Alcohol misuse and psychological resilience among U.S. Iraq and Afghanistan era veterans

The role of resilience in the relationship between stress and alcohol

Stress plays a well-documented role in alcohol consumption and the risk for developing alcohol use disorder. The concept of resilience - coping with and successfully adapting to stressful life experiences - has received increasing attention in the field of addiction research in recent decades, and there has been an accumulation of evidence for resilience as a protective factor against problematic alcohol consumption, risk for alcohol use disorder, disorder severity, and relapse. The conceptual and methodological approaches used in the generation of this evidence vary considerably across investigations, however. In light of this, we carried out this review in order to provide a more thorough understanding of the meaning and scope of resilience, what factors contribute to resilience, how it is measured, and how it relates to alcohol-associated phenotypes. Implications for treatment through the use of resilience-building interventions are likewise discussed, as well as implications for future research on the role of resilience in the etiology and clinical outcomes of alcohol use disorder.

Psychological hardiness, personality factors and coping styles in male patients of alcohol dependence syndrome

Background

Alcohol dependence syndrome (ADS) is a result of complex interplay between biological, psychological, and sociocultural factors. While the biological (genetic) factors remain non-modifiable, better understanding of individual hardiness, personality variables, and coping mechanisms can help us in better understanding and comprehensive management of the illness.

Methods

A cross-sectional comparative study was conducted at a tertiary care hospital. A total of 112 patients with ADS (test group) and 124 healthy age matched male controls were recruited from the same social milieu. They were assessed for hardiness, personality factors, and coping mechanisms using Hardiness scale, 16 Personality factors (5th Edition), and Brief COPE scale, respectively. The data were analyzed with Chi square, Student t tests (two tailed, unpaired), Mann Whitney U test, and Kruskal Waal analysis.

Results

The test group had less hardy personality compared to control group (25% vs 43.54%) (p = 0.002). The level of Hardiness had an inverse relationship with alcohol dependence (p = 0.886). The majority of patients with ADS had high score on extraversion (p < 0.001), anxiety (p < 0.001), and tough-mindedness (p < 0.001), and the severity of alcohol dependence had an inverse relationship with extraversion (p = 0.004) and self-control (p = 0.002). The severity of ADS was directly related to the use of emotional support (p = 0.007) and substance use (p = 0.005) as coping mechanisms while the use of instrumental support (p = 0.001) and humor (p < 0.001) had inverse relationship with the severity of ADS.

Conclusions

ADS had less hardy personality and the level of hardiness had inverse relationship with alcohol dependence. The severity of alcohol dependence had an inverse relationship with extraversion and self-control. In terms of coping styles, substance use and use of emotional support was found to be directly related with the severity of alcohol dependence while the use of instrumental support and humor were found to be protective against severe dependence.

Latent profile analysis of gambling

Early age of gambling onset, ease of gambling with technological developments and lack of controlling online gambling games have led to unmanageable risk of gambling. Individual-centered approaches play a significant role in managing the risk that gambling poses on public health and discerning the heterogeneity of gambling addiction. Therefore, this study employed Latent Profile Analysis (LPA), one of the individual-centered approaches, to model the interactions across the psychosocial characteristics of gamblers. The study aims to reveal the latent profiles of gambling addiction. Unlike variable-centered approaches, LPA is a contemporary technique that provides objective information regarding individual psychological processes and behaviors. The profile indicators of the study involve psychosocial characteristics such as resilience, motives to gamble (excitement/fun, avoidance, making money, socializing), purposefulness, responsibility and worthiness. Data were collected from 317 volunteers (M = 68.9%; F = 31.1%; mean age = 25.16 ± 6.46) through the Brief Resilience Scale (BRS), Gambling Motives Scale (GMS) and Personal Virtues Scale (PVS). The emerging profiles were defined as adventurous players (14.2%), social gamblers (9.8%), professional gamblers (32.8%), problem gamblers (24.6%) and avoidant gamblers (18.6%). The individual-centered modeling is congruent with the literature on gambling and provides a complementary perspective to understand the heterogeneous structure of gambling. The results are expected to assist mental health professionals in developing educational and clinical intervention programs for gambling behavior. Finally yet importantly, it is recommended that new LPA models be offered through the use of different indicators related to gambling addiction.

The longitudinal buffering effects of resilience on alcohol use outcomes

OBJECTIVE

Traumatic events (TE) are a risk factor for alcohol use disorder (AUD). Resilience may be protective of the effects of TE exposure, but few studies have longitudinally tested the buffering hypothesis. Thus, the present study aimed to fill this gap.

METHOD

Participants (N = 6,015) were from a longitudinal investigation into substance use and health outcomes at a large, urban university. Participants completed self-report measures on precollege internalizing symptoms and lifetime trauma load. Resilience was calculated as a quantitative variable. At each of the follow-up assessments, participants reported on past month consumption, AUD symptoms, and new onset TEs. Longitudinal path modeling was used to test interactions.

RESULTS

Higher new onset TE load was associated with greater AUD symptoms, and higher consumption at one time-point. Results demonstrate a significant main effect of resilience at Y1S and Y3S, and a significant interaction between resilience and new onset TE at the last time-point, whereby higher levels of new onset TE were associated with higher levels of AUD symptoms at low (β = .19, p < .001), and average (β = .20, p = .001) levels of resilience. This effect was attenuated at high levels of resilience (β = .07, p = .051). No significant main nor interaction effects of resilience on consumption were found.

CONCLUSIONS

Findings suggest resilience as an important protective factor in relation to the development of AUD symptoms after exposure to a TE, though perhaps less so in relation to consumption. Findings are consistent with prior work demonstrating that AUD symptoms are more clinically relevant than consumption in this population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

How Do Women React to the COVID-19 Pandemic Period? Relationship Between Ego-Resiliency, Anxiety, Alcohol Consumption and Aggression Among Polish Women

Purpose

There are many reports in the literature on the impact of the COVID-19 pandemic on mental health, including the condition of women. Most of these studies refer to a single time point, while there is a lack of studies controlling for selected parameters during different periods of the pandemic. This work aimed to determine the role of ego-resiliency in women's adaptation to the COVID-19 pandemic.

Patients and Methods

The survey was conducted in two stages - all via online forms. A total of 762 Polish women took part in the overall project. The scales used in the study were the Ego-resiliency scale (ER89-R12), Generalized Anxiety Disorder 7 Scale (GAD-7), Alcohol Use Disorders Identification Test (AUDIT), and Buss-Perry Aggression Questionnaire (BPAQ). Statistical analysis was performed using Statistica 13.3.

Results

Women participating in the second study had significantly lower scores on ego-resilience and its components compared to the first study. In the first research, ego-resiliency and optimal regulation were statistically significantly correlated with anxiety, alcohol consumption, generalised aggression, verbal aggression and hostility, while openness to life experiences was correlated with alcohol consumption and hostility. The second part of the project highlighted new significant correlations between ego-resiliency and optimal regulation and physical aggression and anger, but a non-significant correlation of these variables with alcohol consumption. The effect of openness to life experiences on alcohol consumption and anxiety, evident in the first study, was no longer present in the second part of the study.

Conclusion

The lack of a significant effect of openness to life experience on alcohol consumption, lower ego-resiliency and optimal regulation scores are observed in the second part of the research, which might be an expression of adaptation to the COVID-19 pandemic. Ego-resiliency is a protective factor against aggression, while optimal regulation against anxiety among Polish women.

Relationship between three aspects of resilience-adaptive characteristics, withstanding stress, and bouncing back-in hospital workers exposed to prolonged occupational stress during the COVID-19 pandemic: a longitudinal study

BACKGROUND

The term resilience is used to refer to multiple related phenomena, including: (i) characteristics that promote adaptation to stressful circumstances, (ii) withstanding stress, and (iii) bouncing back quickly. There is little evidence to understand how these components of resilience are related to one another. Skills-based adaptive characteristics that can respond to training (as opposed to personality traits) have been proposed to include living authentically, finding work that aligns with purpose and values, maintaining perspective in the face of adversity, managing stress, interacting cooperatively, staying healthy, and building supportive networks. While these characteristics can be measured at a single time-point, observing responses to stress (withstanding and bouncing back) require multiple, longitudinal observations. This study's aim is to determine the relationship between these three aspects of resilience in hospital workers during the prolonged, severe stress of the COVID-19 pandemic.

METHODS

We conducted a longitudinal survey of a cohort of 538 hospital workers at seven time-points between the fall of 2020 and the spring of 2022. The survey included a baseline measurement of skills-based adaptive characteristics and repeated measures of adverse outcomes (burnout, psychological distress, and posttraumatic symptoms). Mixed effects linear regression assessed the relationship between baseline adaptive characteristics and the subsequent course of adverse outcomes.

