Coping Strategies and Workplace Supports for Peers with Substance Use Disorders.

Introduction: Substance use disorder (SUD) peers provide support and navigation through a fragmented treatment system for people who use drugs (PWUD) and those in recovery. While barriers to peers' work are well established, from role ambiguity to stigma surrounding substance use, little research has focused on factors that facilitate peers' work. Methods: We conducted in-depth semi-structured interviews (N=20) with peers as part of an evaluation of a larger project related to the opioid crisis in Western New York. Participants were recruited from a regional peer network via flyers, emails, and a brief presentation. Interviews were conducted in person or by phone, audio recorded, and transcribed. Transcripts were analyzed using thematic content analysis. Results: Peers emphasized two factors: healthy personal coping strategies and strong workplace supports. Coping strategies included a sense of community, setting appropriate boundaries, and self-care routines. At the workplace, peers valued mental and emotional support, as well as professional relationships and organizational policies that made their work easier and supported self-care. For a few peers, professional relationships included advocating on behalf of PWUD by sharing personal experiences of SUD. Conclusions: Peers valued peer colleagues and peer-led organizations, noting how shared experiences of substance use and recovery enabled a unique support system. For peers who lack such support at work, the authors suggest peer networks as an alternative. We also recommend organizational policies and practices to facilitate peers' work, such as promoting peer input and feedback, but further research is needed to measure effects on peer retention and job satisfaction.

Combat exposure, emotional and physical role limitations, and substance use among male United States Army Reserve and National Guard soldiers.

PURPOSE: Combat-exposed soldiers are at an increased risk for health problems that diminish quality of life (QOL) and substance use. We explored the cross-sectional associations between combat exposure and two measures of QOL, and the effect of substance use on those associations. METHODS: Data are from the baseline wave of Operation: SAFETY, an ongoing survey-based study of United States Army Reserve/National Guard (USAR/NG) soldiers and their partners. Our sample consisted of male USAR/NG soldiers with a history of deployment (N = 248). Limitations in usual activity due to physical and emotional problems were assessed using the 36-Item Short-Form Health Survey (SF-36). RESULTS: Greater combat exposure was independently associated with limitations in usual activity due to physical (regression coefficient = -0.35, 95% CI -0.55 to -0.16, R 2 = 0.09; p < 0.01) and emotional (regression coefficient = -0.32, 95% CI -0.56 to -0.09, R 2 = 0.09; p < 0.01) problems. Combat exposure had a significant interaction with frequent heavy drinking on physical role limitations (regression coefficient = -0.65, 95% CI -1.18 to -0.12, R 2 = 0.12; p < 0.05) and emotional role limitations (regression coefficient = -0.83, 95% CI -1.46 to -0.19, R 2 = 0.12; p < 0.05). Combat exposure also had a significant interaction with lifetime non-medical use of prescription drugs on physical role limitations (regression coefficient = 0.81, 95% CI 0.18-1.45, R 2 = 0.11; p < 0.05). CONCLUSION: Combat is an unmodifiable risk factor for poor QOL among soldiers; however, frequent heavy drinking and non-medical use of prescription drugs modifies the relationship between combat exposure and QOL. Therefore, substance use is a potential point of intervention to improve QOL among soldiers.

The impact of military service and traumatic brain injury on the substance use norms of Army Reserve and National Guard Soldiers and their spouses.

INTRODUCTION: Traumatic brain injury (TBI) and substance use are highly prevalent conditions among military populations. There is a significant body of evidence that suggests greater approval of substance use (i.e., norms) is related to increased substance use. The objective of this work is to understand the impact of TBI and military service on substance use norms of soldiers and their partners. Data are from the baseline assessment of Operation: SAFETY, an ongoing, longitudinal study of US Army Reserve/National Guard (USAR/NG) soldiers and their partners. METHODS: Multiple regression models examined associations between alcohol, tobacco, illicit drug use, and non-medical use of prescription drug (NMUPD) norms within and across partners based on current military status (CMS) and TBI. RESULTS: Male USAR/NG soldiers disapproved of NMUPD, illicit drug use and tobacco use. There was no relation between military status and alcohol use. Among females, there was no relation between CMS and norms. The NMUPD norms of wives were more likely to be approving if their husbands reported TBI symptoms and had separated from the military. Husbands of soldiers who separated from the military with TBI had greater approval of the use of tobacco, NMUPD, and illicit drugs. CONCLUSION: Overall, there is evidence to suggest that, while generally disapproving of substance use, soldiers and partners become more accepting of use if they also experience TBI and separate from the military. Future research should examine the longitudinal influence of TBI on substance use norms and subsequent changes in substance use over time.