Management of Substance Use Disorder in Military Services: A Comprehensive Approach

Cumulative incidence of mental disorders in military personnel after 20 years of war in Afghanistan and 10 years in Mali - a comparison

Background: This study compares the mental health effects of deployment on soldiers that have been deployed to Afghanistan and Mali. The psychiatric disorders among Mali veterans represent a previously unstudied area, particularly when compared to the larger and more thoroughly researched group of Afghanistan veterans. This comparison will help shed light on the unique challenges faced by soldiers deployed in Mali.Aims: To gain better insight, all German armed forces personnel who were deployed to Mali before 2023 are compared with the total sample that was deployed to Afghanistan. Because there were more critical incidents per deployed soldier, the cumulative incidence rates of all mental disorders are expected to be higher among Afghanistan veterans.Methods: All N = 111,157 German soldiers who were deployed to Afghanistan (n = 93,000; 2001-2021) or Mali (n = 18,157; 2013-2022) were included. According to the Central Registry, which records all soldiers with documented deployment-related mental disorders, the number for these two missions was n = 2,652 (Afghanistan: n = 2,458; Mali: n = 194; female: n = 183; 6.9%). The cumulative incidence between the two deployments was compared using χ² tests. In addition, the frequency of diagnosis among affected soldiers was compared.Results: The cumulative incidence of all deployment-related mental disorders was higher among Afghanistan veterans (2.6% to 1.1%; OR = 2.51, 95% CI: [2.17, 2.91]). Afghanistan veterans had a higher cumulative incidence of PTSD, anxiety disorders, affective disorders and substance abuse, with ORs ranging from 1.6 to 4.1. PTSD was more common among Afghanistan veterans, while anxiety disorders were most common among Mali veterans.Conclusion: Mali veterans had significantly lower cumulative incidence rates for all mental disorders, but showed a shift in frequency towards more anxiety disorders. These findings have implications for optimising mental health training before and after deployments in Mali and similar areas.

Current War in Ukraine: Lessons from the Impact of War on Combatants' Mental Health during the Last Decade

Ukrainian Military Hospital retrospective analysis during a decade of conflicts (3995 records) unveils specific mental health ICD-10-CM distribution per rank and the long-lasting impact of active conflict or trench warfare. Most hospitalizations in all years of observation were among soldiers. Anxiety-related disorders have been present since 'peacetime', mainly among professional soldiers and high ranks, pointing to the need for rank-tailored psychological training in skills to reduce the anxiety burden. High frequency of psychoactive substance use emerged with acute conflicts and in nonprofessional soldiers during wartime. This dictates the need to strengthen the selection of military personnel, considering the tendency to addiction. Military operations multiply the hospitalizations in psychiatric hospitals. The data warn about a 'need for free beds effect', which is worse for soldiers. This is relevant to estimating and planning the need for hospital resources for the current situation where the general population has been recruited for defense. In the current war, tightening the rules of sobriety in units and up to a ban on the sale of alcoholic beverages in areas where hostilities are taking place is recommended. The specific impact on nonprofessional soldiers is relevant to the current war, with the general population of Ukraine recruited for defense and combat.

Redeveloping Substance Abuse Treatment for Military Personnel

PURPOSE OF REVIEW

We review the prevailing evidence surrounding treatment of substance use disorder (SUD), with specific focus on alcohol, tobacco, and prescription opiates, and how it informs guidelines for treating active duty military. We survey the evidence regarding preventive screening, treatment, and relapse prevention in substance misuse as it pertains to patient-centered care of the service member.

RECENT FINDINGS

Holistic, patient-centered care with an emphasis on identifying maladaptive use or dependence prior to progression to chronic disease is now recognized as the evidenced approach to treating substance use disorders. Early patient-guided intervention with combined behavioral and pharmacologic therapies leads to better outcomes, including greater functional status, lower relapse rates, and decreased rate of psychiatric and other comorbidities. The military has prioritized a patient-centered approach to screening, assessing, and treating SUD. Recent guideline updates represent a progressive, patient-centered approach in delivering unprecedented access to care, serving as a positive example in treating what is widely accepted as one of the country's most pressing public health concerns.