Publication year
2008
Citation Title
Alcohol use and alcohol-related problems before and after military combat deployment.
Journal Name
Journal of the American Medical Association
Journal Volume
300
Issue Number
6
Page Numbers
663-675
DOI
10.1001/jama.300.6.663
Summary
This study’s focus was to determine whether combat exposure was associated with new-onset or continued alcohol misuse. Scores were compared on a self-report measure of alcohol misuse in a sample of Service members who deployed with combat exposure, deployed without combat exposure, or did not deploy. Combat exposure was related to increased risk of new-onset alcohol misuse, particularly in Reserve and National Guard personnel and in younger Soldiers.
Key Findings
Active Duty Service members who experienced combat exposure were most likely to engage in binge drinking, heavy weekly drinking, and to experience alcohol-related problems.
Service members with posttraumatic stress disorder (PTSD) and depression had higher odds of new-onset and continued alcohol-related problems at follow-up.
Among Service members in the Reserve Component, new-onset problematic drinking behaviors were associated with combat exposure, younger age, being a Marine, having PTSD or PTSD and depression, and being a current smoker.
Implications for Program Leaders
Develop pre-deployment classes for Service members to support them in managing the potential stressors that may be experienced immediately upon reintegration
Provide workshops for Service members designed to increase coping skills and decrease problematic drinking behaviors
Offer classes to Service members and their families that aim to increase family cohesion during transitions such as reintegration
Implications for Policy Makers
Continue to support programs for Service members and their families to assist with possible reintegration challenges
Recomend collaboration among military-based and community-based programs to enhance continuity of care for Service members and their families
Encourage training for professionals who work with military families regarding the possible challenges Service members and their families face during the post-deployment period
Methods
Participants were randomly selected from all Service members as of October 1, 2000. They were included in the current study if they had not experienced a deployment before the baseline survey.
Participants answered questions about basic demographics, life stressors, combat-related experiences, psychological symptoms, and drinking behavior.
Data were analyzed to determine predictors of new and continuing problems with alcohol.
Participants
Participants included members from all branches of the military. Of the initial participants, 37,310 participants did not deploy between baseline and follow-up, 5,661 deployed without combat exposure, and 5,510 deployed with combat exposure.
Participants were predominantly male (73%), White (70%), and Active Duty (57%) without prior history of alcohol problems (82%).
Most were members of the Army (47%), followed by Air Force (29%), Navy or Coast Guard (19%), and Marine Corps (5%).
Limitations
The length of time between returning from deployment and completion of the follow-up questionnaire averaged one year, which did not allow for differentiation of short-term and long-term problems with alcohol use.
The questions in the survey asked participants about their alcohol usage during the past year; Service members may have misremembered some information or attempted to answer in a way they thought was more socially acceptable.
Measures of binge drinking differed slightly between the baseline and follow-up assessment, which may have influenced results.
Avenues for Future Research
Include additional time points to more closely identify associations between mental health and alcohol misuse
Examine whether Service members’ alcohol usage after returning from deployment has different patterns short-term versus long-term
Investigate the efficacy of programs that aim to lessen the stressors of deployment and reintegration for Service members and their families
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Context High rates of alcohol misuse after deployment have been reported among personnel returning from past conflicts, yet investigations of alcohol misuse after return from the current wars in Iraq and Afghanistan are lacking. Objectives To determine whether deployment with combat exposures was associated with new-onset or continued alcohol consumption, binge drinking, and alcohol-related problems. Design, Setting, and Participants Data were from Millennium Cohort Study participants who completed both a baseline (July 2001 to June 2003; n=77,047) and follow-up (June 2004 to February 2006; n=55,021) questionnaire (follow-up response rate=71.4%). After we applied exclusion criteria, our analyses included 48,481 participants (active duty, n=26,613; Reserve or National Guard, n=21,868). Of these, 5,510 deployed with combat exposures, 5661 deployed without combat exposures, and 37,310 did not deploy. Main Outcome Measures New-onset and continued heavy weekly drinking, binge drinking, and alcohol-related problems at follow-up. Results Baseline prevalence of heavy weekly drinking, binge drinking, and alcohol-related problems among Reserve or National Guard personnel who deployed with combat exposures was 9.0%, 53.6%, and 15.2%, respectively; follow-up prevalence was 12.5%, 53.0%, and 11.9%, respectively; and new-onset rates were 8.8%, 25.6%, and 7.1%, respectively. Among active-duty personnel, new-onset rates were 6.0%, 26.6%, and 4.8%, respectively. Reserve and National Guard personnel who deployed and reported combat exposures were significantly more likely to experience new-onset heavy weekly drinking (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.36-1.96), binge drinking (OR, 1.46; 95% CI, 1.24-1.71), and alcohol-related problems (OR, 1.63; 95% CI, 1.33-2.01) compared with nondeployed personnel. The youngest members of the cohort were at highest risk for all alcohol-related outcomes. Conclusion Reserve and National Guard personnel and younger service members who deploy with reported combat exposures are at increased risk of new-onset heavy weekly drinking, binge drinking, and alcohol-related problems.
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