RESULTS

The results showed significant main effects of adaptive characteristics and of time on each adverse outcome (all p < .001). The size of the effect of adaptive characteristics on outcomes was clinically significant. There was no significant relationship between adaptive characteristics and the rate of change of adverse outcomes over time (i.e., no contribution of these characteristics to bouncing back).

CONCLUSIONS

We conclude that training aimed at improving adaptive skills may help individuals to withstand prolonged, extreme occupational stress. However, the speed of recovery from the effects of stress depends on other factors, which may be organizational or environmental.

Resilience and alcohol use in adulthood in the United States: A scoping review

High levels of alcohol use and the development of alcohol use disorder (AUD) are associated with various adverse consequences. Resilience has been proposed as a protective factor against increased alcohol use, though the existing research is limited by inconsistencies in the conceptualization and measurement of resilience. As such, the current scoping review examined 14 studies on individual, trait-level resilience as a protective factor against alcohol use and related consequences in adults over the age of 21 in the United States. Findings from the included studies generally suggest resilience as a protective factor against various outcomes, though methodological limitations should be considered. Although future research in this area should improve upon methodological limitations, the present review suggests clinical implications of resilience as beneficial in prevention and intervention programming for alcohol use outcomes.

Psychological resilience buffers the association between cell phone addiction and sleep quality among college students in Jiangsu Province, China

BACKGROUND AND AIMS

Excessive use of cell phones can take up college students' time and energy, and the sleep quality will inevitably be affected. A high level of psychological resilience can help them to maintain a positive attitude and cope with stressful events. However, few studies were conducted to investigate the effects of psychological resilience buffering cell phone addiction on sleep quality. In our hypothesis, psychological toughness would mitigate the worsening impact of cell phone addiction on sleep quality.

METHODS

The sample consisted of 7,234 Chinese college students who completed an electronic questionnaire that included demographic characteristics, such as the Mobile Phone Addiction Index (MPAI), the Psychological Resilience Index (CD-RISC), and the Pittsburgh Sleep Quality Index (PSQI). SPSS 26.0 was used for data analysis, the measurement data were described by x ¯ ± s for those conforming to normal distribution, and the comparison of means between groups was analyzed by group t-test or one-way ANOVA. Those that was not conforming to normal distribution were described by median M (P ₂₅, P ₇₅), and the comparison of M between groups was analyzed by Mann-Whitney U test and Kruskal-Wallis H test. Using Spearman correlation analysis, the associations between mobile phone addiction, psychological resilience, and sleep quality were evaluated. Using SPSS Process, the mediating role of psychological resilience was examined.

RESULTS

The mean scores of cell phone addiction and psychological resilience were 45.00 (SD = 13.59) and 60.58 (SD = 18.30), respectively; the sleep quality score M (P ₂₅, P ₇₅) was 5.0 (3.0, 7.0). Cell phone addiction among college students had a direct predictive effect on sleep quality (β = 0.260, P < 0.01), and psychological resilience had a negative correlation with both cell phone addiction and sleep quality (β = -0.073, P < 0.01, and β = -0.210, P < 0.01). Psychological resilience was responsible for a mediating effect value of 5.556% between cell phone addiction and sleep quality.

CONCLUSION

Cell phone addiction has an impact on sleep quality both directly and indirectly through the mediating effect of psychological resilience. Increased psychological resilience has the potential effect to buffer the exacerbating of cell phone addiction on sleep quality. These findings provide an evidence for cell phone addiction prevention, psychological management, and sleep improvement in China.

Associations between Resilience and Food Intake Are Mediated by Emotional Eating in the NutriNet-Santé Study

BACKGROUND

Resilience, the ability to bounce back or recover from stress, has been associated with several health-related behaviors. However, data on food intake and emotional eating are lacking.

OBJECTIVES

The objective of this cross-sectional study was to analyze the associations between resilience and diet quality and ultraprocessed food (UPF) and food group consumption, and to assess whether emotional eating was a mediator of these associations.

METHODS

In 2017, 17,840 participants (73.5% female, mean age = 55.4 ± 14.0 y) of the NutriNet-Santé study completed the Brief Resilience Scale, the revised 21-item Three-Factor Eating Questionnaire, and ≥3 self-administered 24-h dietary records. Diet quality was assessed with the modified French National Nutrition and Health Program Guideline Score. Foods and beverages consumed were categorized according to their degree of processing by the NOVA classification. We assessed the association between resilience and emotional eating using linear regression models. We also assessed the mediating role of emotional eating in the associations between resilience and diet quality, energy intake, and UPF and food group consumption, controlling for sociodemographic characteristics.

RESULTS

In our study, resilience was negatively associated with emotional eating (P < 0.0001). More resilient participants had greater overall diet quality, greater intakes of seafood, whole-grain foods, fats, unsalted oleaginous fruits, and alcoholic beverages, and lower intakes of UPFs, starchy foods, dairy desserts, sugary fatty products, and sugar and confectionery (all P < 0.05). Emotional eating was a mediator of the inverse associations between resilience and intake of energy, UPFs, dairy desserts, sugary fatty products, and of the positive associations between resilience and alcoholic beverages (all P < 0.05), with a 20-70% mediation.

CONCLUSIONS

Our findings showed that resilience was associated with an overall better diet quality in the NutriNet-Santé population-based study. These associations were partially explained by emotional eating. These findings suggest that resilience should be considered in the promotion of healthy dietary habits.The study is registered at clinicaltrials.gov as #NCT03335644.

Roles of alcohol use disorder and resilience in risk of suicide attempt in men: A Swedish population-based cohort

INTRODUCTION

Alcohol use disorder (AUD) has been identified as a strong risk factor for suicide attempt. However, few studies have considered protective factors that may moderate this association, such as resilience.

METHODS

We used longitudinal nationwide Swedish data of 903,333 males born 1960-1980 and 48,285 males born 1949-1951. We performed Cox proportional hazards models to test the role of AUD, resilience, and their interaction on risk for suicide attempt. We used co-relative models to account for familial factors.

RESULTS

Alcohol use disorder was strongly associated with increased risk of suicide attempt [hazard ratio (HR) = 12.22], while resilience was associated with reduced risk (HR = 0.73). Multiplicative interaction (HR = 1.21) showed that, in the context of AUD, the protective role of resilience on risk of suicide attempt was somewhat attenuated. Co-relative analyses supported both familial liability and a possible causal pathway between AUD, resilience, and suicide attempt. In the cohort born 1949-1951, resilience subcomponents-social maturity, interests, psychological energy, home conditions, and emotional control-were all associated with reduced suicide attempt risk (HRs between 0.63 and 0.74).

CONCLUSION

While resilience is associated with reduced risk of suicide attempt, this effect is less pronounced in the context of AUD. These associations are potentially causal.

Developing an Integrated Model of Care for Veterans with Alcohol Problems

Introduction:

Veterans often do not present with alcohol problems in isolation, they may have a wide range of social, physical, and psychological needs. The aim of this study was to facilitate the development of a co-designed integrated model of care for veterans with alcohol problems.

Methods:

Following the development model by the Agency for Clinical Innovation, a planning symposium was held in North East of England to engage health and social care planners, public health leads, clinical commissioning groups and providers. Service users were empowered in discussions to provide insights and look for solutions (N = 43).

Results:

Using diagramming techniques, three examples of health and social care provision were created demonstrating the current commissioning landscape, one veteran’s experience of accessing services and a proposal for a new integrated model of care for veterans with alcohol problems.

Discussion:

By engaging stakeholders and service users, the model proposed a potential solution to reducing the number of veterans ‘falling through the gaps’ or disengaging from services. The collaborative approach highlighted the difficulties in navigating the current complex health and social care systems. The co-designed hub and spoke model aims to enable alcohol misuse services to adapt and evolve so that they better fit the needs of veterans.

Resilience, Psychological Stress, Physical Activity, and BMI among United States Air National Guardsmen: The COVID-19 Pandemic

Background

Military service members carry the responsibility to maintain physical and psychological readiness. As such, it is critical for researchers to begin unravelling the widespread impact of the COVID-19 pandemic on service member’s mental and physical wellbeing. The aim of this research was to investigate the complex relationships between BMI, physical activity, psychological stress and resilience among United States Air National Guardsmen (USANG), specifically during the pandemic.

Methods

An online survey was distributed to USANG members. The survey included measures of resilience (CD-RISC-25), perceived psychological stress (PSS), perceived psychological stress brought on by COVID-19 (COVID-19 PSL), current levels of physical activity (IPAQ-SF), perceived impact on physical activity brought on by COVID-19 (COVID-19 PAL), and BMI. Pearson’s correlation coefficients (r) were used to assess correlation significance (α ≤ 0.05), direction, and magnitude.

