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[Qualitative Research in Medicine & Healthcare 2020; 4:9001] [page 43]
Introduction
Active duty, enlisted personnel in the U.S military use
alcohol more often than cigarettes or smokeless tobacco
(84.5%, 49.2% and 19.8%, respectively). Alcohol con-
sumption far exceeds the use of recreational drugs among
active duty personnel.1 Levels of drinking nevertheless
vary by military branch, with personnel enlisted in the
Marine Corps, Army and Navy than those enlisted in the
Air Force reporting higher rates of alcohol consumption.2,3
We define problematic drinking as a spectrum of alco-
hol consumption involving risky and excessive drinking
(i.e., drinking which increases the risk of poor health out-
comes), alcohol abuse, and alcohol dependence. Qualitative
and mixed-method research situates active duty personnel
problematic drinking in the context of daily life on military
base, describing the influence of occupational or military
culture on drinking patterns.4-6 Ames et al.’s7 work under-
scores cultural norms that equate the use of alcohol with
stress relief and perceive drinking as a mechanism for so-
cial bonding as contributing to higher rates of drinking in
the military. Likewise, Larson et al.’s8 review of combat
deployment and alcohol misuse highlights that an indoctri-
nation into military culture that instils attitudes and beliefs
about alcohol consumption shapes problematic drinking
during deployment. A more recent study concluded that
military socialization processes influence the current high
use of alcohol among active duty personnel.9
Although military culture has often been evoked in
the scientific literature to explain problematic drinking
in the military, it remains unclear how military culture
Drinking as routine practice among re-integrating National Guard and
Reservists from Arkansas
Traci H. Abraham,1,2 Ann M. Cheney,3 Geoffrey M. Curran,4,5 Karen L. Drummond1,2
1South Central Mental Illness Research, Education, and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System;
2Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock; 3Department of Social Medicine & Population
Health, Center for Healthy Communities, SOM, University of California, Riverside, CA; 4Department of Pharmacy Practice, College
of Pharmacy and Division of Health Services Research, Department of Psychiatry, University of Arkansas for Medical Sciences;
5Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
ABSTRACT
Active duty enlisted military personnel are more likely to misuse alcohol than civilians – a pattern which persists even after the
transition to civilian life. We used in-depth, substance use history interviews to elicit drinking trajectories from 54 re-integrating Army
National Guard, Air Force Reserve and Army Reserve personnel from Arkansas with a history of problematic substance use. A hybrid
inductive-deductive analytic approach revealed institutional norms, shared beliefs about drinking, and social values and expectations
among military peers present in the context of military service that Veterans described as having shaped their drinking trajectories.
Framing Veterans’ narratives vis-à-vis practice theory revealed the complex processes by which excessive drinking was embodied as
routine practice during military service and subsequently reproduced in a very different post-deployment context, often with deleterious
results. Elucidating these implicit processes suggested pro-active strategies for preventing problematic drinking by active duty personnel
and improving the re-integration experiences of Veterans.
Correspondence: Traci H. Abraham, Central Arkansas Veterans
Healthcare System, 2200 Fort Roots Drive, Building 58, Suite
305B, North Little Rock, AR 72114-1706, USA.
Tel.: 507-257-1744
E-mail: Traci.Abraham@va.gov
Key words: Practice theory; military culture; veterans; alcohol con-
sumption.
Conflict of interest: The authors declare no conflict of interests.
Funding: This research was supported by the Department of Vet-
erans Affairs Office of Academic Affiliations Advanced Fellowship
Program in Mental Illness Research and Treatment, the Medical
Research Service of the Veterans Affairs of the Central Arkansas
Veterans Healthcare System, and the Department of Veterans Af-
fairs Center for Mental Healthcare and Outcomes Research. The
VA Clinical Science Research & Development grant ICX000452A
supported the research. The views expressed in this article are those
of the authors and do not necessarily reflect the position or policy
of the Department of Veterans Affairs or the U.S. government.
Acknowledgements: The authors would like to thank the Veterans
who participated in this study and who have reviewed this manu-
script for authenticity. Your service to research helps inform mean-
ingful improvements to healthcare that make a difference in the
lives of Veterans.
Received for publication: 7 April 2020.
Accepted for publication: 9 September 2020.
This work is licensed under a Creative Commons Attribution Non-
Commercial 4.0 License (CC BY-NC 4.0).
©Copyright: the Author(s), 2020
Licensee PAGEPress, Italy
Qualitative Research in Medicine & Healthcare 2020; 4:43-53
doi:10.4081/qrmh.2020.9001
Qualitative Research in Medicine & Healthcare 2020; volume 4:43-53
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relates to alcohol consumption among Veterans. Evi-
dence indicates that active duty personnel’s problematic
drinking continues as they transition to civilian life10 and
that rates of alcohol use disorder (i.e., compulsive alcohol
consumption and loss of control over the volume of al-
cohol consumed, accompanied by a negative emotional
state when not using alcohol) is high among more recent
Veterans.11As some studies have reported rates of alcohol
misuse as high as 40% among12 Veterans of recent U.S.
conflicts, ascertaining the role of military culture in the
perpetuation of problematic drinking is particularly ur-
gent. It is critical to identify innovative and effective
strategies for treating and preventing problematic drink-
ing in Veterans.
