Combat Exposure in Iraq, Afghanistan Linked to High Risk for Alcohol Misuse

Caroline Cassels

August 13, 2008

August 13, 2008 — Soldiers deployed to Iraq and Afghanistan who are exposed to combat are at increased risk of developing alcohol-related problems, with the highest risk found among the youngest troops, reservists, and members of the National Guard.

Investigators at the Naval Health Research Center in San Diego, California, found that among Reserve or National Guard personnel exposed to combat, 8.8% took up heavy weekly drinking, 25.6% began binge drinking, and 7.1% developed other alcohol-related problems after deployment.

Further, compared with their older counterparts, soldiers born after 1980 were 6.7 times more likely to develop new-onset binge drinking and 4.7 times more likely to develop new-onset alcohol-related problems.

"These results are the first to prospectively quantify changes in alcohol use in relation to recent combat deployments," the authors write.

With first author Isabel G. Jacobson, the study is published in the August 13 issue of the Journal of the American Medical Association, in a special theme issue dedicated to violence and human rights.

According to the paper, there is a strong link between posttraumatic stress disorder (PTSD) and other mental health conditions following the kind of extreme stress or trauma typically associated with war.

It is also well-known that many individuals use alcohol as a way of coping with stress and trauma. As a result, researchers examined whether combat deployment increased later rates of alcohol consumption or problem drinking.

High rates of alcohol misuse have been reported among military personnel returning from past conflicts. However, the investigators note that there is little information regarding alcohol misuse among soldiers returning from the current conflicts in Iraq and Afghanistan.

Marines, Women Also At High Risk

To examine the issue, researchers used data from the Millennium Cohort Study. Established in 2001, this longitudinal, prospective study is designed to evaluate the long-term health of military service members and the potential influence of deployment and other military exposures on health.

The study included 77,047 randomly selected members of the US military who completed baseline questionnaires between July 2001 and June 2003 and again 3 years later. The information gathered included data on alcohol use patterns before and after deployment to the current wars.

The researchers looked at 3 drinking outcomes, including heavy weekly drinking, binge drinking, and alcohol-related problems.

The final analyses included 48,481 participants — 26,613 on active duty and 21,868 in the Reserve or National Guard. Of these participants, 5510 were deployed and exposed to combat and 5661 were deployed but not exposed to combat. The remainder, 37,310, did not deploy.

Members of the Reserve or National Guard who deployed and were exposed to combat were 63% more likely to experience new-onset heavy weekly drinking and alcohol-related problems compared with their counterparts who were not deployed.

Among military personnel on active duty, those who experienced combat were 31% more likely to start binge drinking at follow-up. Women were 1.2 times more likely to start drinking heavily but less likely to report new-onset binge drinking or alcohol-related problems.

The youngest members of the cohort were at highest risk for all 3 study outcomes. In addition, Marines were also at increased odds of continuing to binge drink after deployment and to experience new-onset alcohol-related problems.

Furthermore, individuals with a previous history of mental illness were at significantly increased risk for changes in drinking behavior.

In light of these findings, the authors called for interventions targeting these at-risk groups, including Reserve/Guard personnel andyounger individuals as well as those with current or past mental health problems.

The study is funded through the Military Operational Medicine Research Program of the US Army Medical Research and Materiel Command, in Fort Detrick, Maryland, and by the National Institutes of Health and the Department of Defense. The authors report no conflicts of interest.

JAMA. 2008;300:663-675.

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