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Many combat vets turn to alcohol, study says

A new study verifies what physicians, company commanders and mental health workers already knew: Service members who see combat are at higher risk for heavy and binge drinking.

The study, reported in the August edition of the Journal of the American Medicine Association, found that National Guard and Reserve members, troops with a history of post-traumatic stress disorder or depression, and younger service members “are at increased risk of new-onset heavy weekly drinking, binge-drinking and alcohol-related problems.”

But while the statistics sound startling, the study’s definition of “heavy drinking” includes anyone who drinks one glass more per week than the American Heart Association’s definition of “moderation” — one or two drinks a day for men, according to their Web site.

Here are the definitions used in the study:

* Heavy drinking constituted more than 14 drinks a week for men and more than seven drinks a week for women.

* Binge drinking constituted five or more drinks for men and four or more for women per day at least one day a week or at least once in the past year.

* “Alcohol-related problems” included drinking even after a doctor said it was bad for a person’s health; drinking or being hung over while at work, school or other activities; having problems getting along with others while drinking; or driving after drinking. One incident of any of the above meant classification as having an “alcohol-related problem.”

Still, the new research showed an increase in pre- and post-deployment drinking patterns, especially in those who deployed to Iraq or Afghanistan and witnessed combat-related trauma, such as a dying service member or decomposing bodies.

Among reservists who had no alcohol problems prior to deployment and were exposed to combat during deployment, 9 percent were classified as “new onset” heavy drinkers after returning home, while almost 26 percent met the definition of binge drinkers and more than 7 percent had “drinking-related problems.”

Among active-duty troops who had no alcohol problems prior to deployment and who witnessed combat trauma, 6 percent qualified as heavy drinkers after returning home, while 27 percent qualified as binge drinkers and 5 percent developed drinking-related problems.

“New onset” alcohol problems also were an issue for active-duty and reserve component troops who deployed but did not witness combat trauma.

For active-duty members in that category, about 5 percent became heavy drinkers, about 22 percent became binge drinkers and 3 percent developed alcohol-related problems after deployment, according to the study.

Among reservists in that category, almost 6 percent for the study’s definition of “heavy drinker,” more than 19 percent qualified as “binge drinkers,” and more than 3 percent developed alcohol-related problems after deployment.

Paul Rieckhoff, executive director of the advocacy group Iraq and Afghanistan Veterans of America, said the study’s findings on the high risk of alcohol abuse among veterans with combat exposure and young veterans “reflects the tremendous strain these men and women are under.”

“In particular, reserve component troops experience an extremely abrupt transition from the battlefield to their civilian lives,” he said. “They are in Baghdad one week and Brooklyn the next — an incredibly difficult adjustment.”

Researchers from several organizations, including the Uniformed Services University of the Health Sciences, Madigan Army Medical Center, the Veterans Affairs Puget Sound Health Care System, and the Air Force Research Laboratory, wrote that substance abuse is known to be a problem with those who have PTSD and other war-related mental health issues, and that similar issues were reported after Vietnam and Desert Storm.

The researchers theorized that combat vets use alcohol as a coping device, and that because of the corresponding depression and anxiety issues many troops face, they find it harder to control the effects of alcohol.

“Individuals with previous mental health or alcohol problems were at significantly increased risk for changes in drinking behaviors,” researchers wrote.

So they looked at the Millennium Cohort Study, a group of 77,047 randomly selected people who were in the military on Oct. 1, 2000 and completed a baseline survey, to see how alcohol use changed for people after deployment. For this study, researchers did not use anyone who had deployed before the baseline survey.

A follow-up survey included questions about whether the service members had witnessed death because of war, disaster or a tragic event; had seen physical abuse; or had seen dead or decomposing bodies, maimed soldiers or civilians, or prisoners of war or refugees.

The survey also asked if they had been diagnosed with PTSD or depression, or if they had any symptoms.

Then they looked at drinking rates pre- and post-deployment.

Of 48,481 participants, 5,510 deployed and were exposed to combat, 5,661 deployed without seeing combat, and 37,310 did not deploy.

Researchers found that active-duty service members who were exposed to combat had the highest rates of heavy drinking, binge drinking and alcohol-related problems.

A higher rate of women than men reported heavy drinking before and after deploying — possibly due to the stress of preparing to deploy, while men were more likely to binge drink and have alcohol-related problems before and after deploying. The researchers said women tend to use alcohol as a coping mechanism, while men seem more attracted to risk-taking.

People who are young, white, non-Hispanic, Marines and current smokers had the highest rates of all three issues before and after deploying.

Researchers said this was the first study to look specifically at alcohol use before and after deployment.

“This study found a significantly increased risk for new-onset heavy weekly drinking, binge drinking, and other alcohol-related problems among Reserve/Guard personnel deployed with reported combat exposures compared with non-deployed Reserve/Guard personnel,” researchers wrote.

This is a concern because the Defense Department has relied heavily on reserve components during the Iraq and Afghanistan wars, they said.

Another recent study showed that 12 percent of active-duty service members have alcohol problems after deploying, while 15 percent of Guard and Reserve members do.

The JAMA researchers suggested that reserve component service members may have higher rates because they may not be as well-trained or prepared for the added stresses of combat as active components are. They also may lack the unit cohesiveness of active-duty service members, or may not be able to access resources as readily.

The researchers proposed proven drinking intervention programs before, during and after deployment. And, because of the differences between the drinking habits of men and women, those programs should be gender-specific. They also suggested targeting Marines since they appear to be more prone to binge drinking after deployment, as well as developing alcohol problems.

However, they wrote that a stigma still remains in treating mental health, and that though the military has reduced smoking and other drug use, “progress remains slow on reduction in heavy drinking.”

In the future, the researchers plan to look at the long-term effects of combat on alcohol use.