Changes in alcohol use after traumatic experiences: the impact of combat on Army National Guardsmen

Calibrating the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) for detecting alcohol-related problems among Canadian, UK and US soldiers: cross-sectional pre-deployment and post-deployment survey results

OBJECTIVES

Excessive alcohol use can bring about adverse health and work-related consequences in civilian and military populations. Screening for excessive drinking can help identify individuals at risk for alcohol-related problems who may require clinical interventions. The brief validated measures of alcohol use such as the Alcohol Use Disorders Identification Test (AUDIT), or abbreviated AUDIT-Consumption (AUDIT-C), are often included in military deployment screening and epidemiologic surveys, but appropriate cut-points must be used to effectively identify individuals at risk. Although the conventional AUDIT-C cut-points ≥4 for men and ≥3 for women are commonly used, recent validation studies of veterans and civilians recommend higher cut-points to minimise misclassification and overestimation of alcohol-related problems. This study aims to ascertain optimal AUDIT-C cut-points for detecting alcohol-related problems among serving Canadian, UK and US soldiers.

DESIGN

Cross-sectional pre/post-deployment survey data were used.

SETTINGS

Comprised Army locations in Canada and UK, and selected US Army units.

PARTICIPANTS

Included soldiers in each of the above-mentioned settings.

OUTCOME MEASURES

Soldiers' AUDIT scores for hazardous and harmful alcohol use or high levels of alcohol problems served as a benchmark against which optimal sex-specific AUDIT-C cut-points were assessed.

RESULTS

Across the three-nation samples, AUDIT-C cut-points of ≥6/7 for men and ≥5/6 for women performed well in detecting hazardous and harmful alcohol use and provided comparable prevalence estimates to AUDIT scores ≥8 for men and ≥7 for women. The AUDIT-C cut-point ≥8/9 for both men and women performed fair-to-good when benchmarked against AUDIT ≥16, although inflated AUDIT-C-derived prevalence estimates and low positive predictive values were observed.

CONCLUSION

This multi-national study provides valuable information regarding appropriate AUDIT-C cut-points for detecting hazardous and harmful alcohol use, and high levels of alcohol problems among soldiers. Such information can be useful for population surveillance, pre-deployment/post-deployment screening of military personnel, and clinical practice.

Social and psychological predictors of alcohol-related incidents involving servicemen

"The aim of the research was to determine the social and psychological predictors of alcohol-related incidents involving servicemen. The research involved 310 servicemen, who were subjected to disciplinary and administrative penalties within 2016-2021 years for the offence commitment under the influence of alcohol. The control group included 650 servicemen who joined the service within this period. The analysis of psychological features of servicemen was carried out with the help of the following methods: “Determination of Type Accentuation of Character Traits and Temper” Questionnaire, “Self-Esteem Structures of Temper Questionnaire”, “Multilevel Personality ‘Adaptability’ Questionnaire”, “Progressive Matrix”, “16 PF Questionnaire”, and “Self-Esteem Structures of Temper Questionnaire”. Cluster analysis was used to differentiate servicemen who committed incidents under the influence of alcohol. The determined typology was valuable for the organization of preventive works, events dedicated to the improvement of socialization by recruits, adequate formation of servicemen image as well as their identification in accordance with it, and events dedicated to the prevention of suicidal behaviour."

Military service and alcohol use: a systematic narrative review

Background

Despite research highlighting the role of alcohol in military life, specifically in relation to mental health and certain combat experiences, there is no synthesised evidence looking at the relationship between military service and alcohol use.

Aims

To synthesize and examine evidence exploring the relationship between military service and alcohol use.

Methods

Six databases were examined across a 10-year period. Papers were included if they involved a military population and focused on alcohol use. From 4046 papers identified, 29 papers were included in the review.

Results

Military characteristics and experience were linked to high levels of alcohol use across military populations. Societal and cultural factors also played a role in alcohol use in military populations. Predatory behaviour of alcohol establishments, pressures to conform, an acceptance of alcohol use, and the role of religious services and military affiliated social networks were all considered. Excessive drinking impacted physical and mental health. Those diagnosed with PTSD and associated symptoms appeared to have greater alcohol use.

Conclusions

This review identified certain characteristics and experiences of military service that are associated with higher levels of alcohol use. It is important to identify risk factors for alcohol misuse to develop appropriate policy, targeting prevention.