Results

A total of 110 responses met inclusion criteria for data interpretation. A majority reported a decline in physical activity 54.5%, while 60% reported an increase in psychological stress. According to BMI classifications, 60.9% were considered overweight or obese. Seven meaningful (effect size ≥ |2.0|) and statistically significant salient associations were identified resilience-PSS r = -0.38; resilience-COVID-19 PAL r = 0.21; PSS-COVID-19 PSL r = 0.35; PSS-COVID-19 PAL r = -0.23; COVID-19 PSL COVID-19 PAL r = -0.24; IPAQ-SF-BMI r = -0.23; BMI-Covid-19 PAL r = -0.32.

Conclusion

Key outcomes suggest resilience is inversely associated with assessed and perceived stress, resilience may influence health-related behaviour which subsequently might aid as a protective factor against psychological stress. Knowledge regarding the relationships between the aforementioned variables may help inform decisions by military leadership regarding future lockdowns.

Depressive Symptoms Among Adolescents: Testing Vulnerability-Stress and Protective Models in the Context of COVID-19

Adolescents who experience negative life events may be at risk for depression, particularly those with psychosocial vulnerabilities. We investigate longitudinally the impact of vulnerability/protective factors on the relation between a large-scale negative life event, the COVID-19 pandemic, and depressive symptoms. Adolescents (N = 228, M_age = 14.5 years, 53% female, 73% white) self-reported depressive symptoms 2-4 months before the pandemic (Time 1), and again 2 months following stay-at-home orders (Time 2). At T2, adolescents also completed measures of vulnerability, protective factors, and COVID-19-related distress. Depressive symptoms increased at T2, and COVID-19 distress interacted with resilience and negative cognitive style in predicting increases in T2 depression. Focusing on vulnerability and protective factors in adolescents distressed by large scale negative life events appears crucial.

The effect of resilience on the relationship between perceived stress and change in alcohol consumption during the COVID-19 pandemic in Queensland, Australia

The COVID-19 pandemic has led to increased levels of stress and alcohol consumption. This study examined the effect of resilience on the relationship between stress and changes in alcohol consumption in the context of the COVID-19 pandemic in early 2020. A cross-sectional survey of 502 adults in Queensland, Australia (mean age = 45.68 (16.61)), found 23.9% of individuals had increased their alcohol consumption since the start of the pandemic. Regression modelling demonstrated a significant association between perceived stress and change in alcohol consumption. The study also revealed resilience was a moderating factor, where high levels of resilience buffered against increases in alcohol consumption associated with stress during the COVID-19 pandemic.

Exploration of Psychological Resilience during a 25-Day Endurance Challenge in an Extreme Environment

Psychological resilience is the ability to use personal qualities to withstand pressure, consisting of the interaction between the individual and the environment over time. It is essential when operating in extreme environments which are typically characterised by a complex combination of stressors with increased elements of risk and adversity. Psychological resilience has never been investigated “live” (e.g., in the moment) throughout the duration of an extreme endurance challenge, despite anecdotal accounts of the need for resilience to successfully function in such environments. The aim of the study was to explore psychological resilience with challenge team members (n = 4, mean age = 46.0 years) involved in a 25-day extreme endurance challenge. The object of the challenge was to ‘TAB’ (Tactical Advance to Battle, fast marching with weighted packs) 100 peaks in the UK in 25 days and complete long-distance bike rides between base camps. A mixed-methods approach with a focus on qualitative methods was utilised. Specifically, individual reflective video diaries (n = 47) and focus groups (n = 4) were completed and analysed using interpretative phenomenological analysis (IPA). At the same time, the 10-item Connor Davidson Resilience Scale was employed to measure resilience, which highlighted the individualised and dynamic nature of resilience. Two superordinate themes were identified from the video diaries and focus groups, namely, the identification of the stressors within extreme environments and strategies to maintain functioning. Stressors were split into subordinate themes of significant and every day, and collectively, they created a cluster effect which contributed to pressure associated with operating in these environments. Challenge team members employed various strategies to maintain functioning, including using a challenge mindset to positively appraise pressure as a challenging learning experience. Further research should continue to develop an understanding of how participants completing challenges within extreme environments utilise and develop personal qualities to maintain functioning.

Genetic association of FKBP5 with trait resilience in Korean male patients with alcohol use disorder

The FKBP5 gene is known to have an important role in alcohol use disorder (AUD) in response to stress and has been reported to affect stress responses by interacting with childhood trauma. This study investigated the effects of the FKBP5 polymorphism rs1360780 and childhood trauma on trait resilience in male patients with AUD. In addition, allele-specific associations between FKBP5 DNA methylation and resilience were examined. In total, 297 men with AUD were assessed for alcohol use severity, childhood trauma, resilience, and impulsivity. Genotyping for FKBP5 rs1360780 and DNA methylation were analyzed. The effects of the rs1360780 single nucleotide polymorphism (SNP) and clinical variables on resilience were tested using linear regression analysis. Possible associations between FKBP5 DNA methylation and resilience were tested with partial correlation analysis. The rs1360780 risk allele, a low education level, and high impulsivity were associated with diminished resilience, whereas no significant main or interaction effect of childhood trauma with the SNP rs1360780 genotype on resilience was shown. No significant association between FKBP5 DNA methylation and resilience was found. The present study demonstrated the involvement of the rs1360780 risk allele in trait resilience in men with AUD, suggesting that the genetic vulnerability of FKBP5 may influence resilience related to AUD.

The prevalence of hazardous and harmful alcohol use across trauma-exposed occupations: A meta-analysis and meta-regression

BACKGROUND

Trauma exposure is associated with hazardous and/or harmful alcohol use. Occupational groups frequently exposed to trauma may be at risk of alcohol harm. This meta-analysis determined the prevalence of hazardous and harmful alcohol use across trauma-exposed occupations and meta-regressions explored the impact of pre-defined covariates on the variance in prevalence estimates.

METHOD

Literature was searched from 2000 to March 2020, using Scopus, Web of Science and PsycINFO. Studies were included in the meta-analysis if they used a standardized measure of alcohol use (e.g., Alcohol Use Disorder Identification Test (AUDIT)). Studies were excluded if they measured alcohol use following an isolated sentinel event (e.g., 9/11). The following occupations were included: first responders, health care workers, Armed Forces, war journalists and train drivers.

RESULTS

1882 studies were identified; 55 studies were eligible. The pooled prevalence of hazardous use was 22% (95% Confidence Intervals [CI]: 17%-27%) and 11% (95% CI: 8%-14%) for harmful use. Hazardous alcohol use was significantly lower in health care workers (13%; 95% CI: 10%-16%) than first responders (26%; 95% CI: 20%-32%) and Armed Forces (34%; 95% CI: 18%-52%). There was marked heterogeneity across studies and higher prevalence rates in low-quality studies. The meta-regression identified higher proportion of males and younger mean age as predictors of variance.

CONCLUSIONS

Male-dominated occupations, such as police officers and military personnel, showed higher levels of hazardous and harmful alcohol use, indicating that interventions tailored specifically for these occupational groups may be needed.

Resilience among Abstinent Individuals with Substance Use Disorder

BACKGROUND

Understanding resilience among abstinent individuals with substance use disorder would help in enhancing recovery.

AIM

To examine the resilience among abstinent individuals with substance use disorder.

METHODS

The study used a cross-sectional research design. Sample size: 60 samples were selected using a consecutive sampling procedure. Using interview schedule, data was collected from abstinent individuals receiving follow-up services at the out-patient department, government-run de-addiction centre, tertiary care teaching hospital, Bangalore. Persons with SUDs aged between 18-60 years with a minimum abstinence period of three months and above were included. Those who were refused consent for the study were excluded. Statistical test: Descriptive statistics, Spearmen correlation and logistic regression analysis were used to analyze the data.

RESULTS

Mean age of the abstinent individuals was 39.6 (S.D ±9.5) years. Majority (75%) were married, employed (98%), having diagnosis of alcohol dependence (60%). Majority (80%) had past history of abstinence, 40% were maintaining abstinence more than three months. Most (60%) were treated on out-patient basis and they never hospitalized. Mean score of resilience among abstinent individuals was 75 (±9.94) which indicates high resilience in them.

CONCLUSION

Social work interventions focusing on enhancing resilience among person with substance use disorder would help in maintaining long-term abstinence.

Results of a Randomized Trial of Screening, Brief Intervention, and Referral to Treatment (SBIRT) to Reduce Alcohol Misuse Among Active-Duty Military Personnel

OBJECTIVE

Rates of heavy alcohol use among active-duty military personnel in the United States are high and negatively affect individuals within the service branches. This study tested the effectiveness of a military-focused screening, brief intervention, and referral to treatment (SBIRT) intervention for reducing risky alcohol use among active-duty patients.

