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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    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.
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    ABSTRACT: A substantial amount of research has been conducted into the mental health of the UK military in recent years. This article summarises the results of the various studies and offers possible explanations for differences in findings between the UK and other allied nations. Post-traumatic stress disorder (PTSD) rates are perhaps surprisingly low amongst British forces, with prevalence rates of around 4% in personnel who have deployed, rising to 6% in combat troops, despite the high tempo of operations in recent years. The rates in personnel currently on operations are consistently lower than these. Explanations for the lower PTSD prevalence in British troops include variations in combat exposures, demographic differences, higher leader to enlisted soldier ratios, shorter operational tour lengths and differences in access to long-term health care between countries. Delayed-onset PTSD was recently found to be more common than previously supposed, accounting for nearly half of all PTSD cases; however, many of these had sub-syndromal PTSD predating the onset of the full disorder. Rates of common mental health disorders in UK troops are similar or higher to those of the general population, and overall operational deployments are not associated with an increase in mental health problems in UK regular forces. However, there does appear to be a correlation between both deployment and increased alcohol misuse and post-deployment violence in combat troops. Unlike for regular forces, there is an overall association between deployment and mental health problems in Reservists. There have been growing concerns regarding mild traumatic brain injury, though this appears to be low in British troops with an overall prevalence of 4.4% in comparison with 15% in the US military. The current strategies for detection and treatment of mental health problems in British forces are also described. The stance of the UK military is that psychological welfare of troops is primarily a chain of command responsibility, aided by medical advice when necessary, and to this end uses third location decompression, stress briefings, and Trauma Risk Management approaches. Outpatient treatment is provided by Field Mental Health Teams and military Departments of Community Mental Health, whilst inpatient care is given in specific NHS hospitals.
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