In this study, we aimed to gain an understanding of sub-
stance use trajectories among Veterans for whom consum-
ing substances (i.e., alcohol, illicit drugs) had complicated
their re-integration experiences. We used snowball sam-
pling to recruit 45 males and seven females (N=54) Veteran
and/or active duty National Guard and Reservists from
Arkansas with a history of problematic substance use. We
collected data using in-depth substance use life history in-
terviews, using a hybrid inductive-deductive coding ap-
proach to analyze interview data. During the process of
developing analytic memos, we observed concepts from
practice theory emerge inductively.
Bourdieu’s Practice Theory
Bourdieu’s13,14 practice theory provides a framework
for explicating how Veterans’ routine health behaviors de-
velop and are reproduced (i.e., maintained over time)
through daily interactions and practices. This framework
lends valuable insights into the implicit processes that
contribute to Veterans’ problematic drinking. According
to Bourdieu, all behavior is set in social arenas called
fields, or contexts.15 Cooper et al.16 describe the military
as a context distinct from the varied collection of alter-
native fields which constitute civilian life. This context is
nested, consisting of the military as an institution and dif-
ferent arenas/contexts subsumed within that institution
(e.g., the regiment). Regardless of military branch, new
recruits are immersed within the physical boundaries of a
military base possessing its own internal logic, set of rules
and regulations, and reference groups.
These contexts generate a habitus, or framework of
shared understandings and behavioral dispositions or em-
bodied ways of being.17 Habitus determines which behav-
iors are constituted as socially intelligible, normative and
expected. A masculine-warrior habitus, which includes
stereotypically masculine traits of self-control, courage,
physical and emotional “toughness” (i.e., resilience),
competitiveness, and physical aggressiveness structures
the U.S. military. These traits, which prepare soldiers for
combat, are valued and rewarded.18 The process of basic
training, which physically and socially isolates new re-
cruits from the civilian world, socializes new recruits in
all branches of the military, including National Guard and
Reservists, to the military habitus.
By acting in ways that are valued within a social arena
or context, social agents accrue capital (i.e., economic re-
sources and social status). In this regard, military person-
nel who exhibit stereotypically masculine traits are
rewarded with respect and loyalty from peers. Superiors
also promote them up through the ranks. Thus, military
personnel strategically internalize behaviors that will help
them accrue capital such as practices to earn respect (i.e.,
social capital) and be promoted (i.e., economic capital).
In the process, they embody habits or behavioral disposi-
tions that reproduce accrued capital. By embodying a
habitus, military personnel adapt to external conditions
largely beyond their individual control and perform, with-
out thinking, socially and institutionally patterned behav-
iors routinely.
Structure in the Bourdieusian sense is therefore both
external and objective (e.g., social expectations) and inter-
nal and subjective (e.g., shared ways of perceiving and un-
derstanding). By eliciting or constraining behaviors,
structure produces behavioral similarities among social
agents within a context – also known as culture. Once em-
bodied, routine practices structured by a habitus are often
enduring, and thus uncritically reproduced from one con-
text to another. What’s more, although habitus is a produce
of social conditioning and thus transforms as social agents
transition from context to context, a mismatch can occur
between habitus and context as social actors transition from
one social arena to another. Bourdieu terms this mismatch
hysteresis.13 The latter has important implications for how
routine practices learned in the military, such as problem-
atic drinking, might be reproduced out of context, and the
potentially deleterious effect of reproducing behaviors
thusly. Understanding these implicit processes could thus
support the development of more effective treatments.
Materials and Methods
Study design
We aimed to investigate substance use and re-integra-
tion among fifty-four (N=54) Army National Guard, Air
Force Reserve and Army Reserve personnel from
Arkansas; henceforth collectively referred to as Veterans.
Substance use refers to consumption of alcohol, prescrip-
tion drugs and/or illicit drugs. Our multidisciplinary study
team consisted of three research investigators, including
one PhD-level medical sociologist and three PhD-level
medical anthropologists. A research assistant possessing
a Master’s in public health and minor in anthropology
supported the investigators.
Our study design combined rapid-ethnographic tech-
niques that combined insights gained from first-hand ob-
servations and informal interviews at military bases with
in-depth substance use life history interviews. We selected
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this study design based in the potential for rapid ethnog-
raphy to elucidate the implicit, contextual processes that
contribute to Veterans’ problematic drinking and suggest
realistic strategies to develop health interventions for this
population. Rapid ethnographies use long-standing ethno-
graphic methods (i.e., first-hand observations, in-depth
interviews), but focus more narrowly upon a health-re-
lated issue (e.g., problematic drinking) and well-defined
context (e.g., military service).19 As the latter renders con-
text- and experience-rich research feasible in the con-
densed timelines of health services research, rapid
ethnography is increasingly used to develop and assess
health interventions.20 The Institutional Review Board of
the Center for Mental Healthcare and Outcomes Research,
Central Arkansas Veterans Healthcare System approved
study procedures.
Participant selection
We recruited potential participants via contacts within
the National Guard (e.g., chaplains, family groups, med-
ical personnel) and, in keeping with rapid ethnographic
approaches, in-person at National Guard events and Vet-
erans Administration clinics. We also used snowball sam-
pling procedures.21 We asked participants to tell their
friends about the study and to have them contact a mem-
ber of our team if they believed that they would meet el-
igibility criteria.