METHOD

We used a randomized, parallel, two-group design to test the effectiveness of the SBIRT intervention in a convenience sample of service members recruited from the emergency department of a military hospital. A total of 791 participants were randomized to the SBIRT or usual care conditions, and 472 participants (59.7%) completed a 6-month follow-up. Fifteen percent of the sample was female. Self-reported Alcohol Use Disorders Identification Test (AUDIT), controlled drinking self-efficacy (CDSE), and readiness to change drinking behaviors were assessed at baseline and follow-up.

RESULTS

Among higher risk participants (i.e., AUDIT ≥8), results of a complete case analysis showed a significant reduction in scores on the AUDIT-C (consumption questions from the AUDIT) and a significant increase in CDSE. Null findings were observed for intent-to-treat analyses testing the effectiveness of the SBIRT intervention; significant decreases in AUDIT and AUDIT-C scores and significant increases in CDSE were observed over time, irrespective of condition assignment for both complete case and intent-to-treat analyses.

CONCLUSIONS

Results of a complete case analysis provided some support for the effectiveness of the SBIRT intervention for higher risk participants. The results of the more conservative intent-to-treat analyses did not support any of the study hypotheses. Future SBIRT effectiveness trials should also test electronic SBIRT intervention approaches.

Is psychological resilience a protective factor between motivations and excessive smartphone use?

Excessive smartphone use has recently become a topic of interest. Prior studies have suggested that psychological well-being variables and motivations are important predictors of excessive smartphone use. However, few have examined the internal mechanism of these factors in leading to excessive smartphone use. Based on Compensatory Internet Use theory, we investigated the moderating role of psychological resilience between two types of motivation — escapism and social interaction — and excessive smartphone use. Selecting 576 typical smartphone users, we found: (1) Escapism motivation and psychological resilience significantly correlate with excessive smartphone use, whereas social interaction motivation does not; (2) Psychological resilience moderates the relationship between both escapism and social interaction motivation and excessive smartphone use. Our study demonstrates the mechanism of different types of motivation and the protective effect of psychological resilience on excessive smartphone use. Thus, we emphasize resilience training that would help train people to be able to cope with life problems more effectively.

Resilience to Hazardous Drinking Among Never-Deployed Male United States Army Reserve and National Guard Soldiers

BACKGROUND

Negative emotions related to never having been deployed to active duty are associated with an increased risk of hazardous drinking among United States Army Reserve/National Guard (USAR/NG) soldiers. Resiliency factors are known to buffer the effects of combat on hazardous drinking among service members who have been deployed, but it is not known whether these factors are protective for never-deployed service members, or which domains of hazardous drinking might be affected. Therefore, we examined the effects of a range of resiliency factors (i.e., marital satisfaction, psychological hardiness, intrinsic religiosity) on the relation between nondeployment emotions (NDE) and domains of hazardous drinking.

METHODS

We drew a subset of data from Operation: Soldiers and Families Excelling Through the Years (N = 112 never-deployed male soldiers), an ongoing study of USAR/NG soldiers. Regression models examined the main effects of NDE on each of the domains of hazardous drinking (i.e., total Alcohol Use Disorders Identification Test [AUDIT] score, consumption subscale, dependence subscale, alcohol-related problems subscale) and effect modification of each of the resiliency factors on the relations between NDE and the domains of hazardous drinking, separately. Final models controlled for years of military service, rank (enlisted vs. officer), number of military friends in the social network, and depression.

RESULTS

Greater NDE were associated with a higher total AUDIT score, alcohol consumption, and alcohol dependence (ps < 0.05), but not alcohol-related problems (p > 0.05). Marital satisfaction and psychological hardiness buffered the effects of NDE on total AUDIT score and alcohol dependence (p < 0.05). Intrinsic religiosity only modified the effect of NDE on total AUDIT score. None of the resiliency factors modified the effects of NDE on alcohol consumption or alcohol-related problems.

CONCLUSIONS

Soldiers with greater NDE had a greater risk of hazardous drinking in the presence of low resilience. Interventions to promote resiliency are an important consideration for protecting USAR/NG soldiers from hazardous drinking, regardless of their deployment history.

The Cardiometabolic Health Benefits of Sauna Exposure in Individuals with High-Stress Occupations. A Mechanistic Review

Components of the metabolic syndrome (i.e., hypertension, insulin resistance, obesity, atherosclerosis) are a leading cause of death in the United States and result in low-grade chronic inflammation, excessive oxidative stress, and the eventual development of cardiometabolic diseases (CMD). High-stress occupations (HSO: firefighters, police, military personnel, first responders, etc.) increase the risk of developing CMD because they expose individuals to chronic and multiple stressors (i.e., sleep deprivation, poor nutrition habits, lack of physical activity, psychological stress). Interestingly, heat exposure and, more specifically, sauna bathing have been shown to improve multiple markers of CMD, potentially acting as hormetic stressors, at the cellular level and in the whole organism. Therefore, sauna bathing might be a practical and alternative intervention for disease prevention for individuals with HSO. The purpose of this review is to detail the mechanisms and pathways involved in the response to both acute and chronic sauna bathing and collectively present sauna bathing as a potential treatment, in addition to current standard of care, for mitigating CMD to both clinicians and individuals serving in HSO.

The Mediating Roles of Impulsiveness and Maladjustment in the Association of Psychological Resilience with Drug Addiction during Isolated Detoxification

Background: Studies have shown that psychological resilience is a key factor in drug rehabilitation. To explore the feasibility of developing psychological resilience as an addiction treatment intervention, it is essential to explore the role that it plays in drug addiction. Objectives: This study aimed to investigate the relationship between psychological resilience and drug addiction, as well as to examine the underlying mediational roles of maladjustment and impulsiveness in this association. Methods: We used a cross-sectional design that included a sample of 140 male drug addicts in compulsory isolation centers and used questionnaires and scales to ascertain their level of drug addiction, psychological resilience, maladjustment, impulsiveness, social support, and loneliness. Correlation and mediation effect analyses were performed to determine the roles of impulsiveness and maladjustment in the association of psychological resilience with drug addiction. Results: Psychological resilience was an inverse predictor of drug addiction. The results of the mediation effect analysis showed that maladjustment acted as a mediator between resilience and drug addiction and between impulsiveness and drug addiction. Furthermore, impulsiveness and maladjustment jointly mediated the relationship between psychological resilience and drug addiction. Conclusion: These findings highlight the importance of psychological resilience in maladjustment and impulsiveness for drug addicts and suggest that the role of psychological resilience in drug addiction needs to be further explored.

Longitudinal Examination of the Impact of Resilience and Stressful Life Events on Alcohol Use Disorder Outcomes

Stressful life events (SLEs) are a risk factor for alcohol use problems, and there is a need for identification of factors that may offset this risk. Resilience is uniquely, inversely associated with alcohol use, but there remains a dearth of research examining the buffering effect of resilience toward alcohol use problems in the context of SLEs. Objectives: This study used prospective data from an epidemiological twin sample (N = 7441) to test whether resilience at Time 1 would act as a buffer for new onset SLEs (e.g. assault, marital problems) against risk for alcohol dependence (AD) symptoms at Time 2. Results: The final model, adjusted for familial relatedness and controlling for demographic covariates and Time 1 (lifetime) AD symptoms, identified significant main effects of resilience and SLEs; those with greater resilience at Time 1 reported fewer symptoms (β=-.087, p<.001) and those with greater new-onset SLEs reported greater symptoms (β=.116, p<.001) at Time 2. However, there was no significant interaction (β=-.008, p>.05). Conclusions: Although findings further support the association of resilience and SLEs with AD, results do not support the conceptualization of resilience as a buffer against the impact of future life stressors on alcohol use outcomes. This suggests other factors may be more relevant for understanding protective factors for alcohol use problems or the relation between resilience and SLEs on alcohol use outcomes.

The impact of protective psychosocial factors on khat chewing among male medical and dental future health-care providers in Yemen

BACKGROUND/PURPOSE

Khat chewing, a green leaf with amphetamine effects, is a public health concern. Yet, it is prevalent and evident, in the khat belt region, among male students in health faculties. This study aimed to examine whether psychosocial factors have a protective impact on khat chewing among male dental and medical students.

MATERIALS AND METHODS

A cross-sectional study included all students (1457) in second year and above at a Yemeni university. A self-administered questionnaire was used to obtain sociodemographic data and to assess students' psychosocial characteristics namely, depression, resilience and social support (perceived or received [living with or away from family]). Data analysis included descriptive statistics and multivariable logistic regression modelling.

RESULTS

The response rate was 61% (male = 334, female = 547) and the responding students' mean ± SD age was 22.95 ± 1.56 years. Of the respondents 185 (21% [95%CI = 18%-24%]) were current khat chewers (7 [4%] females and 178 [96%] males respectively). In the adjusted model, among male students living away from family was significantly associated with khat chewing (adjusted odd ratio [AOR] = 3.15,95%CI = 1.96-5.07, p < 0.001) and perceived social support was inversely significantly related to khat chewing (AOR = 0.98; 95%CI = 0.96-1.00; p = 0.019).

