Article

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.

2 Followers
 · 
120 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of the study was to evaluate which alcohol use expectancies could predict harmful use in the French Army to explore some hypotheses concerning socialising or coping effects. A cross-sectional survey, using self-administered questionnaires, was conducted in two Army units in 2011 (n = 249). Hazardous alcohol use and dependence were screened using the Alcohol Use Disorders Identification Test (AUDIT). Alcohol expectancies were measured with the Alcohol Effects Questionnaire (AEFQ). A cluster analysis was performed to identify AEFQ dimensions in our sample. Relationships between AUDIT and AEFQ were explored using multinomial logistic regression. According to AUDIT, 46.6% of soldiers used alcohol without hazard, 26.1% had hazardous use without dependence and 18.1% had use with dependence. The AEFQ had an adequate internal coherence with a 0.78 α coefficient. The scales identified by the cluster analysis in our sample fitted those retained in the originally validated AEFQ, with a correspondence ranging from 60% to 100%. In multivariate analysis, the scale "Social and physical pleasure" was associated with increasing hazardous use and subjects who scored higher on "Global positive" and "Social and physical pleasure" scales were more at risk of dependence. The present study, in line with previous research in terms of importance of alcohol use disorders among military personnel, found that alcohol use expectancies are associated with alcohol misuse among soldiers. This could suggest underlying coping mechanisms towards stress that have to be further explored.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Several studies have documented factors related to increases 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=0.0g, 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.
    Drug and Alcohol Dependence 11/2014; 147. DOI:10.1016/j.drugalcdep.2014.11.019 · 3.28 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective This prospective study aimed to investigate whether prior internalizing disorders (PID) moderate the relationship between stress exposure (SE) and the onset of alcohol use disorders (AUD) and nicotine dependence (ND) in deployed military personnel. Methods 358 male soldiers were examined directly before and 12 months after return from deployment using standardized interviews. Combat experiences, concerns about family disruptions, and difficult living and working environment were assessed as different aspects of SE. PID diagnoses (mood disorders (PMD), anxiety disorders (PAD)) and substance use disorders were defined according to the DSM-IV-TR. Results PMD were related to a stronger association between concerns about family disruptions and the risk of AUD onset (OR = 7.7, 95%CI 1.8-32.8, p = 0.006). The number of PID diagnoses (OR per diagnosis: 1.7, 95%CI 1.0-2.8, p = 0.036) and PAD (OR: 2.6, 95%CI 1.1-6.3, p = 0.038) were further related to a stronger association between difficult living and working environment and the risk of AUD onset. With regard to ND, PMD were related to a weaker association between difficult living and working environment and the risk of ND onset (OR = 0.4, 95%CI 0.2-0.8, p = 0.013). Conclusions PID might be related to an increased risk for the onset of AUD but not ND following SE. This effect is probably restricted to specific constellations of PAD, PMD, comorbid PID and specific aspects of SE. These critical constellations of PID and SE might be a promising target for future research and could contribute the development of preventive measures to reduce the risk of AUD following SE.
    Addictive Behaviors 12/2014; 43. DOI:10.1016/j.addbeh.2014.12.013 · 2.44 Impact Factor