Predictors of Aversive Alcohol Consequences in a Military Sample

Male sex and hazardous alcohol use following military sexual assault increase suicide risk among US service members and veterans

Background: Higher alcohol use and military sexual assault (MSA) are associated with increased risk of death by suicide. Risk for death by suicide is rapidly increasing among females, who report higher rates of MSA, yet actual death by suicide and alcohol use are higher among males. It is not well understood whether higher alcohol use confers greater suicide risk in male or female service members and veterans who have experienced MSA.Objective: To determine whether the association between alcohol misuse and suicide risk was moderated by biological sex in a sample of male and female service members (N = 400, 50% female) who reported MSA.Method: Participants completed surveys of alcohol use and suicide risk as well as a demographic inventory. Linear regression with an interaction term was used to determine if suicide risk differed by sex and alcohol use severity after accounting for discharge status, sexual orientation, and age.Results: Average scores on the suicide risk measure were consistent with an inpatient psychiatric sample and scores on the AUDIT-C were indicative of a probable positive screen for alcohol misuse. Suicide risk was most pronounced among males who reported higher levels of hazardous alcohol use. A sensitivity analysis examining suicide risk by sex and screening results for alcohol misuse (positive/negative) showed that men with a probable positive screen had higher suicide risk.Discussion: The current study provides novel findings on suicide risk among survivors of military sexual violence by including both male and female survivors. Interventions to decrease suicide risk following MSA may consider alcohol reduction strategies, and optimizing these interventions in males. Engaging military culture at both the US Departments of Defense and Veterans Affairs to encourage more healthy alcohol consumption may mitigate this public health concern. Future research may consider how country of origin relates to these associations.

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."

Trajectories of alcohol misuse among the UK Armed Forces over a 12-year period

AIM

To identify the main trajectories of alcohol misuse among UK military personnel from 12 years after the start of the Iraq war (2003) and the factors associated with each trajectory.

DESIGN

Longitudinal cohort study with three phases of data collection (2004-06, 2007-09 and 2014-16).

SETTING

United Kingdom.

PARTICIPANTS

Serving and ex-serving personnel of the UK Armed Forces (n = 7111) participating at Phase 1 and at least one follow-up phase of the King's Centre for Military Health Research (KCMHR) cohort study.

MEASUREMENTS

Trajectories of alcohol misuse were derived from scores using the Alcohol Use Disorders Identification Test (AUDIT-10) over three data collection phases. Demographic and military characteristics were collected and, among the key covariates, post-traumatic stress disorder (PTSD) was measured using the PTSD checklist (PCL-C) and childhood interpersonal stress and violence was measured using items from the Adverse Childhood Experiences questionnaire.

FINDINGS

Five trajectories of alcohol misuse were identified, including 'no misuse' (n = 2249, 31.6%) and 'hazardous' (n = 3398, 47.8%), 'harmful' (n = 832, 11.7%), 'severe-to-hazardous' (n = 258, 5.3%) and 'severe' (n = 374, 3.6%) drinking. Substantial changes were evident only among severe drinkers, where more than half reduced over the study period. The factors most strongly associated with belonging to harmful/severe drinking classes were young age, male gender and childhood adversities and antisocial behaviour. Severe drinkers at Phase 1 were more likely to report probable PTSD and shorter military careers and were less likely to serve as Officers. Persistent severe drinkers were less likely to serve in the RAF compared to the Army and were more likely to be reserves. Not misusing alcohol was also associated with reserve status and having left service.

CONCLUSIONS

In a cohort of approximately 7000 UK military personnel, trajectories of alcohol misuse appeared stable between 2004 and 2016. More than half of severe drinkers made substantial improvements over the period, but 68% of the cohort continued to drink hazardously or harmfully. Lack of change for the majority of the sample signals the need for strategies to address alcohol misuse and its cultural and psychosocial drivers.

The Challenges of Afghanistan and Iraq Veterans' Transition from Military to Civilian Life and Approaches to Reconnection

Afghanistan and Iraq veterans experienced traumas during deployment, and disrupted connections with friends and family. In this context, it is critical to understand the nature of veterans' transition to civilian life, the challenges navigated, and approaches to reconnection. We investigated these issues in a qualitative study, framed by homecoming theory, that comprised in-depth interviews with 24 veterans. Using an inductive thematic analysis approach, we developed three overarching themes. Military as family explored how many veterans experienced the military environment as a "family" that took care of them and provided structure. Normal is alien encompassed many veterans experiences of disconnection from people at home, lack of support from institutions, lack of structure, and loss of purpose upon return to civilian life. Searching for a new normal included strategies and supports veterans found to reconnect in the face of these challenges. A veteran who had successfully transitioned and provided support and advice as a peer navigator was frequently discussed as a key resource. A minority of respondents-those who were mistreated by the military system, women veterans, and veterans recovering from substance abuse problems-were less able to access peer support. Other reconnection strategies included becoming an ambassador to the military experience, and knowing transition challenges would ease with time. Results were consistent with and are discussed in the context of homecoming theory and social climate theory. Social support is known to be protective for veterans, but our findings add the nuance of substantial obstacles veterans face in locating and accessing support, due to disconnection and unsupportive institutions. Larger scale work is needed to better understand how to foster peer connection, build reconnection with family, and engage the broader community to understand and support veterans; interventions to support reconnection for veterans should be developed.