Immediately before each interview, a member of our
team used a modified version of the Alcohol Abuse and
Dependence and Non-Alcohol Psychoactive Substance
Use Disorders sections of the Mini International Neu-
ropsychiatric Interview (MINI) to screen volunteers for
eligibility. The MINI is a short structured diagnostic in-
terview used to identify psychiatric disorders in the past
12 months.22 After experiencing recruitment challenges
(i.e., volunteers who had not misused substances in the
specified time period), we broadened the tool to assess
substance use since entering the military. This strategy al-
lowed us to recruit Veterans with diverse substance use
trajectories that had nevertheless once lived on a military
base, were socialized in the military ethos, and had expe-
rienced the transition from the military to civilian life. As
Veterans who volunteered were explained the purpose of
our study during recruitment and before consenting to par-
ticipate, the excerpts presented below represent the per-
spectives and experiences of Veterans who acknowledged
having consumed alcohol excessively since having en-
tered the military.
Participants
A total of 45 males and seven women (N=54) Veteran
and active duty National Guard and Reservists from
Arkansas with a history of problematic substance use par-
ticipated. Participants ranged from 23 to 70 years of age. A
majority had served overseas, including deployments to
Afghanistan, Bosnia, Ecuador, Germany, Iraq, Vietnam and
Korea. All but one were enlisted military personnel (i.e.,
not commissioned officers). While some participants ini-
tially enlisted in the National Guard or Reserves, others ini-
tially enlisted full-time and subsequently joined the Guard
or Reserves. Regardless of these differences, all participants
had been socialized in the military via basic training, al-
lowing us to identify shared perspectives and experiences
that transversed military branch and service era.
Data collection
We first collected data using focused observations and
informal interviews conducted at National Guard drill ex-
ercises, deployment preparation briefings, pre-deploy-
ment health screenings, day-long post-deployment service
events, and events sponsored for service members and
families (e.g., retirement ceremonies). These data helped
us gain a sense of general attitudes, shared understand-
ings, language, and social practices related to substance
use in the National Guard and Reserves. We recorded ob-
servations and informal interviews as field notes, using
these data to develop interview guide questions for the
substance life history interviews (described below) that
included terminology familiar to Veterans (i.e., acronyms
common in the military).
We then used substance use life history interviews, a
form of life history interview adapted to the goals of this
study, to collect data pertaining to individual substance
use trajectories, perceptions of substance use, and histo-
ries of help seeking for substance misuse. Life history in-
terviews permit an in-depth exploration of individual
biographies23 and are well-suited to embedding individ-
ual-level data in social and cultural context.24 These inter-
views employ broad, open-ended questions to explore
events in a participant’s life history to which he or she ret-
rospectively assign significance, and those experiences
influenced behavior in relation to the topic of interest
(e.g., substance use). Life history interviews produce in-
depth narratives with render explicit the meaning that par-
ticipants attribute to behavior and the contexts in which
behavior is situated, producing rich data that is amenable
to theory development.
For this study, we used life history interviews to explore
substance use in the context of participants’ military service
and transition to civilian life. Although we used a semi-
structured interview guide to keep questions consistent
across participants, questions were raised in an open a man-
ner to encourage lengthy narratives describing the social
context, interpersonal relationships, organizational struc-
tures, and individual life experiences that influenced sub-
stance use. The semi-structured interview guide is
presented in Appendix. Interviews took place face-to-face,
in Veterans’ homes or in the privacy of staff members’ of-
fices, depending on participant preferences. The substance
use life history interviews were 90 minutes to four hours in
length, and audio recorded with participants’ permission.
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Audio recordings of the interviews were transcribed ver-
batim and imported into a software program for analysis.
Data analysis
We used a hybrid deductive-inductive approach fol-
lowing the tenants of content analysis to analyze the in-
terview transcripts.25 Two anthropologists on our team
first developed top-level deductive codes related to the
goals of the study (e.g., perceptions of substance use).
This initial coding scheme was later deepened by incor-
porating inductive codes (e.g., military culture) that
emerged repeatedly across interviews through an iterative
reading of the first batch of transcripts. During subsequent
readings of transcripts, we refined the initial coding
scheme and developed sub-codes. A software program
was used to ensure coding consistency and to help the
coders attain intercoder agreement.21
The software program’s memo feature, which permits
analysts to interact more fully with data by reflecting upon
the relationship between codes facilitated theory develop-
ment. Memoing supports the development of hypotheses
regarding the relationship of patterns in the data to the
context of military service and re-integration.26 A close
reading of individual biographies led to the development
of memos referencing key Bourdieusian concepts (e.g.,
context, adaptation, routine practice). Our use of Practice
Theory as a conceptual framework is thus consistent with
how participants made sense of their substance use life
histories and re-integration experiences.
Results
During substance use life history interviews, Veteran
participants described their socialization and experiences
in the military. Qualitative analysis of individual biogra-
phies revealed institutional practices and norms, shared
beliefs about drinking, and social values and expectations
among military peers that participants believed con-
tributed to the development of problematic drinking. Par-
ticipants also described problematic drinking vis-à-vis
structural conditions present on military bases at home
and overseas.
The social and institutional context of drinking among
active duty personnel
Veterans consistently recalled that as new recruits they
were immersed in a context in which consuming large
quantities of alcohol was routine practice (i.e., per Bour-
dieu, a behavior which is common and accepted uncriti-
cally and therefore normative). The normalization of
drinking is evident in the words of an Army Veteran who
stated that: I think I started drinking before I joined the
military around 16, 17 years old. But after I joined the
military in ’82, I was exposed to it every day (S1031). Ac-
cordingly, most participants described having first embod-
ied problematic drinking as habitual practice following
submersion in the military arena. The contrast between
life before and after having been socialized to the military
habitus is evident in the following exchange between a
researcher and a 23-year-old Veteran of Operation Iraqi
Freedom who had been an in-patient for alcohol depend-
ency treatment multiple times:
Interviewer: Before you joined the military, had
you used anything, or did you drink at all?
