Vets’ Alcohol Problems Linked to Stress on the Home Front

Returning national guardsmen more likely to turn to alcohol than the general public when faced with issues at home

Ann Arbor, MI, July 31, 2014

Regardless of traumatic events experienced during deployment, returning National Guard soldiers were more likely to develop a drinking problem if faced with civilian life setbacks, including job loss, legal problems, divorce, and serious financial and legal problems - all commonplace in military families. Results of the study by researchers at Columbia University's Mailman School of Public Health are published online in the American Journal of Preventive Medicine.

Alcohol abuse is a major concern for reservists returning home. Nearly 7% of Americans abuse or are dependent on alcohol, but among reserve soldiers returning from deployment, the rate of alcohol abuse is 14%, almost double that of the civilian population.

The study looked at a group of 1,095 Ohio National Guard soldiers, who had primarily served in either Iraq or Afghanistan in 2008 and 2009. Over three years, the soldiers were interviewed three times via telephone and were asked about their alcohol use, exposure to deployment-related traumatic events and stressors like land mines, vehicle crashes, taking enemy fire, and witnessing casualties, and any stress related to everyday life since returning from duty.

More than half (60%) of the responding soldiers experienced combat-related trauma, 36% of soldiers experience civilian stressors, and 17% reported being sexually harassed during their most recent deployment. Among the group, 13% reported problems consistent with an alcohol use disorder in the first interview, 7% during the second, and 5% during the third. Alcohol use disorder is defined as alcohol abuse or dependence.

The researchers found having at least one civilian stressor or a reported incident of sexual harassment during deployment raised the odds of alcohol use disorders. The effect of the stressors was restricted to cases of new-onset alcohol use disorders, and was not seen among those with a history of problem drinking. In contrast, combat-related traumatic events were only marginally associated with alcohol problems.

The study highlights the important role civilian life and the accompanying stress play in cases of alcohol use disorder in the National Guard.

"Exposure to the traumatic event itself has an important effect on mental health in the short-term, but what defines long-term mental health problems is having to deal with a lot of daily life difficulties that arise in the aftermath — when soldiers come home," explains lead investigator Magdalena Cerdá, DrPH, MPH, Assistant Professor of Epidemiology, Mailman School of Public Health, Columbia University. "The more traumatic events soldiers are exposed to during and after combat, the more problems they are likely to have in their daily life — in their relationships, in their jobs — when they come home. These problems can in turn aggravate mental health issues, such as problems with alcohol that arise during and after deployment."

With high rates of alcohol abuse among soldiers, there is a critical need for targeted interventions to help soldiers handle stressful life events without alcohol, the investigators observe. More than 1.6 million service members have been deployed in support of war efforts Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn.

"Guardsmen who return home need help finding jobs, rebuilding their marriages and families, and reintegrating into their communities," says Karestan Koenen, PhD, Professor of Epidemiology at the Mailman School and senior author of the study. "Too many of our warriors fall through the cracks in our system when they return home. This is particularly true of Guardsmen who do not have the same access to services as regular military personnel. We need to support our soldiers on the home front just as we do in the war zone."

The findings from this study are consistent with two reports the Institute of Medicine released this year, which call attention to the serious mental health issues faced by the military population upon return from Iraq and Afghanistan, and highlight the need for the Department of Defense to develop an evidence base on the effectiveness of prevention and treatment programs targeted at service members and their families. A co-author of the current study, Sandro Galea, MD, DrPH, chair of Epidemiology at the Mailman School, led the Commission that issued one of the reports; Dr. Koenen was a co-author of the same.

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Notes for editors
"Civilian Stressors Associated with Alcohol Use Disorders in the National Guard," by Magdalena Cerdá, Catherine Richards; Greg Cohen; Joseph Calabrese; Israel Liberzon; Marijo Tamburrino; Sandro Galea; Karestan Koenen, is published in the American Journal of Preventive Medicine, online ahead of Volume 47, Issue 5 (November 2014), DOI: http://dx.doi.org/10.1016/j.amepre.2014.06.015.

Funding: Design and conduct of the original study, data collection, management and analysis were supported by grants from the Department of Defense: W81XWH-07-1-0409, W81XWH-08-2-0650, and W81XWH-08-2-0204, as well as a grant from the National Institute of Mental Health: MH 082729. Analysis and interpretation of the data, as well as preparation, review and approval of the manuscript were supported by a grant from the National Institute on Drug Abuse: DA030449 and a grant from the National Institute on Mental Health: MH093612.

Full text of the article is available to credentialed journalists upon request; contact Angela J. Beck at +1 734 764 8775 or ajpmmedia@elsevier.com. Journalists wishing to interview the authors should contact Stephanie Berger at +1 212 305 4372 or sb2247@columbia.edu.

About the American Journal of Preventive Medicine
The American Journal of Preventive Medicine is the official journal of The American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials.
 
The American Journal of Preventive Medicine, with an Impact Factor of 3.945, is ranked 15th out of 158 Public, Environmental, and Occupational Health titles and 18th out of 151 General & Internal Medicine titles according to the 2012 Journal Citation Reports® published by Thomson Reuters.

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