Type of army service and decision to engage in risky behavior among young people in Israel

Previous studies have examined the impact of military service on the decision to engage in risky behavior. Yet most of these studies focused on voluntary recruits, did not distinguish between legal and illegal risky activities and did not compare combat and non-combat soldiers during and after service according to gender. The current study is unique because of the nature of Israeli compulsory army service. It examines the relationship between type of army service and five legal and illegal risky behaviors for three groups: non-combat, combat without fighting experience, and combat with fighting experience. We also examine differences in the propensity for risky behavior between men, most of whom are assigned to combat units due to the army’s needs, and women, who serve in combat units on a voluntary basis only. A questionnaire survey was randomly distributed at train stations and central bus stations in Israel among 413 soldiers and ex-soldiers between the ages of 18-30. The predictor variables include type of service or battle experience, the Evaluation of Risks scale and socio-demographic characteristics. In general, we found that high percentages of young people engage in risky behavior, especially illegal behavior. The results indicate that fighting experience is significantly and positively correlated with the consumption of illegal substances for currently serving men soldiers (but not for women) and this effect is mitigated after discharge from the army. Importantly, the use of illegal substances is not a result of the individual’s preferences for engaging in various risky behaviors. Thus, our results suggest that the effect of the increased propensity toward risky behavior following the experience of fighting overrides the combat unit’s discipline for men when it comes to the consumption of illegal substances. In addition, our findings indicate that serving in a combat unit as opposed to a non-combat unit affects the tendency of women ex-combat soldiers to travel to risky destinations, though this is probably related to their original higher risk attitude, since women must volunteer for combat units.

The prevalence and correlates of risky driving behavior among National Guard soldiers

OBJECTIVE

Previous studies have reported that risky driving is associated with deployment and combat exposure in military populations, but there is limited research on risky driving among soldiers in the National Guard and Reserves, a group increasingly deployed to active international conflicts. The goal of this analysis was to assess the prevalence of risky driving and its demographic, mental health, and deployment-related correlates among members of the Ohio Army National Guard (OHARNG).

METHODS

The study group comprised 2,616 eligible OHARNG soldiers enlisted as of June 2008, or who enlisted between June 2008 and February 2009. The main outcome of interest was the prevalence of risky driving behavior assessed using six questions: "How often do you use seat belts when you drive or ride in a car?"; "In the past 30 days, how many times have you driven when you've had perhaps too much to drink?"; "In the past year, have you ever become impatient with a slow driver in the fast lane and passed them on the right?"; "In the past year have you crossed an intersection knowing that the traffic lights have already changed from yellow to red?"; "In the past year have you disregarded speed limits late at night or early in the morning?"; and "In the past year have you underestimated the speed of an oncoming vehicle when attempting to pass a vehicle in your own lane?" We fit multiple logistic regression models and derived the adjusted prevalence of risky driving behavior for soldiers with mental health conditions, deployment experience, exposure to combat or trauma, and psychosocial stressors or supports.

RESULTS

The prevalence of risky driving was higher in soldiers with a history of mental health conditions, deployment to a conflict area, deployment-related traumatic events, and combat or post-combat stressors. In contrast, the prevalence of risky driving was lower for soldiers who reported high levels of psychosocial support.

CONCLUSIONS

Efforts to mitigate risky driving in military populations may be more effective if they incorporate both targeted messages to remediate dangerous learned driving behaviors and psychosocial interventions to build resilience and address underlying stressors and mental health symptoms.

Sexual Healthcare for Wounded Warriors with Serious Combat-Related Injuries and Disabilities

INTRODUCTION

Short of the rich literature on sexuality in men following spinal cord injury, started largely by physicians and mental health professionals within the United States Department of Veterans Affairs (VA) system following earlier wars, little attention has been paid to the sexual healthcare of wounded warriors with other serious combat-related injuries. The recent wars in Iraq and Afghanistan-Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND)-resulted in physical injuries including traumatic brain injuries (TBIs), amputations, and serious burns. There are wounded warriors who are left blind or deaf, and a significant percent of OEF/OIF/OND warriors acquire other "invisible" injuries. While the signature injury of the war in Iraq is said to be TBI, there are a substantial number of service members surviving with posttraumatic stress disorder (PTSD). Many with serious injury are struggling with co-occurring depression. Furthermore, many of our wounded warriors are surviving with polytrauma (multiple traumatic injuries, i.e., amputation plus burns). One specific constellation of injuries seen too frequently among our service members in Afghanistan is referred to as a Dismounted Complex Blast Injury (DCBI) sometimes resulting in orchiectomy and/or penile injury. As with other blast injuries, burns, shrapnel injuries, vision loss, hearing loss, TBI, and PTSD often accompany DCBIs. All of the above injuries have significant sexual, endocrine, psychological, and relationship issues that need to be addressed.