Respondent: I had a baseball scholarship and I was
on the swim team. I didn’t do drugs, I didn’t drink
at all; but, you know, it was always around.
Interviewer: It started afterwards?
Respondent: Yes … yes, it started after. Definitely.
Definitely (S1003).
While a small minority remembered drinking casually
prior to military service, most participants recalled con-
suming alcohol routinelyand in large quantitiesonly after
entering the military. The excerpt which follows illustrates
how drinking excessively as habitual practice was embod-
ied during military service. The participant recounted
how, during the conflict in Vietnam:
Interviewer: Vietnam was the first time you started
drinking?
Respondent: Well, basic [training], really… We
got a three-day pass, went down to town, got
drunk, throwed up. You know, ever since then [em-
phasis placed by the authors] (S1016).
In recounting that we…went down to town and got
drunk, the Veteran cited above alluded to drinking as a so-
cial practice among new recruits, rather than an individual
behavior. Likewise, the words ever since then in the same
passage renders the habitual nature of drinking as a prac-
tice embodied during military service and reproduced by
Veterans following re-integration into the civilian context
evident. Participants were thus aware of having embodied
new routine practices related to alcohol consumption
through their socialization in the military habitus, and
often explicitly referenced routine drinking as a socially
and institutionally patterned behavior.
Veterans furthermore described shared understand-
ings, such as a work hard play hard attitude, present in
the military habitus that framed alcohol consumption as
a reward for hard work. These shared understandings nor-
malized (and valorized) problematic drinking. In the so-
cial arena shaped by this habitus, even frequent, excessive
drinking was perceived as unproblematic. The way in
which shared understandings elicited drinking as routine
practice is evident in the words of a woman Veteran of
Operation Desert storm. She stated: The majority of alco-
holics and addicts are in the military, and most of them
don’t know or don’t realize that they’re alcoholics. Be-
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cause when you get off duty, you go drink. And that was
the norm... It’s just everyday routine (S1019). By refer-
encing excessing drinking as a routine practice accepted
uncritically (i.e., most of them don’t realize that they’re
alcoholics) in this social arena, this Veteran also alludes
to the internalization of habitual drinking (i.e., It’s just
everyday routine). Like many in our study, she also rec-
ognized in hindsight that the very ordinariness of drinking
among military peers made the routine practice of drink-
ing excessively problematic.
Veterans also explicitly referenced institutional norms
(e.g., regulations) that rescinded economic capital from
military personnel who consumed other substances (i.e.,
illicit drugs) and inadvertently promoted or valorized al-
cohol consumption. These norms included random drug
testing and stronger putative measures enforced against
those who screened positive for drug use. If you get
caught drinking on duty, you’re going to get your hand
slapped and maybe even get some money taken from you,
one Veteran explained. If you get caught doing drugs on
duty, you’re definitely going to get money taken from you
(S1013). Participants also stated that superiors reinforced
institutional norms in the military by ignoring or encour-
aging drinking. In the excerpt below, a Veteran deployed
to Egypt and Iraq who had been an in-patient for alcohol
dependency two weeks before participating in an in-depth
interview wonders how his experience of re-integration
might have been different if superiors had not inadver-
tently encouraged drinking:
And it was very acceptable in the military [to
drink]. It still is, yes. Even underage, I mean, it’s
acceptable. It was a bunch of crap because it
should’ve never been accepted for me. It’s almost
a shame that it was. I really wish my leaders
would’ve taken a little bit better care of me with
that. Because it could be, it could be a little differ-
ent now, maybe (S1041).
Participants thus attributed the embodiment of drink-
ing as routine practice to military service. Once embodied,
problematic drinking was obfuscated by the very routine-
ness of consuming alcohol among military peers, shared
understandings in the military regarding what constituted
acceptable levels of alcohol consumption, and institu-
tional norms that rescinded economic capital from per-
sonnel who consumed other substances.
Drinking during deployment overseas
While some participants embodied drinking as new
recruits and subsequently reproduced that routine practice
while deployed overseas, others initially described having
begun drinking in the context of deployment. Thus, the
way in which the context of military service elicited ha-
bitual drinking is evident, as well, in narratives centered
on alcohol consumption during deployment. To illustrate,
a Veteran of the conflict in Iraq stated: Me and my unit
got deployed overseas. Before I went over there, I didn’t
drink, I didn’t smoke, I never even used drugs. My grand-
dad, my uncles were all alcoholics, and it was just never
something I ever did (S1027). The words before I went
over there, I didn’t drink reveals drinking as a practice that
had not been embodied before deployment, despite a fam-
ily history of alcohol abuse.
Veterans moreover often recounted in-depth how the
structural conditions present in the context of deployment
evoked psychological and emotional distress, and how
this structural distress in turn elicited habitual drinking.
Participants described structural conditions, including a
sense of lacking control, boredom, exposure to physical
threats, witnessing deaths and atrocities, and separation
from family and other sources of emotional support, as
having been present during deployment. Participants often
related these conditions, and the structural distress they
evoked, to drinking as a routine practice. For example, in
the excerpt below, a Veteran describes strategically drink-
ing to manage structural distress experienced while de-
ployed to Iraq:
I kind of was afraid all the time. I had to do my job
- that was it. But then once I found out that I can
get something to drink over there, hey, I felt better.
I’d go to bed, get ready for the next day. You’re
mentally not there for a minute. That’s what drink-
ing did for me (S1014).