CONCLUSION

Within the limitation of the study of a single institute, social support whether received (living with family) or perceived appeared to be a protective factor from khat chewing among male medical and dental students. Social support should be enhanced and targeted to discourage khat chewing during the preparation of this future health care force.

Is deployment status the critical determinant of psychosocial problems among reserve/guard soldiers?

A general assumption that deployment is the primary catalyst for psychological and social difficulties may contribute to underrecognition and undertreatment of problems among never-deployed service members (i.e., having no history of ever being deployed). We aimed to determine if ever-deployed (i.e., having a history of at least one deployment) and never-deployed United States Army Reserve and National Guard (USAR/NG) soldiers differed in mental health, substance use, and resiliency factors, and to determine the relative influence of deployment status and each of these factors on poor psychosocial outcomes. We analyzed a subset of data from Operation: SAFETY (Soldiers and Families Excelling Through the Years) (N = 404), an ongoing study examining the health and well-being of USAR/NG soldiers. Bivariate analyses demonstrated that soldiers did not significantly differ across a range of measures on the basis of deployment status (ps > 0.05). In fact, Factor Analyses and Discriminant Function Analysis revealed that deployment status was the least salient factor to psychosocial problems among the measured variables and that the observed variables could not accurately discriminate between ever-deployed and never-deployed soldiers, F(8, 374) = 1.34, p > .05. Measures of mental health and substance use were more salient to psychosocial problems (ps < .05). Measures of resiliency loaded negatively onto psychosocial problems (ps < .05), indicating that they contribute to better well-being. Targeting screening and intervention efforts only on soldiers who have been deployed will miss opportunities to intervene on an equally affected group. Resiliency factors should be considered as intervention targets. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

U.S. Military Veteran Versus Nonveteran Use of Licit and Illicit Substances

INTRODUCTION

To provide up-to-date substance use surveillance data among U.S. military veterans versus nonveterans, this study assesses current use of tobacco products, alcohol, marijuana, prescription pain relievers, tranquilizers, sedatives, stimulants, cocaine, heroin, methamphetamines, inhalants, and hallucinogens.

METHODS

Pooled data were from the 2015-2017 National Survey on Drug Use and Health, a nationally representative, self-reported survey of the U.S. adult non-institutionalized population. Military veterans were those who had "ever been in the United States Armed Forces" and were "now separated/retired from reserves/active duty" (n=7,301). Nonveterans were those who had never been in the U.S. Armed forces (n=121,366). Age- and gender-stratified weighted prevalence estimates were calculated and compared with chi-square tests. All analyses were conducted in 2019.

RESULTS

Illicit substance use, including marijuana and cocaine, was generally lower among veterans than nonveterans, whereas use of licit substances such as tobacco and alcohol was higher among veterans than nonveterans. The most commonly used substances among veterans were tobacco and alcohol. Among male participants aged 18-25 years, 59.8% of veterans reported past-12-month cigarette/cigar smoking (vs 46.6% of nonveterans), whereas 17.6% reported heavy drinking (vs 12.2% of nonveterans). For both cigarette/cigar smoking and binge drinking, there was a marked narrowing of the male-female gap in prevalence with increasing age among veterans. Female veterans aged 18-25 years reported significantly higher opioid use than their nonveteran counterparts (54.7% vs 35.0%); they also had the highest prevalence of opioid misuse (15.3%) than any other group.

CONCLUSIONS

Intensified efforts are needed to reduce substance use among veterans and provide cessation and mental health services.

Drinking as routine practice among re-integrating National Guard and Reservists from Arkansas

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.

A randomized controlled trial protocol for engaging distress tolerance and working memory to aid smoking cessation in low socioeconomic status (SES) adults

Low income and low educational attainment are among the strongest predictors of both smoking prevalence and lapse (i.e., return) to smoking after cessation attempts. Treatment refinement is limited by inadequate knowledge of the specific lapse- or relapse-relevant vulnerabilities characteristic of populations that should be the target of treatment. In the context of a randomized clinical trial design, we describe an experimental medicine approach for evaluating the role of 2 specific lapse-relevant targets relative to the higher stress characteristic of low-socioeconomic contexts: low distress tolerance and low working memory capacity. Furthermore, we use an innovative approach for understanding risk of smoking lapse in smokers undergoing a quit attempt to examine candidate mechanistic targets assessed not only during nicotine use, but also during the conditions smokers will face upon a cessation attempt-during stressful nicotine-deprivation windows. This study is designed to show the incremental value of assessments during deprivation windows, in part because of the way in which specific vulnerabilities are modified by, and interact with, the heightened stress and withdrawal symptoms inherent to nicotine-deprivation states. Specifically, the study is designed to evaluate whether a novel mindfulness intervention (mindfulness combined with interoceptive exposure) can improve upon existing mindfulness interventions and extend therapeutic gains to the modification of mechanistic targets assessed in high-stress or negative affectivity contexts. The overall goal is to validate mechanistic targets and associated interventions for the purpose of expanding treatment options for at-risk smokers. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Problems with Social Acceptance and Social Victimization Predict Substance Use among US Reserve/Guard Soldiers

The effects of negative social interactions/experiences on substance use have largely been studied in civilian populations, but less is known about United States Army Reserve/National Guard (USAR/NG) soldiers-a high-risk group. We examined the associations between problems with social acceptance, social victimization, and substance use among USAR/NG soldiers, and examined potential differences by deployment history. The sample consisted of soldiers who completed baseline and 1-year follow-up assessments (N = 445) of Operation: SAFETY, an ongoing study of USAR/NG soldiers. We examined the effects of baseline problems with social acceptance/social victimization on nonmedical use of prescription drugs (NMUPD), illicit drug use, frequent heavy drinking (FHD), and alcohol problems at follow-up. Significant effects were small in magnitude but consistent in direction. Greater problems with social acceptance were associated with higher odds of NMUPD and illicit drug use. Greater social victimization was associated with higher odds of NMUPD and illicit drug use. There were no differences by deployment history. Problems with social acceptance/social victimization were not associated with FHD or alcohol problems. Problems with social acceptance/social victimization may contribute to drug use among USAR/NG soldiers. Intervention programs should address social issues, regardless of deployment history.

Resilience, Emotions, and Character Strengths as Predictors of Job Stress in Military Personnel

Background: Job stress, which undermines productivity and physical and mental health, has been reported to be high among military personnel. Objectives: The present study aimed to explore the role of character strengths, emotions, and resilience in predicting job stress in a sample of Iranian military personnel. Methods: This cross-sectional study recruited a total number of 146 military personnel via convenience sampling and administered the Health and Safety Executive Stress Questionnaire, Conner-Davidson Resilience Scale, Values in Action Inventory of Strengths, and Positive and Negative Affect Schedule. The correlation analysis and stepwise linear regression were performed using SPSS22. Results: Job stress was negatively associated with resilience, positive emotions, and character strengths and positively associated with negative emotions (P < 0.001). Regression analysis revealed that three variables, including resilience, courage, and negative emotions could predict 57% of the variance in job stress (Adj. R2 = 0.57, P < 0.001). Conclusions: Higher resilience and courage are associated with lower job stress. Also, negative emotions such as anger, guilt, and anxiety would contribute to higher job stress. Providing training courses to develop and boost resilience and courage and manage negative emotions can offset the negative effects of job stress on military personnel. Also, considering these factors as recruitment criteria would lead to the enlistment of cadets who may be more resilient to stress.

Determinants of new-onset alcohol use disorder in U.S. military veterans: Results from the National Health and Resilience in Veterans Study

BACKGROUND

Although veterans are at increased risk of alcohol use disorder (AUD) relative to civilians, few longitudinal studies have examined both risk and protective factors that influence the development of AUD. This study aimed to identify risk and protective factors that contribute to incident AUD.

METHODS

Data were analyzed from the National Health and Resilience in Veterans Study (NHRVS), a nationally representative, prospective cohort study of U.S. veterans. The sample included 1,770 veterans who did not meet criteria for lifetime AUD at Wave 1 and completed at least one follow-up assessment over a 7-year period. Veterans completed self-report measures to assess for risk and protective factors. A multivariable binary logistic regression analysis was conducted to examine baseline factors associated with incident AUD.

RESULTS

A total of 5.9% of veterans without AUD at Wave 1 developed AUD in the 7-year follow-up period. Adult sexual trauma, greater severity of anxious arousal symptoms of PTSD, lifetime history of drug and nicotine use disorders, and higher alcohol consumption at Wave 1 were independently associated with incident AUD. Lifetime drug use disorder (75.9%) and higher alcohol consumption (22.1%) explained the most variance in incident AUD.