AIM

This article presents an overview of the effects of serious, combat-related injuries on sexual health and provides medical and other health professionals a framework within which to address comprehensive sexual healthcare using a medical rehabilitation model.

CONCLUSIONS

Sexual healthcare for persons with combat-related disabilities presents a complex array of biopsychosocial and relational issues that call for a coordinated interdisciplinary approach that connects physical health, psychological health, and sexual health. Tepper MS. Sexual healthcare for wounded warriors with serious combat-related injuries and disabilities. Sex Med Rev 2014;2:64-74.

Gender differences in substance use treatment utilization in the year prior to deployment in Army service members

Although military men have heavier drinking patterns, military women experience equal or higher rates of dependence symptoms and similar rates of alcohol-related problems as men at lower levels of consumption. Thus, gender may be important for understanding substance use treatment (SUT) utilization before deployment. Military health system data were analyzed to examine gender differences in both substance use diagnosis (SUDX) and SUT in 152,447 Army service members returning from deployments in FY2010. Propensity score analysis of probability of SUDX indicated that women had lower odds (AOR: 0.91, 95% CI: 0.86-0.96) of military lifetime SUDX. After adjusting for lifetime SUDX using propensity score analysis, multivariate regression found women had substantially lower odds (AOR: 0.61; 95% CI: 0.54-0.70) of using SUT the year prior to deployment. Findings suggest gender disparities in military-provided SUT and a need to consider whether military substance use assessment protocols are sensitive to gender differences.

Examining the association between binge drinking and propensity to join the military

It is unclear to what degree previous and/or current alcohol consumption predicts enlistment into the military. The current investigation explored the extent to which binge drinking was related to propensity to join the military among a national sample of high school seniors (n = 14,577) responding to the 2008 Monitoring the Future survey. Independent sample t-tests and logistic regression analyses were employed to explore the research question. Results indicated that twelfth grade students who intended to join the military after graduating from high school binge drank a significantly greater number of days (p < 0.001, Cohen's d = -0.22) than those not intending to enlist. Even after controlling for various sociodemographic and lifetime drinking characteristics, binge drinkers had a higher propensity to join the military (odds ratio = 1.079, Wald = 5.53, df = 1, p < 0.05) than those who did not binge. Moreover, as binge drinking increased, so did one's propensity to join the military. Our findings lend credence to the notion that high school binge drinkers may be self-selecting into military service. These findings underscore the importance of adequately assessing the frequency of high-risk alcohol consumption and their associated correlates among potential military recruits before accession.

Drinking and driving and riding with an alcohol impaired driver among United States Air Force recruits

OBJECTIVE

To identify the prevalence and correlates of binge drinking, driving after drinking, and riding in a vehicle with a driver who had consumed alcohol in US Air Force active duty recruits.

METHODS

A military cohort (N = 31,108; 25.1% female) was analyzed to identify variables associated with binge drinking, drinking and driving, and riding with a driver who had consumed alcohol.

RESULTS

Results indicated that 53 percent (including 45% of those under the legal drinking age) reported alcohol use in the month prior to entering basic military training (BMT). Thirty-eight percent of all active duty recruits reported binge drinking (ie, consuming 5 or more drinks on a single occasion) at least one time in the past 30 days. Nearly 1 in 4 (23%) reported 1 to 3 episodes of binge drinking. Three percent of reported alcohol users drove after consuming five or more drinks, and 9 percent rode as a passenger in a vehicle with a driver who had been drinking heavily.

CONCLUSIONS

Several demographic, behavioral, and attitudinal correlates of risky drinking patterns were identified. Prevention efforts are needed to address the implications of these findings because they influence the health, safety, and military readiness of active duty personnel.

Patterns of drinking in the UK Armed Forces

AIMS

To examine patterns of drinking in the UK Armed Forces, how they vary according to gender and other demographics, and to make comparisons with the general population.

DESIGN

Large cross-sectional postal questionnaire study (response rate 60%).

SETTING

United Kingdom.

PARTICIPANTS

A random representative sample of the regular UK Armed Forces who were in service in March 2003 (n = 8686; 7937 men, 749 women). Comparisons were made with the general population of Great Britain.

MEASUREMENTS

Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT).

FINDINGS

Sixty-seven per cent of men and 49% of women in the UK Armed Forces had an AUDIT score of 8+ (defined as hazardous drinking), compared to 38% of men and 16% of women in the general population. In both sexes, for all ages, the military have a higher prevalence of hazardous drinking. Binge drinking was associated with being younger, being in the Army, being single, being a smoker and being white. Among military men, heavy drinking (AUDIT score 16+) was associated with holding a lower rank, being younger, being single, being in the Naval Service or Army, being deployed to Iraq, not having children, being a smoker, having a combat role and having a parent with a drink or drug problem.

CONCLUSIONS

Excessive alcohol consumption is more common in the UK Armed Forces than in the general population. There are certain socio-demographic characteristics associated with heavy drinking within the military; for example, young age, being single and being a smoker, which may allow the targeting of preventive interventions.