The use of alcohol to adapt to the structural distress
evoked by contextual conditions present during deploy-
ment is evident again in the words of a 44-year-old Vet-
eran who remembered drinking to feel mellow. To ease the
pain or ease the mental state - go to bed (i.e., sleep)
(S1014) while deployed to Ecuador and Afghanistan.
Likewise, another participant described having consumed
alcohol habitually to numb everything out (S1034) while
deployed to Afghanistan, indicating that drinking was
used to cope with unpleasant thoughts and/or emotions
and thereby adapt to the context of deployment.
The passages above reveal Veterans as social agents
who strategically engaged in a socially valued and insti-
tutionally sanctioned practice to adapt to distressing con-
ditions during deployment. Participants thus adapted to
structural conditions by reproducing a socially and insti-
tutionally valued, routine behavior: habitual drinking. As
consuming alcohol, even to excess, was normative and
thus perceived as unproblematic by peers and superiors
in this context, problematic drinking persisted unchecked
if participants could consume alcohol and still perform of-
ficial duties. To have done otherwise would have violated
the values and norms in the masculine-warrior habitus,
which rewards combat preparedness with capital.
As alcohol was, in some contexts (e.g., Iraq,
Afghanistan), more easily obtained at home than abroad,
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drinking often increased dramatically during combat
leave. The danger of having alcohol readily available after
having transitioned to the context combat leave is evident
in the following statement from a Veteran of the conflicts
in Iraq and Afghanistan:
Interviewer: Let’s talk about your leave time dur-
ing deployments.
S1033: I don’t remember most of them (i.e., com-
bat leaves). I was drunk. As soon as I got off the
plane in Atlanta, I was drinking. I was drunk when
I got off the plane, I was drunk when I got back on
the plane, and stayed drunk up until we got to
Shannon, Ireland for refueling.
Most Veterans in our study described having con-
sumed alcohol excessively during combat leave, some-
times to the point of losing consciousness - repeatedly.
What’s more, they most often recalled drinking in this
context to psychologically and emotionally distance them-
selves from the structural conditions experienced during
deployment. Veterans thus recounted how habitual drink-
ing helped them manage the uncomfortable thoughts and
emotions associated with structural distress, and thereby
adapt to structural conditions present during deployment,
even while on leave.
Habitual drinking post-deployment,
during re-integration
Participants also described having uncritically repro-
duced drinking habits embodied while in the military in a
very different context: civilian life. The way problematic
drinking was reproduced uncritically as habitual practice
out-of-context is explicit, for example, in the words of a
Veteran who described consuming alcohol to excess as
just something that I felt like I have to do most of the time
(S1014) as a civilian. Other participants described having
consumed alcohol habitually after transitioning to the
civilian context in a more deliberate manner, often in re-
sponse to structural distress evoked by this new arena.
Structural conditions described by participants as hav-
ing been present in the civilian context included a lack of
purpose and meaning and everyday life stressors, such as
having to pay bills. The different kinds of distress (i.e.,
stress, anxiety, uncertainty) evoked by the transition from
one context to another are evident in the following narra-
tive from a 34-year-old Veteran:
Interviewer: Were there any particular days or ex-
periences that stand out to you during deployment?
S1013: A lot of emotions that people deal with that
they’ve never dealt with before and haven’t had to
deal with the whole time we’ve been in country
(i.e., deployed overseas). But now there’s a lot
more stress — a lot of different stress. A lot of anx-
iety, a lot of uncertainty and, you know, you ball
that all into the mental psyche where we normally
don’t deal with things like that very well (S1013).
Thus, having successfully adapted to a highly regi-
mented context with an explicit mission and clearly de-
fined roles, many Veterans in our study were thrust into
unfamiliar and distressing circumstances upon transition-
ing to the arena of civilian life. The depth of distress
evoked by the structural conditions present during re-in-
tegration is apparent in the words of a Veteran of Opera-
tion Iraqi Freedom, who lamented:
Interviewer: So, what was it like to come home
when it was finally time to come home – not on
leave, but for real?
S1003: How are you happy to be home? How are
you happy to come back from killing people? How
are you happy to come back from a stress-free life
where you didn’t have to worry about nothing but
waking up, going on missions, coming back home
playing video games? I don’t know man - it was…
different. It was like the first day of school.
For some participants, the very experience of transition-
ing from one context to another was the primary source of
distress. Veterans sometimes explicitly related drinking to
the experience of transitioning out of the military context,
as illustrated by the following description of transitioning
to the civilian context during combat leave:
Interviewer: So, tell me about your leave time.
S1003: Leave, I got fifteen days.
Interviewer: Okay so what did you do? What do
people do on leave?
S1003: We got home, man… I trashed so many
beer cans and so many bottles. Yeah, man, I got
messed up; I’m not going to lie. Whoo! But that’s
all there is to do. I mean, what are you going to
do? I mean, you’re transitioning from going to Iraq
and fighting all day to coming back home and just
supposedly being normal.
Equally distressing for other participants was the way
in which the structural conditions present in the context
of deployment overseas were reproduced post-deploy-
ment. For these Veterans, structural conditions were in-
ternalized and embodied post-deployment as lived
experiences of trauma. Although no longer deployed for
combat, structural conditions were embodied in the form
of post-traumatic stress disorder [i.e., PTSD], depression,
and survivor’s guilt, and thus reproduced in the context
of post-deployment civilian life. The embodiment of
structural conditions as lived experiences of trauma in the
form of survivor’s guilt, for example, is apparent in the
following passage from an interview with a Veteran of
Operation Iraqi Freedom:
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We had one soldier die… He just got back from
leave; he had a baby or son, you know, and that
was the main thing, just because… I wasn’t mar-
ried. I didn’t have any kids, I still don’t, you know,
and that’s -. That’s the only thing that ate at me re-
ally was like: ‘Why not me,’ you know? (S1007).
