Cigarette and alcohol use in the UK Armed Forces, and their association with combat exposures: A prospective study

National Heart & Lung Institute, Imperial College London, London SW3 6LR, UK.
Addictive Behaviors (Impact Factor: 2.44). 09/2008; 33(8):1067-71. DOI: 10.1016/j.addbeh.2008.03.010
Source: PubMed

ABSTRACT Retrospective studies of military personnel and survivors of community disasters suggest a link between traumatic exposure and substance use. This is the first study to investigate this association prospectively in a military population. A representative cohort of members of the UK Armed Forces was recruited into a longitudinal study, with 1382 people surveyed at baseline, and 941 followed up around three years later. Alcohol and cigarette use were assessed on both occasions, and combat exposures during this time were assessed at follow-up. Alcohol consumption and the prevalence of binge-drinking increased over the course of the study. The increase in alcohol consumption was greater in those subjects who had been deployed, in particular in those who thought they might be killed (p=.010), or who experienced hostility from civilians while on deployment (p=.010). The effects of these combat exposures were strongest in those most recently deployed. In contrast, cigarette smoking declined during the three years of the study.

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    • "Additionally, some literature suggests that underlying genetic vulnerability modifies the risk of comorbid psychiatric disorders after exposure to traumatic events, including combat (Kilpatrick et al., 2007; Koenen et al., 2003). Although recent studies have begun to elucidate how specific combat experiences increase the risk of both mental illness and alcohol abuse following deployment (Browne et al., 2008; Hoge et al., 2006; Hooper et al., 2008; Wilk et al., 2010), more research is required to determine whether these exposures constitute a common etiologic pathway that drives both substance use and psychiatric conditions in soldiers of the National Guard. There are several other possible explanations for the observed associations between peri-/post-deployment alcohol abuse and coincident psychiatric problems. "
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    ABSTRACT: Although alcohol problems are common in military personnel, data examining the relationship between psychiatric conditions and alcohol abuse occurring de novo peri-/post-deployment are limited. We examined whether pre-existing or coincident depression and post-traumatic stress disorder (PTSD) predicted new onset peri-/post-deployment alcohol abuse among Ohio Army National Guard (OHARNG) soldiers. We analyzed data from a sample of OHARNG who enlisted between June 2008 and February 2009. Participants who had ever been deployed and who did not report an alcohol abuse disorder prior to deployment were eligible. Participants completed interviews assessing alcohol abuse, depression, PTSD, and the timing of onset of these conditions. Logistic regression was used to determine the correlates of peri-/post-deployment alcohol abuse. Of 963 participants, 113 (11.7%) screened positive for peri-/post-deployment alcohol abuse, of whom 35 (34.0%) and 23 (32.9%) also reported peri-/post-deployment depression and PTSD, respectively. Soldiers with coincident depression (adjusted odds ratio [AOR]=3.9, 95%CI: 2.0-7.2, p<0.01) and PTSD (AOR=2.7, 95%CI: 1.3-5.4, p<0.01) were significantly more likely to screen positive for peri-/post-deployment alcohol abuse; in contrast, soldiers reporting pre-deployment depression or PTSD were at no greater risk for this outcome. The conditional probability of peri-/post-deployment alcohol abuse was 7.0%, 16.7%, 22.6%, and 43.8% among those with no peri-/post-deployment depression or PTSD, PTSD only, depression only, and both PTSD and depression, respectively. Coincident depression and PTSD were predictive of developing peri-/post-deployment alcohol abuse, and thus may constitute an etiologic pathway through which deployment-related exposures increase the risk of alcohol-related problems.
    Drug and alcohol dependence 02/2012; 124(3):193-9. DOI:10.1016/j.drugalcdep.2011.12.027 · 3.28 Impact Factor
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    • "A prospective study of troops deployed to Iraq followed up a representative sample of 941 UK service personnel (Hooper et al ., 2008). After three years, alcohol consumption and binge drinking increased over time but the rise was greatest in those individuals who thought that they might be killed or who experienced hostility from Iraqi civilians. "
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    ABSTRACT: Traditionally alcohol has been used by the military to cope with the intense stress of battle but also as a way of mediating the transition from the heightened experience of combat to routine safety. The use of alcohol has divided medical opinion. Some doctors viewed it as wholly harmful to both social and occupational function and to health, while others argued that alcohol had a specific role in lifting morale, aiding unit cohesion and protecting soldiers from adjustment disorders. Although alcoholism has always been identified as incompatible with military service, the effects of habitual heavy drinking among military personnel are less well understood. Recent studies have suggested that young single males and those who have undergone particularly stressful experiences are at greatest risk of misusing alcohol. These associations, observed in the aftermath of recent conflicts in Iraq and Afghanistan, have again raised questions about the place of alcohol in military culture.
    International Review of Psychiatry 04/2011; 23(2):166-72. DOI:10.3109/09540261.2010.550868 · 1.80 Impact Factor
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    • "It may be that threatening combat experiences, both specific incidents and a general sense of possible death, are the most reliable predictor of post-deployment alcohol misuse. Additionally, Hooper et al. (2008) found that experiencing hostile reactions from civilians while on deployment was a significant predictor of increased alcohol consumption. There was a lack of agreement among our subject matter experts about categorizing this item, and it was therefore not included in our main analyses. "
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    ABSTRACT: Studies have shown a relationship between combat experiences and alcohol misuse in military personnel; it is not known if there are specific combat experiences that confer a greater risk. The current study examined the association of specific types of combat experiences with a positive screen for alcohol misuse. 1120 U.S. soldiers who were members of brigade combat infantry teams were surveyed anonymously 3-4 months after returning from deployment to Iraq regarding their experiences in combat and their physical and mental health. Combat items were independently rated and placed into the following categories: (1) Fighting; (2) Killing; (3) Threat to oneself; (4) Death/injury of others; (5) Atrocities; and, (6) Positive experiences. Alcohol misuse was measured using a 2-item alcohol screen combined with alcohol-related behavioral items. Of the soldiers sampled, 25% (N=275) screened positive for alcohol misuse 3-4 months post-deployment; 12% (N=125) screened positive and exhibited alcohol-related behavioral problems. Most combat exposure factors were significantly related to alcohol misuse individually. When factors were analyzed simultaneously, soldiers who had higher rates of exposure to the threat of death/injury were significantly more likely to screen positive for alcohol misuse; exposure to atrocities predicted misuse of alcohol with alcohol-related behavioral problems. High exposure to threatening situations and atrocities was associated with a positive screen for alcohol misuse. Clinicians treating combat veterans should be aware of the potential association of alcohol misuse with specific types of experiences and closely follow those soldiers upon their return home.
    Drug and alcohol dependence 04/2010; 108(1-2):115-21. DOI:10.1016/j.drugalcdep.2009.12.003 · 3.28 Impact Factor
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