of these two coefficients:.811+ −.626= .185. The positive value indicates slightlyhigher odds of past-year hallucinogen use for veterans ascompared to nonveterans, although a postestimationWaldtest (not shown) indicates this difference is not statisticallysignificant. The control variables act as expected and inthe same direction as they did previously in the APC anal-ysis reported in Table 2.

Does Differential Selection Explain The Findings?The final set of analyses consider the counterhypothesisthat any trends in hallucinogen use across veterans andnonveterans is due to differential selection over time and

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Table 3. Results of age-period-cohort model of past-year hallucinogen use and veteran status; unexponentiated coefficients from logisticregression model

Entire population Population that used illegal drugs before age 18

Variable Coefficient Standard error Wald chi-square Coefficient Standard error Wald chi-square

Veteran (in 1960–1964 cohort) 0.811∗∗ 0.2 0.642∗∗ 0.214Veteran × Cohort Interactions

Vet × Cohort 1930–1944 −0.892 0.942 −4.65∗∗ 1.26Vet × Cohort 1945–1949 −1.24 0.651 −3.21∗∗ 0.881Vet × Cohort 1950–1954 −1.16∗∗ 0.439 −0.997 0.581Vet × Cohort 1955–1959 −0.593 0.416 −0.671 0.474Vet × Cohort 1960–1964 ReferentVet × Cohort 1965–1969 −0.626∗ 0.273 −0.636∗ 0.29Vet × Cohort 1970–1974 −0.662∗∗ 0.256 −0.721∗ 0.283Vet × Cohort 1975–1979 −0.772∗∗ 0.254 −0.841∗∗ 0.288Vet × Cohort 1980–1984 −0.799∗∗ 0.262 −0.972∗∗ 0.276Vet × Cohort 1985–1989 −0.596∗ 0.253 F(10,1011) =

2.03∗−0.861∗∗ 0.276 F(10,1011) =

3.59∗∗

CohortCohort 1930–1944 −0.0439 0.594 2.16∗∗ 0.794Cohort 1945–1949 −0.462 0.372 1.06∗ 0.52Cohort 1950–1954 0.447∗ 0.197 0.818∗∗ 0.234Cohort 1955–1959 0.361∗ 0.141 0.426∗∗ 0.149Cohort 1960–1964 ReferentCohort 1965–1969 0.0388 0.113 0.152 0.129Cohort 1970–1974 0.258 0.134 0.498∗∗ 0.149Cohort 1975–1979 0.553∗∗ 0.171 0.855∗∗ 0.191Cohort 1980–1984 0.457∗ 0.207 0.722∗∗ 0.232Cohort 1985–1989 0.495∗ 0.238 F(9,1012) =

7.52∗∗0.84∗∗ 0.267 F(9,1012) =

12.30∗∗

AgeAge1 −0.142∗∗ 0.0104 −0.131∗∗ 0.0112Age squared1 0.00168∗∗ 0.00034 F(2,1019) =

115.66∗∗0.00221∗∗ 0.000396 F(2,1019) =

83.58∗∗

PeriodYear 1985–1989 ReferentYear 1990–1994 −0.266 0.142 −0.337∗ 0.153Year 1995–1999 −0.191 0.178 −0.256 0.195Year 2000–2004 −0.00889 0.205 −0.232 0.225Year 2005–2010 −0.0344 0.241 F(4,1017) =

4.13∗∗−0.313 0.264 F(4,1017) =

2.03∗∗

ControlsSex

Male ReferentFemale −0.827∗∗ 0.0325 F(1,1020) =

648.16∗∗−0.684∗∗ 0.039 F(1,1020) =

307.32∗∗

Race/ethnicityWhite ReferentBlack −0.785∗∗ 0.0549 −0.594∗∗ 0.0608Hispanic −0.746∗∗ 0.046 F(2,1019) =

217.81∗∗−0.398∗∗ 0.0544 F(2,1019) =

69.37∗∗

Constant −3.81∗∗ 0.135 −3.19∗∗ 0.148

∗p < .05.∗∗p < .01.1Age centered at 30.

not to an effect of the military antidrug policies on tra-jectories of illegal drug use. This counterhypothesis leadsto the expectation that the percentage of veterans whoenter the service with a history of illegal drug use (be-fore age 18 years) should steadily decline among veterans

as compared to nonveterans over historical time. Specif-ically, veterans who were in the 1960–1964 birth cohortshould have the highest prevalence of illegal drug use be-fore age 18 relative to nonveterans because this birth co-hort had the highest odds of past-year hallucinogen use.