CONCLUSION

Approximately 6% of veterans without AUD at Wave 1 developed AUD over a 7-year period. Lifetime drug use disorder and greater alcohol consumption at baseline, as well as trauma-related characteristics (i.e., adult sexual trauma, anxious arousal symptoms), were associated with increased risk of developing AUD. Future research should examine whether treatment of drug use disorder and PTSD symptoms in at-risk veterans may help mitigate risk of developing AUD in this population.

Young men's behavioral competencies and risk of alcohol use disorder in emerging adulthood: Early protective effects of parental education

We investigate how early exposure to parental externalizing behaviors (EB) may contribute to development of alcohol use disorders (AUD) in young adulthood, testing a developmental cascade model focused on competencies in three domains (academic, conduct, and work) in adolescence and emerging adulthood, and examining whether high parental education can buffer negative effects of parental EB and other early risk factors. We use data from 451,054 Swedish-born men included in the national conscript register. Structural equation models showed parental EB was associated with academic and behavioral problems during adolescence, as well as with lower resilience, more criminal behavior, and reduced social integration during emerging adulthood. These pathways led to elevated rates of AUD in emerging and young adulthood. Multiple groups analysis showed most of the indirect pathways from parental EB to AUD were present but buffered by higher parental education, suggesting early life experiences and competencies matter more for young men from lower socioeconomic status (SES) families than from higher SES families. Developmental competencies in school, conduct, and work are important precursors to the development of AUD by young adulthood that are predicted by parental EB. Occupational success may be an overlooked source of resilience for young men from low-SES families.

Longitudinal associations of psychological resilience with mental health and functioning among military personnel: A meta-analysis of prospective studies

BACKGROUND

Military personnel are exposed to severe stressors across different stages of their career that may have a negative impact on mental health and functioning. It is often suggested that psychological resilience plays an important role in the maintenance and/or enhancement of their mental health and functioning under these circumstances.

METHOD

A systematic literature search was conducted using PsycINFO, MEDLINE, PsycARTICLES, Psychology and Behavioral Sciences Collection, Web of Science, and PubMed up to August of 2019 retrieving 3,698 reports. Schmidt and Hunter meta-analytical techniques were used to assess the predictive value of psychological resilience on ten different military relevant mental health and functioning outcomes. Multivariate meta-analysis assessed the origin of heterogeneity among bivariate effect sizes.

RESULTS

The effect sizes of 40 eligible peer-reviewed papers covering 40 unique samples were included in the meta-analysis. Seventy-eight percent of these studies were published after 2010 and were predominantly conducted in western countries. Bivariate effect sizes were low to medium (absolute values: 0.08 to 0.36) and multivariate effect sizes, adjusting for across studies varying sets of covariates, were low to trivial (absolute values: 0.02 to 0.08). Moderator analyses using multivariate meta-analysis on 60 bivariate effect sizes, revealed no significant effect of type of psychological resilience scale, time-lag, and career stage.

CONCLUSIONS

The current review found no indications that different conceptualizations of psychological resilience across a variety of research designs, are strongly predictive of mental health and functioning among military personnel. Future directions (moderator/mediator models, stressor type specifications, and directionality) for prospective studies are discussed. Our results question the usefulness of interventions to enhance the resilience of soldiers to improve their mental health and functioning.

Hardiness protects against problematic alcohol use in male, but not female, soldiers

Military service members are at high risk for problematic substance use compared with the general population; deployment and combat exposure further increases this risk. It is thus critical to identify resiliency factors that can buffer the negative effects of military experiences and potentially prevent problematic alcohol use. The current research examines the extent to which psychological hardiness predicts lower risk of problematic alcohol use and explores potential sex differences in this association. Data are from Operation: SAFETY, an ongoing study of U.S. Army Reserve/National Guard soldiers. Negative binomial regression models examined the relation between baseline hardiness, assessed by the 15-item Dispositional Resiliency Scale, and problematic alcohol use at the 1-year follow-up, assessed by the Alcohol Use Disorders Identification Test (N = 260), controlling for baseline combat exposure (Combat Exposure subscale, Deployment Risk and Resilience Inventory-2) and baseline quantity and frequency of alcohol use. To examine the impact of hardiness on men and women, models were stratified by sex. In final, adjusted models, hardiness predicted lower risk of problematic alcohol use (adjusted risk ratio = 0.98; p < .05) for male soldiers and was unrelated to alcohol use for female soldiers (adjusted risk ratio = 1.01; p > .05). Post hoc analyses explored the impact of each dimension of hardiness (i.e., commitment, control, and challenge) on problematic alcohol use. Hardiness assessment may complement existing screening tools to identify high-risk populations; interventions to promote hardiness may help in preventing problematic alcohol use, particularly among male soldiers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Ethanol consumption following mild traumatic brain injury is related to blood-brain barrier permeability

Several preclinical and clinical studies that deal with the neuropathological consequences of mild traumatic brain injury (mTBI) have focused on unraveling its effect on ethanol drinking behavior. Previous reports describe changes in ethanol consumption, both in animal models of mTBI as well as in patients, after concussive brain injury. However, the neurobiological mechanisms underlying this phenomenon are still poorly understood. In the present study, we used a unique model of mouse lines divergently selected for high (HA) or low (LA) swim stress-induced analgesia to examine the effect of mTBI on ethanol drinking behavior. In comparison with LA mice, their HA counterparts exhibited increased blood-brain barrier (BBB) permeability, lower basal alcohol preference, and lower level of stress-induced ethanol intake. Here, we showed that mTBI attenuates voluntary ethanol intake in LA, but not in HA mice. Interestingly, BBB disruption after mannitol infusion also decreases the level of ethanol drinking behavior in this line. We conclude that in alcohol-preferring LA mice, BBB disruption as a consequence of mTBI attenuates ethanol consumption. Our results suggest that the innate level of BBB integrity plays a pivotal role in regulation of ethanol consumption in mice showing differential endogenous opioid system activity.

Positive adaptation of HPA axis function in women during 44 weeks of infantry-based military training

BACKGROUND

Basic military training (BMT) is a useful model of prolonged exposure to multiple stressors. 8-12 week BMT is associated with perturbations in the hypothalamic-pituitary-adrenal (HPA) axis which could predispose recruits to injury and psychological strain. However, characterisations of HPA axis adaptations during BMT have not been comprehensive and most studies included few if any women.

METHODS

We studied women undertaking an arduous, 44-week BMT programme in the UK. Anxiety, depression and resilience questionnaires, average hair cortisol concentration (HCC), morning and evening saliva cortisol and morning plasma cortisol were assessed at regular intervals throughout. A 1-h dynamic cortisol response to 1 μg adrenocorticotrophic hormone-1-24 was performed during weeks 1 and 29.

RESULTS

Fifty-three women (aged 24 ± 2.5 years) completed the study. Questionnaires demonstrated increased depression and reduced resilience during training (F 6.93 and F 7.24, respectively, both p < 0.001). HCC increased from 3 months before training to the final 3 months of training (median (IQR) 9.63 (5.38, 16.26) versus 11.56 (6.2, 22.45) pg/mg, p = 0.003). Morning saliva cortisol increased during the first 7 weeks of training (0.44 ± 0.23 versus 0.59 ± 0.24 μg/dl p < 0.001) and decreased thereafter, with no difference between the first and final weeks (0.44 ± 0.23 versus 0.38 ± 0.21 μg/dl, p = 0.2). Evening saliva cortisol did not change. Fasting cortisol decreased during training (beginning, mid and end-training concentrations: 701 ± 134, 671 ± 158 and 561 ± 177 nmol/l, respectively, p < 0.001). Afternoon basal cortisol increased during training while there was a trend towards increased peak stimulated cortisol (177 ± 92 versus 259 ± 13 nmol/l, p = 0.003, and 589 ± 164 versus 656 ± 135, p = 0.058, respectively).

DISCUSSION

These results suggest a normal stress response in early training was followed quickly by habituation, despite psychological and physical stress evidenced by questionnaire scores and HCC, respectively. There was no evidence of HPA axis maladaptation. These observations are reassuring for women undertaking arduous employment.

Measurement properties and implications of the Brief Resilience Scale in healthy workers

Objectives

The aim of this study was to study measurement properties of the Dutch Language Version of the Brief Resilience Scale (BRS‐DLV) in blue and white collar workers employed at multiple companies and to compare the validity and factor structure to other language versions.

Methods

Workers (n = 1023) were assessed during a cross‐sectional health surveillance. Construct validity was tested with exploratory and confirmatory factor analyses (EFA and CFA) and hypothesis testing. Reliability was tested with Cronbach's alpha.