In the expert above, the participant explicitly relates
lingering trauma in the form of survivor’s guilt (That’s the
only thing that ate at me really…) to structural conditions
encountered during deployment (We had a soldier die).
Other participants recounted embodying structural condi-
tions encountered in the context of deployment as moral
injury – a profound sense of moral transgression at having
witnessed or participated in violence. A Veteran who had
been deployed to Iraq described the lived experience of
moral injury thusly:
I had two children, so it was like: ‘I can’t believe
I just killed somebody and I hope God forgives me
for it,’ pretty much. I couldn’t sleep for like four
days. It took me two days to even eat, man. I mean,
I never had killed anybody before I went to the
Army. The main thing that really messed with me
was my conscious. You always hear what you do
unto other people comes back to you… (S1003).
After having internalized a habitus which predisposed
them to consume alcohol habitually in response to struc-
tural distress, participants thus reproduced that routine
practice in response to a different set of structural condi-
tions (e.g., survivor’s guilt). Having deliberately con-
sumed alcohol to manage the distress evoked by the
structural conditions reproduced as lived experience is ev-
ident in the excerpt below from an interview with a Vet-
eran of the conflict in Iraq:
It was a party for six months long. Drugs and al-
cohol. That’s all it was, was a party… I was numb-
ing myself from that feeling of what I’ve had to do
(during deployment). What I’ve had to see and the
feelings that I wasn’t - didn’t belong here, you
know, I belong back over there [in Iraq] (S1028).
In the narrative above, both lived experiences of
trauma and feelings of not belonging emerge as having
elicited problematic drinking in the context of post-de-
ployment civilian life. Thus, participants described having
binged on alcohol upon transitioning to the civilian arena
and, free of institutional constraints, sometimes illicit sub-
stances, as well.
Some participants described habitual drinking as a
strategy they used to psychologically and emotionally dis-
tance themselves from combat-related trauma. In this re-
spect, one Veteran recalled how he was ready to party and
just to get drunk after returning home from Iraq to dis-
tance himself from the structural distress experienced dur-
ing combat deployment: I was frustrated, he recounted. I
lost friends; saw innocent kids get blown up in a bus, he
explained. I just wanted to get away from that. I just
wanted to get drunk and spend all my money (S1004).
Other participants described having consumed alcohol
habitually in response to the lingering effects of physical
trauma in the civilian context. For example, one 50-year-
old Veteran drank habitually during each of three deploy-
ments, subsequently reproducing that routine practice by
drinking routinely until inebriated in the civilian arena. I
drink by myself, he stated. That’s what I used to do when
my back was hurting or something to take my mind off it
(i.e., the pain) (S1039). Thus, the participant described
drinking as a way to cope with physical trauma during de-
ployment (i.e., that’s what I used to do when my back was
hurting) which was reproduced as routine practice as a
civilian (i.e., I drink by myself).
As drinking had been embodied as routine practice
during military service and was furthermore routine in the
context of the military, Veterans who habitually consumed
alcohol in large quantities often did not immediately rec-
ognize how problematic this behavior was in a very dif-
ferent post-deployment context. The way in which
drinking was both a routine practice elicited by distress
and obfuscated by an internal habitus of perceptions is ap-
parent in the following statement from a Veteran who had
served overseas in Ecuador and Afghanistan:
And it’s like they (i.e., the military) turn on a
switch, but they don’t turn back off the switch. But
then when I got home, I didn’t even realize, you
know, that I had a [drinking] problem. I came
home and I wasn’t even home 24 hours and I was
drinking! And I wasn’t drinking once a week. I
was drinking every day. It was a downhill battle
from day one (S1034).
Echoing his words, a female Veteran of Operation
Desert Storm described how an internal habitus embodied
through socialization in the military structured her percep-
tion regarding what constitutes acceptable levels of alcohol
consumption in a very different context. She stated that:
It’s okay, you know, to be an alcoholic [in the mil-
itary], because they’re not realizing that it is a
problem. And then you trying to live this everyday
life without the military, and you’re sitting at home
— you can’t function because you’ve got to drink
all day, you know? You got issues because you’re
not in the military anymore and you’re trying to
medicate it, and so you think it’s okay, but it’s not
okay (S1019).
Participants thus described a disjuncture between a
habitus in which drinking was routine and the civilian
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arena in which such behavior was more often perceived
as problematic, or hysterisis. Participants often described
the consequences of habitual drinking out-of-context upon
re-integration. For example, a Veteran deployed to Beirut,
Granada and the Honduras who had lost a couple of jobs
from drinking post-deployment recalled that: When I first
got out [of the service], I got into fights all the time. All
the time. I was working at a penitentiary up there, too and
I got to shooting at people and stuff. He furthermore re-
counted how drinking as routine practice post-deployment
had disrupted his marriage: I’d go out and I wouldn’t come
home. I started drinking really heavily, and after 16 years,
my wife said ‘I just can’t take this no more’ because it
wouldn’t stop (S1039). Such passages illustrate how re-
producing once normative practices out-of-context re-
sulted in a loss of capital in participants’ civilian lives.