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FIGURE 4. Percentage of veterans and nonveterans age 25–29 who reported use of illegal drugs before age 18, by year.

This cohort was about age 25–29 years in 1985–1989. Inall subsequent birth cohorts, the prevalence of illegal druguse before age 18 years among veterans should decline ascompared to nonveterans.

Figure 4 presents results to evaluate this counterhy-pothesis, which is not empirically supported. The differ-ence in illegal drug use before age 18 years across veter-ans and nonveterans is similar across all historical eras,and does not follow any linear trend. In 1985–1989, theprevalence of illegal drug use before age 18 years amongadults age 25–29 years was 55% for veterans and 44% fornonveterans, a relative difference of 25% (55/44). This rel-ative difference remains similar throughout different his-torical periods and in 2005–2010 it is 29%, about the samelevel it was two decades earlier (the prevalence for veter-ans is 49% and for nonveterans is 38%, for a relative dif-ference of 29%). As a formal test (not shown), we usedthe pooled analytic sample of 25–29 year olds to examineif the association of veteran status with illegal drug usebefore age 18 years significantly differed across historicaleras. Such a difference would be indicated by amultiplica-tive interaction of veteran status and historical year. Thisinteraction term was not statistically significant (p = .46)

in a logistic regression model that included the interactionand its component terms, and it was also not significant(p = .41) in a model that additionally included controlsfor sex and race/ethnicity.

DISCUSSION

In this study, we use a life course perspective to ana-lyze the substance use of veterans in comparison to non-veterans, and focus specifically on the outcome of past-year hallucinogen use. The life course perspective mo-tivates analysis of two unique issues that to our knowl-edge have not been previously considered at the popu-lation level: (1) the lasting effect of military service onveterans’ hallucinogen use over their life course and (2)whether the military’s antidrug policies of the mid-1980saltered veterans’ hallucinogen use careers and led to a life-long reduction in hallucinogen use. We find that trendsin hallucinogen use are driven primarily by birth cohorts,and that within birth cohorts, the prevalence of hallu-cinogen use of veterans as compared to nonveterans haschanged substantially over historical time. It is theorizedthat military service is a potentially transformative social

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institution (Wilmoth & London, 2012a) and that mil-itary service can contribute to discontinuities in thelife course—either positive or negative turning points(Elder, et al., 1991; Laub & Sampson, 2003; Sampson &Laub, 1996; Teruya & Hser, 2010). Our results indicatethat military service after the military implemented strin-gent anti-drug policies andmandatory screening programsacts as a turning point that alters the substance use trajec-tories of veterans—especially those who used drugs priorto service—and can lead to a lifelong reduction in ille-gal drug use. Although the military’s intent in implement-ing these policies and programs may have been to addressimmediate concerns about military-incubated drug use,their policies and programs appear to have had a longer-term impact on the lives of veterans who were subject tothem.

In order to demonstrate the utility of incorporatinglife course perspectives into studies of substance use, inthis paper, we developed an empirical example that fo-cused on past-year hallucinogen use. This analysis beganwith an APC analysis of long-term trends in past-yearhallucinogen use, which served two purposes. The firstpurpose was to examine whether birth cohort effects orhistorical period effects have been the main drivers of hal-lucinogen trends over time; the second purpose was toupdate trends in hallucinogen use, because the last pa-per on such trends of which we are aware was publishedmore than a decade ago. The results of this analysis in-dicate little change in the prevalence of hallucinogen useover the past decade. Specifically, the birth cohort effectson hallucinogen use are similar for the most recent co-hort born 1980–1989 and the preceding birth cohort born1975–1979. Additionally, we find support for our first hy-pothesis; our results point to the primacy of birth cohorteffects as the driver of trends in hallucinogen use overtime.