Results

A two‐factor structure of the BRS‐DLV had good model fit in both EFA and CFA, which could be explained by difficulties of workers with reversed order items. After excluding these inconsistent answering patterns, a one‐factor structure showed good model fit resembling the original BRS (χ² = 16.5; CFI & TLI = 0.99; SRMR = 0.02;RMSEA = 0.04). Internal consistency is sufficient (Cronbach's α = 0.78). All five hypotheses were confirmed, suggesting construct validity.

Conclusions

Reliability of the BRS‐DLV is sufficient and there is evidence of construct validity. Inconsistent answering, however, caused problems in interpretation and factor structure of the BRS‐DLV. This can be easily detected and handled because item 2, 4 and 6 are in reversed order. Other language versions differ in factor structure, most likely because systematic errors are not corrected for. To collect valid data, it is advised to be aware of inconsistent answering of respondents.

The association between problematic online gaming and perceived stress: The moderating effect of psychological resilience

BACKGROUND AND AIMS

Vulnerability to stress appears to be a potential predisposing factor for developing specific internet-use disorders, such as Internet Gaming Disorder (IGD). Studies investigating the protective effect of psychological resilience against the impact of perceived stress on IGD and weekly gameplay have yet to be reported in the existing literature. The aim of this study was to examine the potential moderating relationships between perceived stress and online gaming (more specifically operationalized as IGD and weekly gameplay) with psychological resilience.

METHODS

An online survey was administered to 605 participants (males = 82%, M_age = 24.01 years, SD_age = 6.11). A multivariate multiple regression model was applied to test for the possible contribution of perceived stress and psychological resilience to weekly gameplay and IGD.

RESULTS

Perceived stress was associated with higher scores of IGD, whereas psychological resilience was related to lower scores of IGD. In addition, the combination of having higher perceived stress and lower level of psychological resilience was associated with a particularly high hours of gameplay per week.

DISCUSSION AND CONCLUSIONS

These findings further support the importance of personal traits (perceived stress and psychological resilience) in online gaming (IGD severity and weekly gameplay), and also emphasize the unique moderating relationship between perceived stress and weekly gameplay with lack of resilience. Enhancing psychological resilience to decrease the likelihood of online gamers who experience higher level of stress from spending more hours per week gaming is recommended.

Differences in protective factors among U.S. Veterans with posttraumatic stress disorder, alcohol use disorder, and their comorbidity: Results from the National Health and Resilience in Veterans Study

BACKGROUND

Comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are associated with greater clinical and functional impairments than either disorder alone, including higher rates of suicidality and reduced functioning and quality of life. Although PTSD/AUD is associated with more severe risk factors relative to either disorder alone, it is unclear whether PTSD/AUD and its related impairments are also associated with lower levels of protective factors.

METHODS

We examined two composite factors of protective qualities derived from exploratory factor analyses-social connectedness (i.e., structural social support, perceived social support, secure attachment style) and protective psychosocial characteristics (i.e., resilience, purpose in life, dispositional optimism and gratitude, and community integration), in a nationally representative sample of U.S. Veterans (using data from the National Health and Resilience in Veterans Study) with PTSD alone, AUD alone, and comorbid PTSD/AUD.

RESULTS

Veterans with PTSD and PTSD/AUD scored significantly lower than those with AUD alone but did not differ from each other on measures of social connectedness and protective psychosocial characteristics (ps < .001). Both factors partially mediated the relationship between diagnostic status (PTSD or PTSD/AUD vs. AUD alone) and suicidal ideation (ORs = 0.58-0.62), as well as between diagnostic status and functioning/quality of life (psychosocial protective characteristics, β = 0.39; social connectedness, β = 0.16). Only protective psychosocial characteristics (OR = 0.54) emerged as a partial mediator between diagnostic status and lifetime suicide attempts.

CONCLUSIONS

U.S. Veterans with PTSD and PTSD/AUD score lower on measures of protective factors than Veterans with AUD. These factors may be important targets for prevention and treatment efforts.

Alcohol Use Among Never-Deployed U.S. Army Reserve and National Guard Soldiers: The Effects of Nondeployment Emotions and Sex

BACKGROUND

Limited research shows that mental health problems are prevalent among never-deployed soldiers and many experience negative emotions related to their nondeployment. U.S. Army Reserve/National Guard (USAR/NG) soldiers are also at high risk for alcohol misuse. However, it is not known if nondeployment emotions contribute to an increased risk of alcohol misuse among never-deployed USAR/NG soldiers.

METHODS

Data are from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing study of USAR/NG soldiers. We used regression models to examine the relations between nondeployment emotions, assessed by the Non-Deployment Emotions (NDE) Questionnaire, and a range of alcohol use outcomes, assessed by the Alcohol Use Disorders Identification Test and standard quantity and frequency questions, among a sample of never-deployed soldiers who were partnered at baseline (N = 174). Final models controlled for years of military service, current number of close military friends in the social network, marital satisfaction, and depression. We also tested for potential differences in these associations by sex.

RESULTS

Nondeployment emotions were associated with frequency of getting drunk (adjusted risk ratio [aRR] = 1.02, 95% CI: 1.01, 1.04; p < 0.05) and typical number of drinks consumed during a drinking episode (aRR = 1.03, 95% CI: 1.01, 1.04; p < 0.01). Nondeployment emotions had a trend-level association with percent of days drinking (adjusted odds ratio = 1.05, 95% CI: 1.00, 1.11; p = 0.055). Nondeployment emotions had a significant interaction with sex (p < 0.05) on the likelihood of alcohol problems, such that only male soldiers experienced a greater likelihood of alcohol problems when they had highly negative nondeployment emotions. There was no relation between nondeployment emotions and alcohol problems among female soldiers.

CONCLUSIONS

Findings demonstrate that greater nondeployment emotions are associated with increased alcohol use among never-deployed USAR/NG soldiers. The NDE Questionnaire may assist in identifying those at highest risk for alcohol problems.

Military status and alcohol problems: Former soldiers may be at greater risk

OBJECTIVES

The goal of this study was to explore differences in alcohol problems as a function of military status (current soldier, previous soldier and civilian spouses), and the possible interaction between sex and military status. We hypothesized that 1) soldiers would be at greater risk for alcohol problems than civilian spouses, and 2) former soldiers would be at greater risk compared to current soldiers.

METHODS

Data were drawn from Operation: SAFETY, a longitudinal study examining physical and mental health among U.S. Army Reserve and National Guard soldiers and their partners. The analytic sample included male and female participants who completed both the baseline and first follow-up assessments (N = 772). Negative binomial regression models were used to examine differences between military status group on alcohol problems at follow-up, controlling for sex and alcohol consumption at baseline. Interactions between military status and sex were also examined.

RESULTS

Among current soldiers, males experienced significantly more alcohol problems compared to women (4.47, 3.46; p = 0.005). Likewise, among previous soldiers, males experienced significantly more alcohol problems compared to women (6.69, 2.92; p = 0.002). Male previous soldiers had significantly more alcohol problems compared to both male current soldiers and male civilian spouses (6.69, 4.47, p = 0.04; 6.69, 3.96; p = 0.02). Among women, there were no significant differences by military status.

CONCLUSIONS

Our results indicate that male previous soldiers are at greater risk of alcohol problems than both current soldiers and civilian spouses. Health care and service providers should consider screening and monitoring soldiers who separate from the military, as alcohol use may increase.

Race/ethnicity, psychological resilience, and social support among OEF/OIF combat veterans

This study examined the relationship between race/ethnicity and psychological resilience, and the moderating role of social support in this relationship among non-Hispanic White (n = 605), Hispanic (n = 107), African American (n = 141), and Asian American (n = 97) Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) combat veterans. Veterans were primarily male (88%) with a mean age of 31.4 years (SD = 8.35). An analysis of covariance showed that Asian American veterans reported significantly lower psychological resilience than non-Hispanic White veterans. The interaction of race/ethnicity and social support with psychological resilience was examined via linear regression. We found that the relationship between psychological resilience and social support significantly differed by race/ethnicity such that social support was positively associated with psychological resilience among non-Hispanic White veterans, but not among other racial/ethnic groups. Our findings are consistent with previous studies that show Asian American veterans report lower psychological resilience than non-Hispanic White veterans. Cultural differences in how and why individuals use social support may underlie racial/ethnic differences in the relationship between social support and psychological resilience. Future qualitative and quantitative research is encouraged to better understand how social support relates to psychological resilience among minority OEF/OIF combat veterans.

Adaptation of Screening, Brief Intervention, Referral to Treatment to Active Duty Military Personnel in an Emergency Department: Findings From a Formative Research Study

BACKGROUND

The transient nature of military life coupled with environmental and psychosocial stressors increase the risk for alcohol misuse and abuse among active duty (AD) military service members and recent epidemiological studies demonstrate high rates of heavy drinking among AD personnel. Over the past decade, Department of Defense health care systems have observed increases in the utilization of substance use services among military personnel demobilizing from Operation Enduring Freedom and Operation Iraqi Freedom. Given the high rates of heavy drinking and increased use of substance use services in this population of AD personnel, the purpose of this study was to investigate how to best translate and implement an effective alcohol abuse prevention intervention tool (screening, brief intervention, and referral to treatment [SBIRT]) used in civilian populations to a military emergency department (ED) setting.