Dedicated to the Cause

Abstract. The threat of terrorism and rise of extremist movements across the globe pose some of the greatest challenges the world currently faces. While there have been serious conceptual and methodological problems within the psychological study of terrorism, the nascent field has advanced and the evidence, theories, and models have developed in their sophistication. The current article explores the role of social or collective identity in instigating, propagating, and diminishing engagement in violent extremism. Specifically examining how when a fundamental need to belong is challenged through threats and uncertainty this can lead to the people joining entitative groups which can fuse personal and social identities. These identities can be further amplified through ingroup and outgroup processes leading to involvement in violent extremism. The paper also explores how identity can mediate the stress of this extremist lifestyle and sustain engagement in violence. In order to illustrate these processes the article draws on interviews with Northern Irish paramilitaries. Finally, the paper explores the role of identity in moderating violent extremism, and provides suggestions of approaches to promote desistence from violent extremism.

Mental Health, Sexual Orientation, and Perceived Social Network Support in Relation to Hazardous Alcohol Consumption Among Active Duty Military Men

Knowledge surrounding perceived network support and alcohol consumption among active duty U.S. military personnel is limited, particularly among sexual minorities.We sought to determine the correlates of hazardous alcohol consumption and whether perceived network support moderated the relationship between sexual orientation and Alcohol Use Identification Test (AUDIT-C) score.The sample comprised cisgender men currently serving in the U.S. military (N = 292). Participants were recruited through respondent-driven sampling and completed an online survey. Logistic regression analysis evaluated associations between positive AUDIT-C with sociodemographic characteristics (including sexual orientation), military service, mental health, and perceived social network support. Interaction analysis assessed the moderating effect of perceived network support on sexual orientation and AUDIT-C.Among study participants, 52.7% (154/292) had positive AUDIT-C, while 65.4% (191/292) self-identified as heterosexual/straight and 34.6% (101/292) identified as gay or bisexual. In adjusted analysis, positive AUDIT-C was associated with increased post-traumatic stress disorder symptomatology (adjusted odds ratio [adjOR] 1.03; 95% CI [1.00, 1.06]; p = .019) and high perceived network support (adjOR 1.85; 95% CI [1.04, 3.29]; p = .036), while mental health service utilization had reduced odds of positive AUDIT-C (adjOR 0.40; 95% CI [0.20, 0.78]; p = .007). In interaction analysis, high perceived network support was associated with increased odds of positive AUDIT-C among sexual minority men (adjOR 3.09; 95% CI [1.21, 7.93]; p = .019) but not heterosexual men (adjOR 1.38; 95% CI [0.68, 2.81]; p = .37).Hazardous alcohol use was prevalent among all men in our sample. Perceived social network support may influence hazardous alcohol consumption, particularly among sexual minority servicemen. These findings suggest the potential role of tailored social network-based interventions to decrease hazardous alcohol use among military personnel.

Staying Engaged in Terrorism: Narrative Accounts of Sustaining Participation in Violent Extremism

Research exploring radicalization pathways and how and why people become involved in terrorism has expanded since the 9/11 attacks. Likewise, over the last decade research exploring de-radicalization and desistence from terrorism has grown and expanded in an attempt to promote exit from extremist or terror groups. However, research studies on how individuals sustain engagement in terrorism and their involvement with extremist organizations, often in the face of great adversity, are absent from the body of research. To address this scarcity of research this study analyzed accounts of engagement in violent extremism produced by Northern Irish loyalist and republican paramilitaries in order to explore how their paramilitary lifestyle, perpetration of acts of political violence and the pressure from countering threats posed by rival groups, and the State security forces impacted on them. The analysis utilized a hybrid of thematic analysis and interpretative phenomenological analysis (IPA). The themes raised through the analysis reflected the psychological, social and economic hardship associated with this lifestyle. The narrative accounts also illustrated psychological changes associated to engagement in violence and from insulation within tightly knit extremist groups. As most of the participants faced incarceration during their paramilitary careers, themes also reflected on the impact imprisonment had on them. The themes explored factors that sustained their involvement, including the role of identity development and identity fusion in sustaining their extremism, the impact of insulated group membership, feelings of efficacy, dehumanization processes, community support, and beliefs in the utility of violence.