As all Veterans screened positive for alcohol misuse
in order to participate in our study, their narratives often
revealed promising lives come undone because of a so-
cially valued and institutionally sanctioned practice em-
bodied during military service and reproduced during
re-integration. For some participants, drinking as routine
practice outside the context of the military had devastat-
ing consequences, as it no longer resulted in the accrual
of either social or economic capital. In another example,
one Veteran who had been deployed to Afghanistan re-
counted how:
I didn’t realize I had a [drinking] problem until two
years later (i.e., after leaving the military). It’s that
so many things happened. I lost my house. I owned
a house before I went over there [to Afghanistan].
And I lost my family. I lost my kid. I mean, you
name it - it happened (S1034).
As vividly illustrated by the narratives above, once
embodied as an adaptive strategy, the routine practice of
drinking was reproduced habitually in response to distress
evoked by structural conditions present in the context of
civilian life. Removed from a social arena in which it was
adaptive and rewarded, the routine practice of drinking
became highly problematic, resulting in a loss of social
and/or economic capital. Thus, not only was habitual
drinking out-of-context post-deployment, it was often
deleterious to re-integration for our participants.
Discussion
During substance use life history interviews, Veterans
made sense of their problems with alcohol and difficulties
re-integrating vis-à-vis institutional norms, shared beliefs
about drinking, and social values and expectations learned
in the context of military service. Participants described
drinking as a routine – even expected – behavior in the
context of life on military bases at home and abroad. They
also repeatedly recounted how the very ordinariness of
drinking in the military obscured a potentially deleterious
practice that might, in other contexts, have been condoned
and punished rather than tolerated (by superiors) and re-
warded (by peers). Although reflecting the experiences of
a subset of Veterans who began drinking excessively
while in the military and reproduced that habit during re-
integration, these narratives lend support to the assertion
by Fuehrlein et al.27 that: Heavy drinking may often be
normalized in military culture and such normalization
may increase the likelihood that vulnerable veterans will
develop alcohol use disorder.
Interpreting Veterans’ substance use trajectories
through the lens of practice theory lends fresh insights
into alcohol misuse by Veterans. Our analysis revealed
drinking as an adaptive strategy that was, for many Vet-
erans in our study, initially embodied to accrue capital and
subsequently employed to adapt to structural conditions
which placed them at physical, emotional, and psycho-
logical risk during deployment. Drinking allowed partic-
ipants to numb the unpleasant thoughts and emotions
evoked by structural conditions while maintaining the ap-
pearance of physical and emotional toughness and self-
control that are so highly valued in the military. This
illusion likely protected them from the negative conse-
quences of violating social expectations and institutional
norms. It also allowed participants to exert their agency
over internal (i.e., distress) and external (i.e., social ex-
pectations) conditions present in the military context.
As deployment is time-limited, consuming alcohol
often helped participants manage structural distress suc-
cessfully in the short term, with few negative conse-
quences. However, having learned to uncritically use
alcohol to adapt to structural distress subsequently elicited
this practice out-of-context post-deployment. The mis-
match between an internal habitus in which drinking was
normative and the social arena Veterans encountered in
their lives as civilians resulted in hysteresis. As a result of
this mismatch, a once-adaptive behavior was out-of-con-
text, and therefore constrained participants’ agency to re-
integrate post-deployment. Practice theory thus rendered
explicit, for the first time, the implicit cultural and social
processes by which drinking habits learned during mili-
tary service may be reproduced by Veterans.
To be clear, we do not claim that participants had no
choice but to respond to distressing conditions by drinking
excessively. On the contrary, social actors deliberately and
strategically internalize practices that help them adapt to
structural conditions. Problematic drinking is furthermore
a complex phenomenon at the intersection of many lived
experiences, such as genetics and gender, that did not
emerge from our analysis. Rather than objective facts, our
findings thus reflect participants’ subjective sense of how
their problems developed. Their biographies suggest that
embodying drinking as routine practice in the military
arena predisposed them to uncritically reproduce this be-
havior in response to distress encountered as civilians.
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Thus, routines embodied during military service con-
strained participants’ ability to choose healthier strategies
for managing distress. After all, individuals can only prac-
tice habits which they have learned.
Using a Bourdieusian framework to explicate why
participants reproduced problematic drinking habits post-
deployment aligns with recent work using practice theory
to explain the re-integration of Veterans into civilian life.28
In this research, the authors described the distress that Vet-
erans from the United Kingdom experienced during the
difficult transition from a military to civilian habitus, and
how that impacted their reintegration. Veterans in our
study likewise described distress evoked by conditions
present in the civilian context and how they consumed al-
cohol to cope with that distress. Together, these studies
reveal reintegration as a vulnerable period for some Vet-
erans that may require intervention.
Findings from our study furthermore provide impor-
tant context for quantitative evidence correlating sub-
stance misuse among Veterans with PTSD, negative
emotionality and depression,29 survivor’s guilt,30 combat-
related physical trauma1 and military sexual trauma.31 Par-
ticipants described these problems as having been rooted
in the structural conditions present in the military context.
We have labelled the cognitive and emotional distress
evoked by these structural conditions structural distress,
thereby firmly situating conditions such as PTSD, moral
injury, and survivor’s guilt within a Bourdieusian frame-
work. Moreover, using passages from the interviews to il-
lustrate how structural distress was embodied as lived
experiences of PTSD, survivor’s guilt, and moral injury
expands the scope of practice theory to explain the devel-
opment of trauma-related disorders.