METHODS

We conducted focus groups with ED staff as well as short interviews with AD personnel at a Naval Medical Center in the southwestern United States to determine the suitability of SBIRT with military populations as well as how to best translate SBIRT to a military hospital setting.

FINDINGS

Participants expressed support for utilizing civilian health educators to conduct the SBIRT intervention; however, many were concerned with issues of confidentiality and were skeptical of whether AD would speak truthfully about alcohol consumption.

CONCLUSIONS

Results of this formative research study clearly indicate the implementation and translation of SBIRT into a military medical setting require attention to issues related to confidentiality, the veracity of alcohol reporting, as well as use of civilians over AD military personnel to deliver the SBIRT intervention. Furthermore, most participants expressed support for the SBIRT model and felt it could be implemented, with caveats, into a military health care setting such as an ED.

Childhood trauma, combat trauma, and substance use in National Guard and reserve soldiers

BACKGROUND

The goal of this work was to examine associations among childhood trauma, combat trauma, and substance use (alcohol problems, frequent heavy drinking [FHD], current cigarette smoking, and current/lifetime drug use) and the interaction effects of childhood trauma and combat exposure on those associations among National Guard/reserve soldiers.

METHODS

Participants (N = 248) completed an electronic survey asking questions about their military experiences, physical and mental health, and substance use. Childhood trauma and combat exposure were examined jointly in regression models, controlling for age, marital satisfaction, and number of deployments.

RESULTS

Childhood trauma was associated with current drug use (trend level, odds ratio [OR] = 1.44, 95% confidence interval [CI]: 0.97, 2.14; P = .072) in the main effect model; however, there was not a significant interaction with combat. Combat exposure had a significant interaction with childhood trauma on alcohol problems (b = -0.56, 95% CI: -1.12, -0.01; P = .048), FHD (b = -0.27, 95% CI: -0.47, -0.08; P = .007), and lifetime drug use (OR = 1.78, 95% CI: 1.04, 3.04; P = .035). There were no associations with either of the trauma measures and current cigarette smoking.

CONCLUSIONS

These results demonstrate that childhood and combat trauma have differential effects on alcohol use, such that combat trauma may not add to the effect on alcohol use in those with greater child maltreatment but may contribute to greater alcohol use among those with low child maltreatment. As expected, childhood and combat trauma had synergistic effects on lifetime drug use. Screening for multiple types of trauma prior to enlistment and/or deployment may help to identify at-risk individuals and allow time for early intervention to prevent future adverse outcomes.

Effects of social support and resilient coping on violent behavior in military veterans

Violence toward others has been identified as a serious postdeployment adjustment problem in a subset of Iraq- and Afghanistan-era veterans. In the current study, we examined the intricate links between posttraumatic stress disorder (PTSD), commonly cited psychosocial risk and protective factors, and violent behavior using a national randomly selected longitudinal sample of Iraq- and Afghanistan-era United States veterans. A total of 1,090 veterans from the 50 United States and all United States military branches completed 2 waves of self-report survey-data collection 1 year apart (retention rate = 79%). History of severe violent behavior at Wave 1 was the most substantial predictor of subsequent violence. In bivariate analyses, high correlations were observed among risk and protective factors, and between risk and protective factors and severe violence at both time points. In multivariate analyses, baseline violence (OR = 12.43, p < .001), baseline alcohol misuse (OR = 1.06, p < .05), increases in PTSD symptoms between Waves 1 and 2 (OR = 1.01, p < .05), and decreases in social support between Waves 1 and 2 (OR = .83, p < .05) were associated with increased risk for violence at Wave 2. Our findings suggest that rather than focusing specifically on PTSD symptoms, alcohol use, resilience, or social support in isolation, it may be more useful to consider how these risk and protective factors work in combination to convey how military personnel and veterans are managing the transition from wartime military service to civilian life, and at what point it might be most effective to intervene. (PsycINFO Database Record

Resilience as a moderating factor between stress and alcohol-related consequences in the Army National Guard

Due to the current prolonged conflicts in Iraq and Afghanistan, members of the United States National Guard and Reserve have shifted from a historically support-based role to an integral segment of combat efforts. Clinical and epidemiological research studies conducted on both civilian and military populations have documented high rates of comorbidity of stress disorders and substance use disorders. It is widely understood that excessive alcohol use is an issue among military personnel. The aim of this paper is to describe risk factors for alcohol-related serious consequences in a study of Army National Guard service members, as well as the role of resilience in protecting against these risks. Members of the National Guard (N=320) participated in the survey. We conducted a multiple regression to predict alcohol-related serious consequences and a simple moderation analysis was performed. After controlling for race, education, and deployment history, several variables emerged as significant predictors of alcohol-related consequences. Higher stressors, lower resilience, younger age, being unmarried and not living as married, being male, and identifying as non-Hispanic were associated with higher levels of serious alcohol-related consequences. Results revealed that resilience significantly moderated the relationship between stress and alcohol-related consequences. This study furthers our understanding of the alcohol-stress relationship by contextualizing it in terms of behaviors related to alcohol, as opposed to measuring consumption only. Most importantly, our work extends prior research in its examination of resilience as a moderator of the relationship between stress and serious alcohol-related consequences.

Trajectories of alcohol consumption in U.S. military veterans: Results from the National Health and Resilience in Veterans Study

BACKGROUND AND OBJECTIVES

While alcohol use disorder is prevalent in U.S. veterans, little is known about the nature and determinants of predominant trajectories of alcohol consumption in this population. The objective of the current study was to identify predominant trajectories of alcohol consumption over a 4-year period, and baseline determinants of these trajectories in veterans.

METHODS

Data were analyzed from the National Health and Resilience in Veteran Study, which surveyed a nationally representative sample of 3,157 veterans (Wave 1). Assessments (Waves 2 and 3) were conducted every 2 years thereafter. Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test-Consumption, a brief alcohol screen for identifying problematic drinking based on alcohol consumption. Wave 1 sociodemographic, military, health, and psychosocial variables were examined as possible determinants of trajectories of alcohol consumption.

RESULTS

Latent growth mixture modeling revealed that a four-class model best fit the data: rare drinkers (65.3%), moderate drinkers (30.2%), excessive drinkers (2.6%), and recovering drinkers (1.9%). Lifetime major depressive disorder (MDD) was linked to an excessive drinking trajectory, while fewer medical conditions and lower social support were linked to a moderate drinking trajectory. Having a secure attachment style and greater social support, and absence of lifetime MDD was linked to recovery from excessive drinking.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Four predominant trajectories of alcohol consumption were identified. Targeting MDD and related interpersonal factors such as attachment style and social support in population-based prevention and treatment initiatives may help prevent, mitigate, and promote recovery from excessive alcohol consumption in veterans. (Am J Addict 2018;XX:1-8).

Alcohol Misuse in Reserve Soldiers and their Partners: Cross-Spouse Effects of Deployment and Combat Exposure

BACKGROUND

Military deployment and combat are associated with worse outcomes, including alcohol misuse. Less is known about how these experiences affect soldiers' spouses.

OBJECTIVE

The study objective was to explore relationships between deployment, combat exposure, and alcohol misuse; especially cross-spouse effects (effect of one partner's experiences/behavior on the other partner), which has been under-examined in military samples.

METHODS

U.S. Army Reserve/National Guard soldiers and their partners completed a questionnaire covering physical and mental health, military service and substance use. Negative binomial regression models examined number of deployments and combat exposure individually for alcohol misuse and frequent heavy drinking (FHD). In additional models, we examined combat exposure's role on alcohol outcomes, controlling for the soldiers' number of deployments, PTSD symptoms, age, and in cross-spouse models, alcohol use and FHD. We considered individuals' deployment experiences related to their alcohol outcomes and to their spouses' alcohol outcomes.

RESULTS

The study sample included male soldiers with current/lifetime military service (n = 248) and their female partners. Combat exposure was related to FHD (RR: 1.01, p < .05, 95% CI: 1.01, 1.01) among male soldiers while controlling for PTSD symptoms, number of deployments, and age. Female partners of male soldiers were more likely to engage in FHD (RR: 1.01, p < .05, 95% CI: 1.01, 1.01) if their spouse experienced combat.

CONCLUSIONS

Our results demonstrate that male soldiers and their spouses are at increased risk of FHD if the soldier experienced combat. This points to the need for better screening, particularly of spouses of soldiers, whose alcohol misuse may be overlooked.