Veteran status had a lasting effect on hallucinogen usewithin birth cohorts as they aged, supporting military ser-vice as a turning point in substance use careers. In supportof Hypothesis 2, our analysis showed that military serviceincreased hallucinogen use over the life course amongveterans as compared to nonveterans, at least among birthcohorts that were young adults in the early 1980s beforethe full implementation of the military’s antidrug policiesand drug screening programs. This finding was apparentboth in the general population and also among the sub-group who reported illegal drug use in adolescence. Con-sistent with the concerns of military planners in the 1980s,military service at the time appeared to act as an incubatorof illegal drug use.

Our results indicate, specifically, that military serviceled to increased substance in the 1960–1964 birth cohort.Among earlier birth cohorts, veterans typically had lowerhallucinogen use than nonveterans. These results thereforemodify Hypothesis 2 by indicating that military service asan incubator of hallucinogen use was a phenomenon thatemerged in the 1960–1964 birth cohort and, as we discussbelow, was quickly addressed by the military’s antidrugpolicies.

Military service as a turning point that increased sub-stance use over the life course ended abruptly in the 1980swhen the military implemented its new antidrug policies.The heightened prevalence of hallucinogen use for veter-ans as compared to nonveterans in the 1960–1964 birthcohort was significantly diminished in every subsequentbirth cohort, all of which were young adults after the an-tidrug policies were implemented. Hypothesis 3 predictedthat after the implementation of the antidrug policies, mil-itary service would act as a turning point that actually ledto significantly reduced use of hallucinogens for veteransas compared to nonveterans over the life course, and thishypothesis finds qualified support. This prediction playsout among the sample of respondents who reported ille-gal drug use before age 18 years. Among this group, theuse of hallucinogens over the life course was significantlylower for veterans as compared to nonveterans for adultsborn in 1975 and later—adults who were aged 20 yearsin 1995 and afterward. Thus, we find specific support forour subsidiary Hypothesis 3a, and it is this evidence thatis most compelling with respect to the military as positiveturning point hypothesis.

This finding of an effect emerging among cohortswho were young adults around 1995—and not inthe mid-1980s, when the antidrug policies were fullyimplemented—raises the question of the reasons behindthis 10-year delay. We speculate that the lagged effect re-flects the specific drugs that the military monitored underits drug testing program. Hallucinogens, such as ecstasywere only first monitored in 1993, with substantial im-provements in monitoring in 1997 and 1998, and an im-proved test for LSD developed in 1999 (Department ofDefense, 2012a). It is possible that the military served as aturning point for hallucinogen use for veterans only afterthe military started specifically monitoring hallucinogenconsumption. If so, these results suggest that drug testingis a key component of the military’s zero-tolerance drugpolicies.

In the full sample, support for Hypothesis 3 is morelimited. Among cohorts that were young adults in themid-1980s and later, hallucinogen use among veterans was notlower than among nonveterans, as predicted by Hypothe-sis 3. It is, instead, about the same. However, our analysisindicated that veterans were about 25% more likely thannonveterans to report adolescent illegal drug use, a riskfactor that increases the probability of hallucinogen use inadulthood almost tenfold. The finding of similar levels ofhallucinogen use among veterans and nonveterans in thefull sample, therefore, suggests that the military alteredthe hallucinogen use trajectories of veterans and reducedoverall use to bring them to the level of nonveterans.

The analysis tested a possible alternative interpreta-tion that differences in hallucinogen use across veter-ans and nonveterans over the life course are the resultof self-selection with respect to who serves in the mil-itary and, therefore, do not represent a turning point. Itis theoretically possible that after the mid-1980s, youngadults who used illegal drugs were less likely to en-list in the armed forces, and therefore, differences in

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hallucinogen use across veterans and nonveterans resultfrom changes in the characteristics of recruits that werepreexisting before they joined the military. If this alterna-tive hypothesis were true, it would be expected that af-ter the mid-1980s, levels of adolescent illegal drug usewould grow substantially lower for veterans as comparedto nonveterans. Empirical analysis did not support thisprediction, and in fact, levels of adolescent drug useacross veterans and nonveterans remain unchanged fromthe 1980s to the present. These results therefore suggestthat the military as a turning point is a more plausibleinterpretation of the study results than the self-selectionhypothesis.