Healthcare providers should understand that drinking
excessively is, for many Veterans, a learned behavior that
was rewarded and valorized during military service. As
consuming alcohol likely initially helped some former
military personnel who subsequently develop unhealthy
drinking habits cope with structural conditions during de-
ployment, healthcare providers could explicitly acknowl-
edge the adaptive purpose that drinking once served.
Establishing rapport in this way could help providers to
work with Veterans to help them recognize the mismatch
between context and habitus which renders drinking ex-
cessively out-of-context in their lives as civilians, and thus
no longer results in an accrual of capital.
Findings regarding the role played by alcohol in man-
aging structural distress, combined with participants’ ac-
counts of how norms and shared understandings in the
military habitus obfuscated the negative consequences of
excessive drinking, suggest that multi-faceted treatment
approaches for alcohol misuse will be most effective. For
Veterans, engagement in evidence-based treatments (i.e.,
cognitive behavioral therapy), which help people embody
healthy strategies for coping with the distressing thoughts
and emotions which trigger substance use could be en-
hanced by concurrently delivered group therapies in
which peers share their experiences and support one an-
other through treatment. However, it is worth noting that
routinely drinking to excess was embodied while Veter-
ans were still in the military. As such, the most effective
interventions are likely to be those which target active
duty personnel and are proactive, rather than reactive, oc-
curring early in the military socialization process. Inter-
ventions aimed at building psychological resilience
constitute pro-active strategies. Psychological resilience
generally refers to the inter- and intra-personal process
of adapting to and coping with stress and adverse life ex-
periences (i.e., trauma). Resilience is multi-faceted, en-
compassing factors at the individual- (e.g., positive
coping behaviors, affect and thinking, behavioral con-
trol), family- (e.g., emotional ties, communication, sup-
port, adaptability), and community-level (e.g., cohesion,
collective efficacy). In the military context, resilience
also includes unit-level factors (i.e., positive command
climate, teamwork, cohesion).32
Many factors associated with resilience, such as cop-
ing, behavioral control, and adaptability, align well with
the Bourdieusian concepts which emerged from analysis
of the in-depth interviews, suggesting that resilience-
based interventions would resonate with active and former
military personnel. Interventions that build resilience fur-
thermore emphasize prevention rather than treatment and
thus encourage the embodiment of routine practices early
in the military socialization process, which our findings
indicate is critical if the goal is to reduce problematic
drinking and improve re-integration experiences. There
thus exists a close fit between practice theory, which
aligned with participants’ own understanding of how their
problematic drinking developed and their reintegration
experiences, and resilience-based interventions.
The U.S. military has already begun implementing re-
silience training as part of a broader strategy aimed at in-
creasing access to mental health services. These programs
include Defenders Edge, implemented by the U.S. Air
Force, Comprehensive Soldier Fitness and Battlemind,
implemented by the U.S. Army, and Life Guard, imple-
mented by the National Guard.33 As in the present study
Veteran participants explicitly described having consumed
alcohol to manage structural distress, such programs may
indirectly reduce problematic drinking by providing
healthier ways to cope with unpleasant thoughts and emo-
tions. Evidence that psychological resilience may reduce
excessive drinking in former military personnel comes
from a recent study in which higher levels of psycholog-
ical resilience correlated with lower rates of problematic
drinking in Iraq and Afghanistan Veterans exposed to
combat.34
Although initial evidence suggests that enlisted mili-
tary personnel perceive interventions which build psycho-
logical resilience as helpful,33 a recent review of resilience
training for active duty military personnel found wide-
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ranging differences in treatment effectiveness.35 Findings
from this review indicate that a lack of leadership support,
logistical problems, limited funding, poor fit with military
culture, and mental health stigma have hampered the ef-
fectiveness of these programs.35 Situating these findings
in relation to results from our study suggests that future
research is needed to explore the adaptive practices of ac-
tive duty military personnel who chose not to embody ha-
bitual drinking to identify potential resilience-enhancing
habits aligned with the masculine-warrior habitus. This
formative research would ensure that interventions aimed
at building resilience are acceptable, and evidence based,
potentially reducing some barriers to program effective-
ness. Our findings indicate that it may also be necessary
to adapt resilience programs to the different structural
conditions encountered during military service (e.g., basic
training, deployment, post-deployment) and to deliver
these interventions longitudinally to achieve maximum
effectiveness. As elucidated by practice theory, the suc-
cess of such programs will also require a broader cultural
shift in the military whereby less problematic coping and
social behaviors are rewarded and valorized by peers, val-
ued and encouraged by superiors, and receive institutional
support in the form of funding.
Conclusions
Framing participants’ biographies via practice theory
supported the development of a hypothesis relating mili-
tary culture to problematic drinking by Arkansas Veterans.
During substance use life history interviews, Veterans de-
scribed how social expectations, shared understandings
and institutional norms in the military elicited drinking as
habitual practice. Participants furthermore described this
socially and institutionally patterned behavior as having
been strategically used to manage structural distress dur-
ing deployment on military bases overseas, often success-
fully and with few negative consequences. The deleterious
consequences of a once adaptive practice reproduced un-
critically out-of-context, however, were evident in
poignant narratives in which participants described their
difficulties re-integrating and living life as civilians. Qual-
itative findings revealing the way in which practices em-
bodied and rewarded during military service can be
uncritically reproduced out-of-context suggest that inter-
ventions aimed at teaching new recruits healthy coping
strategies could, over time, reduce rates of harmful alco-
hol use by U.S. Veterans.
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