The evolution of mental health outcomes across a combat deployment cycle: A longitudinal study of the Guam Army National Guard

In the United States, National Guard soldiers have been called upon at unprecedented rates since 2001 to supplement active duty military forces. Frequent military deployments generate many occupational and environmental stressors for these citizen-soldiers, from serving in a dangerous zone to being away from family and home for long periods of time. Whereas there is a substantial amount of research focused on deployment-related health outcomes in relation to active duty (i.e., full-time) military populations, reserve forces are less understood. This study focuses on a United States Army National Guard combat unit deployed to Afghanistan. This prospective longitudinal study was conducted over the course an operational deployment cycle (i.e., before, during, and after) to document the evolution of salient mental health outcomes (i.e., post-traumatic stress, depression, general anxiety, and aggression). The findings show that both combat (e.g., killing others) and non-combat (e.g., boredom) stressors negatively affect mental health outcomes, and the severity of these outcomes increases over the course of a deployment cycle. Of special note, the study reveals key gender differences in the evolution of post-traumatic stress (PTS), depression, and anxiety across a deployment cycle: females report increased PTS, depression, and anxiety 6 months post-deployment, whereas the levels reported by males stabilize at their mid-deployment levels. The findings offer insights for medical providers and policymakers in developing more targeted health promotion campaigns and interventions, especially at the post-deployment phase.

Post-deployment Mental Health in Reserve and National Guard Service Members: Deploying With or Without One's Unit and Deployment Preparedness

Background

Given the greater prevalence of post-deployment mental health concerns among reservists, the higher likelihood of deploying without their regular unit, and potentially lower rates of deployment preparedness, we examined associations between deploying with or without one's regular unit (individual augmentee status, IAS), deployment preparedness, and mental health problems including post-traumatic stress disorder (PTSD), depression (MDD), and binge drinking in a nationally representative sample of Reserve Component (RC) Army and Marine-enlisted males (n = 705).

Methods

A series of multivariate regressions examined the association of mental health with IAS and deployment preparedness, adjusting for demographics. To examine whether deployment preparedness varied by IAS, an IAS × deployment preparedness interaction was included.

Findings

In an adjusted model, being an individual augmentee and low deployment preparedness were associated with any mental health problem (screening positive for PTSD, MDD, binge drinking, or any combination of the three). There was a significant IAS × deployment preparedness interaction. Mental health problems did not vary by preparedness among individual augmentees. Participants deploying with regular units with low-medium preparedness had greater risk for mental health problems (odds ratio [OR] = 3.69, 95% confidence interval [CI] = 1.78-7.62 and OR = 2.29, 95% CI = 1.12-4.71), than those with high preparedness. RC-enlisted male personnel who deployed without their regular unit were five times more likely to have a mental health problem, and were 61% more likely to report binge drinking. Additionally, those with lower levels of deployment preparedness were up to three times more likely to have a mental health problem and up to six times more likely to report PTSD.

Discussion

The current investigation found that both IAS and deployment preparedness were associated with negative mental health outcomes in a large representative sample of previously deployed RC-enlisted male personnel. In particular, low deployment preparedness was associated with an increased likelihood of PTSD, and deploying without one's regular unit was associated with increased rates of binge drinking. There were also significant main and interaction effects of IAS and deployment preparedness on having a mental health problem. It is possible that limiting the number of RC personnel deploying without their regular unit may help to decrease alcohol misuse among U.S. Armed Services reservists during and after future conflicts. Also, to the extent that deployment preparedness is a modifiable risk factor, future studies should examine whether increasing deployment preparedness could mitigate some of the correlates of deployment-related trauma exposure. Finally, future investigation is needed to explain why those who deploy without their regular unit, but who report high deployment preparedness, remain at elevated risk for mental health problems. It is possible that individual augmentees can benefit from a specific preparation for deployment. Those deploying without their regular unit had higher rates of mental health problems regardless of preparedness. These findings have implications for deployment preparedness training for those deploying without their regular unit.

A Review of Military Health Research Using a Social–Ecological Framework

Objective:

We aim to contextualize the growing body of research on the sequelae of military service in the wars in Afghanistan and Iraq. We employ a social–ecological (SE) framework for the taxonomy of military health research and classify risk as arising from the individual, family, community, and the institutional levels. We intend for this review to inform enhanced health promotion efforts in military communities.