This life course perspective and the results of this studyhave important implications for “gateway” theory. On theone hand, our results provide support for the key propo-sition of the theory: that illegal drug use early in the lifecourse plays a causal role in later drug use. If this proposi-tion is true, then the prediction logically follows that peo-ple who are prevented from using illegal drugs in youngadulthood for an extended period of time should be lesslikely to use drugs in adulthood. To our knowledge, thisstudy is one of the first to provide support for this pre-diction. On the other hand, the results of this study haveimplications for gateway theory that are unexpected andpromising. It is surprising that the effects of the militaryantidrug policies were strongest for veterans who had al-ready used illegal drugs before age 18. This finding sug-gests that the policies had their greatest effect by alteringsubstance use trajectories that had already started. This isunexpected because gateway theory focuses in large parton first use of illegal drugs and the way in which first usepredisposes individuals to future use through mechanismssuch as changes in brain chemistry and the development ofa “taste” for illegal drug use (discussed in Hall & Lynskey,2005). The results of this study indicate that it is possiblefor anti-drug policies—in a particular institutional contextand in conjunction with everything else that occurs as aconsequence of military service—to alter substance usetrajectories in mid-flight, and provide both motivation andjustification for future work to identify the specific mech-anisms at work.

This study has two limitations that are important tonote. First, the APC analysis of this study rests on the as-sumption that the association of age with past-year hallu-cinogen is (a) continuous and (b) can be adequately mod-eled with a curvilinear functional form. In this case, theassumption seems reasonable in light of the fact that aconsistent, monotonic decline in past-year hallucinogenuse is present in the observed data. The model also restson the assumption of no interactions between the age, pe-riod, and cohort terms. The development and testing oftheory-based hypotheses for such interactions is a promis-ing “next step” for future research to unpack these overalleffects in greater detail.

A second limitation is that this study focuses only onthe outcome of past-year hallucinogen use. It does notcover other substances that are of concern to both pol-icy and theory such as alcohol and prescription opioids.Analysis of each additional substance will likely warrant

a separate paper in itself, given the need to review thesubstance-specific literature and to develop a discussionand conclusion that builds on and extends previous workon the specific substance. This paper on hallucinogen usewill ideally serve as a useful comparison for future analy-ses of other substances.

A third limitation is that the measure of hallucinogenuse is self-reported. Ideally measures of past-year hallu-cinogen use could be based on objective measures that arefree from recall and other types of potential bias. But forthe purposes of this study any self-report bias is less con-sequential because the research question centers specifi-cally on the relative prevalence of hallucinogen use amongveterans and nonveterans, and self-report bias should the-oretically cancel out when comparing two groups that areboth subject to the same self-report bias.

CONCLUSION

Service in today’s armed forces acts as a turning point that,overall, leads to a lasting, lifelong reduction in hallucino-gen use among veterans. Whether such long-term effectswere intended or not, the military’s antidrug policies andmandatory drug screening program serves as a model thatwarrants more detailed analysis. Of particular interest arefuture life course studies that examine whether compo-nents of the military’s antidrug policies can be extendedoutside the armed services or if their effects are specific toa total institution such as the military. Such analysis pro-vides high potential to yield new, important insights intothe factors that have lasting effects on substance use overthe life course and provide new targets for policies andinterventions aimed at the lasting reduction of substanceabuse such as hallucinogens.

Declaration of Interest

The authors report no conflicts of interest. The authorsalone are responsible for the content and writing of thearticle.

RESUME

La politique anti-drogue de l’armee et les carrieres detoxicomanie: le cas de la consommation deshallucinogenes dans l’annee ecoulee

Nous analysons les tendances a long terme dans laconsommation d’hallucinogenes, dans l’annee ecoulee,chez les veterans par rapport aux non-veterans. Ce su-jet est strategique parce que l’armee a adopte une poli-tique anti-drogues stricte et reussie dans les annees 1980,ce qui sert comme une experience naturelle pour ex-aminer l’impact potentiel a long terme des politiquesanti-drogues comprehensives sur la consommation dedrogues illegales. Employant des methodes age-periode-cohorte, nous constatons que, apres que la politique dedepistage de drogue a ete mise en œuvre, dans l’anneeecoulee les veterans ont eu une prevalence significative-ment plus faible de la consommation d’hallucinogenes

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par rapport aux non-veterans. Ces constatations signa-lent que le service dans les forces armees d’aujourd’huirepresente un tournant qui, dans l’ensemble, conduit a unereduction durable et permanente dans la consommation desubstances.

