Substance abuse and mental health challenges are disproportionately common in the Marine Corps and Army when compared to the other military services, according to a Rand study published Tuesday.

And the reason may have more to do with culture than the individual troops themselves.

Researchers compared the services using 2015 Defense Department survey data from nearly 17,000 active-duty troops.

Marines self-reported the highest instance of binge drinking, alcohol dependance and nicotine use, as well as the highest rates of depression and anxiety. The study found that the Army had the highest rates of prescription drug abuse and post-traumatic stress order, while the Air Force and Coast Guard reported the lowest prevalences.

“After adjustment, service members in the Army, Marine Corps and Navy exhibited nearly two-to-three times the odds of multiple mental health conditions and substance use behaviors relative to the Air Force,” according to the study results, published in the journal Drug and Alcohol Dependence.

The question is why, and it’s something that the study isn’t able to answer.

Even when comparing demographics across the services, as well as multiple, specific, traumatic experiences in combat zones, substance abuse and mental health issues were disproportionately prevalent in the Army and Marine Corps.

“PTSD has been found to be more prevalent among service members in the Army and the Marine Corps compared to other service branches,” according to the report. “Analyses of the Military Health System Data from 2005 to 2016 indicate that prevalences of both depression and anxiety disorders have risen since 2005 and is disproportionately high among Army service members, relative to other branches.”

Service culture may have an effect, not only because of stigma regarding mental health treatment, but because drinking to excess is so common.

“Other contributing factors may include variation in military culture and attitudes regarding substance use as well as stigma and barriers relating to behavioral health treatment seeking,” according to the study. “Culture and attitudes, particularly towards alcohol and tobacco use, have been found to vary across service branches, with prior work suggesting that the Marine Corps, in particular, has more permissive norms regarding alcohol and tobacco use.”

Indeed, survey data showed that 74% of Marine respondents and 69% of soldiers believed that military culture was supportive of drinking, compared to 60% of Coast Guardsmen.

The study also called out sexual assault and harassment as risk factors that may affect not only mental health concerns, but substance use among service members.

“The risk of sexual assault has been shown to vary substantially by service branch ― rates of sexual assault are approximately 1.7 times lower among women in the Air Force and four-to-five times lower among men in the Air Force, relative to those in the Army, Navy, and Marine Corps,” according to the report.

While the services have made great efforts to improve mental health resources, and better understand substance abuse as part of mental health concerns, the study added that use of these resources varies across the services.

“Prior studies have demonstrated that military service members underutilize behavioral health services, likely due to factors including public and internal stigma, negative attitudes or distrust towards providers, or organizational barriers,” according to the report, though the authors note that the Army reports the highest usage rates of its behavior health services.

Researchers suggest further study is needed on the differences among the services, particularly drilling down into the differences among troops who have never deployed.

Meghann Myers is the Pentagon bureau chief at Military Times. She covers operations, policy, personnel, leadership and other issues affecting service members.

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