Data Source:

Articles reviewed were extracted from Web of Science, PubMed, and Scopus.

Inclusion and Exclusion Criteria:

Research focused on somatic and psychological sequelae of combat deployment published from 2001—the year the war in Afghanistan began—through the end of 2014. We excluded studies of non-US military personnel, other systematic reviews, meta-analyses, book chapters, and theoretical papers.

Data Extraction:

We examined and summarized the aims, participants, methods, study design, SE framework tier, risk factors, and health outcomes.

Data Synthesis:

Studies were categorized according to SE tier, whether they focused on somatic, behavioral, or psychological outcomes, and by risk factor.

Results:

Of the 352 peer-reviewed papers, 84% focused on war’s sequelae on the index military personnel, and 75% focused on mental or behavioral health outcomes—mostly on post-traumatic stress disorder. We find comparatively little research focusing on the family, community, or institutional tiers.

Conclusions:

We know relatively little about how family and community respond to the return of personnel from combat deployment; how family resources affect the health of returning military personnel; and how a war’s persistence presents challenges for federal, state, and local agencies to meet military health-care needs. Such work is especially salient as US troops return home from war—particularly in communities where there are substantial military populations.

Hardiness, avoidance coping, and alcohol consumption in war veterans: A moderated-mediation study

Military personnel often engage in excessive alcohol use after returning from deployments. Thus far, research has paid scant attention to personality factors that may increase or diminish the risk for increased alcohol consumption in this population. The present study explores how psychological hardiness, avoidance coping, and stress exposure may interact to influence alcohol consumption patterns in soldiers following deployment. U.S. Army National Guard soldiers (N = 357) were surveyed shortly after returning from combat operations in Afghanistan. Conditional process analysis was used to test for mediation and moderation effects. Mediation effects were further tested in a replication sample of Norwegian Army soldiers (N = 230) deployed to Kosovo. Findings show that hardiness is a significant (negative) predictor of increased alcohol use and that this relation is mediated by avoidance coping. Further, this effect was moderated by combat stress exposure in the U.S. sample, such that the mediation is stronger for those with greater exposure (moderated-mediation). Avoidance coping also mediated the effects of hardiness on alcohol consumption in the Norwegian sample. These findings suggest that avoidance coping and hardiness may be fruitful areas for interventions aimed at reducing risky drinking in high-stress groups like the military.

Predictors of changes in daily alcohol consumption in the aftermath of military deployment

BACKGROUND

Several studies have documented factors related to increase in alcohol consumption in the context of stressful experiences. However, little is known about predictors of different courses of alcohol use in this context. This study aims to investigate diverse predictors and correlates of increase and decrease of average daily alcohol consumption (aDAC) in the aftermath of military deployment taking into account a variety of potentially relevant factors.

METHODS

N=358 soldiers were examined before (T1) and 12 months after return from deployment (T2) using standardized interviews. Change in aDAC was categorized into decreased (n=72), stable (n=215) and increased (n=71) aDAC.

RESULTS

Overall, aDAC did not change significantly between T1 and T2 (median change=0.0 g, inter quartile range=11.3g). Compared to stable aDAC, increase was characterized by a lower proportion of high-educated individuals (OR: 0.3 (0.1-0.7), p=0.008), lower rank (marginally significant: OR: 2.0 (1.0-4.1), p=0.050), and less acceptance (trend: MR: 0.97 (0.93-1.00), p=0.053). Correlates of increased aDAC were less social support (MR: 0.84 (0.71-0.99), p=0.043), more sleeping problems (MR: 1.15 (1.00-1.31), p=0.045) and more negative post-event cognitions following deployment (MR: 2.32 (1.28-4.21), p=0.006). Decrease in aDAC was predicted by lower PTSD symptom severity before deployment (MR: 0.34 (0.16-0.72), p=0.005) and less childhood emotional neglect (marginally significant: MR: 0.78 (0.60-1.00), p=0.050).

CONCLUSIONS

Increase and decrease in alcohol use after stressful experiences might have differential risk factors and correlates. Findings might stimulate future research that could result in improved measures to prevent increases as well as in interventions that could foster decreases in alcohol consumption in the context of stressful experiences.