RESUMEN

Programas contra el uso de la droga y tendencias delconsumo en las fuerzas militares: El caso anual del usode alucinogeno

Analizamos tendencias a lo largo plazo del uso del alu-cinogeno durante el ultimo ano entre los veteranos com-parados con los no-veteranos. Este topico es estrategico enque durante la decada de los ochenta, el ejercito adoptounos programas rigurosos y exitosos contra el consumode droga, lo cual sirve como experimento natural para ex-aminar el posible impacto a lo largo plazo que ejercenprogramas comprensivos anti-droga en el consumo ile-gal de drogas. Implementando metodos de edad-periodo-cohorte, encontramos que despues de implementar losprogramas de pruebas de deteccion del consumo de dro-gas, los veteranos mostraron una prevalencia reducida sig-nificativamente durante el ano anterior del consumo dealucinogeno comparados con los no veteranos. Se puedeconcluir que servir en las fuerzas armadas de hoy en dıaproduce un cambio que, en terminos generales, conduce auna reduccion durante toda la vida en la toxicomanıa.

THE AUTHORSDr. Richard Miech is aProfessor in the Department ofHealth and Behavioral Sciencesat the University of ColoradoDenver. His research focuses onthe social determinants of illegaldrug use over the life course. Hisrecent work using APC modelsallows him to explicitly takeinto account historical context,a strong influence on illegaldrug use behavior that warrantsmore attention than it currently

receives.

Andrew S. London is Professorand Chair of Sociology, FacultyAffiliate in the Aging StudiesInstitute, Senior ResearchAffiliate in the Center for PolicyResearch, and Senior Fellow inthe Institute for Veterans andMilitary Families at SyracuseUniversity. His researchfocuses on the health, care,and well-being of stigmatizedand vulnerable populations,including: persons living with

HIV; informal caregivers; welfare-reliant and working poorwomen and their children; the previously incarcerated; and

veterans. As part of the Substance Abuse and Mental Health teamof the RAND/AHRQ HIV Cost and Service Utilization (HCSUS)Study, his prior research on substance use and service utilizationhas been published in Archives of General Psychiatry, Journal ofGeneral Internal Medicine, and Journal of Studies on Alcohol.

Janet M. Wilmoth is Professorof Sociology, Director ofthe Aging Studies Institute,Senior Research Affiliate in theCenter for Policy Research, andSenior Fellow in the Institutefor Veterans and MilitaryFamilies at Syracuse University.Her research examines later-life well-being from a lifecourse perspective. She haspublished in the areas of olderadult migration and living

arrangements, health status, and financial security. Her work hasbeen published in the Journals of Gerontology: Social Sciences,The Gerontologist, Research on Aging, the Journal of Agingand Health, Population Research and Policy Review, Journalof Marriage and the Family, Journal of Family Issues, Journalof Poverty, and Social Service Review. She also edited (withKen Ferraro) Gerontology: Perspectives and Issues, 4th Editionand (with Andrew London Life Course Perspectives on MilitaryService.

Professor Stephen Koesterhas been conducting researchwith drug users for over twentyyears. His training is in medicalanthropology, and the emphasisduring much of his career hasbeen on understanding blood-borne disease transmissionamong injection drug users andidentifying contextual factorsthat influence drug use and risk.His recent research continuesthis work but also includes

studies of drug overdose, the nonmedical use of prescriptiondrugs, trends in marijuana use and a study examining women’sroles in drug marketing. The theme that ties these various projectstogether is his interest in extending our understanding of thesephenomena by viewing them as processes and in context, anapproach that emphasizes the lived experience and relies heavilyon ethnography and qualitative research methods. As such, he hasdesigned, conducted and collaborated on qualitative and mixedmethods studies throughout his career and has been the PI andCo-PI of NIDA funded mixed methods R0-1s as well numeroussmaller projects funded by NIH, CDC, the Ford Foundation andpublic health departments.

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the effects of the military’s antidrug policies over the

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