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Alcohol Use and Alcohol-Related Problems Before and After Military Combat Deployment
Isabel G. Jacobson, MPH;
Margaret A. K. Ryan, MD, MPH;
Tomoko I. Hooper, MD, MPH;
Tyler C. Smith, PhD, MS;
Paul J. Amoroso, MD, MPH;
Edward J. Boyko, MD, MPH;
Gary D. Gackstetter, DVM, PhD, MPH;
Timothy S. Wells, DVM, PhD, MPH;
Nicole S. Bell, ScD, MPH
JAMA. 2008;300(6):663-675.
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, 5510 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.
Author Affiliations: Department of Defense Center for Deployment Health Research, Naval Health Research Center, San Diego, California (Drs Ryan and Smith and Ms Jacobson); Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Hooper); Madigan Army Medical Center, Fort Lewis, Washington (Dr Amoroso); Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington (Dr Boyko); Air Force Research Laboratory, Wright-Patterson Air Force Base, Dayton, Ohio (Dr Wells); Analytic Services Inc, Arlington, Virginia (Dr Gackstetter); and Social Sectors Development Strategies Inc, Tacoma, Washington (Dr Bell).
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