Alcohol abuse in the military: prevention through better screening
By Paul Bartone
One of the biggest problems facing U.S. military forces returning from deployment is alcohol abuse. Abuse of alcohol is devastating to individual lives, while driving up health care costs and degrading the readiness of U.S. forces. In addition, alcohol and substance abuse contribute to a range of other negative outcomes, including family violence and suicide. A study currently underway at the National Defense University seeks to improve screening methods for early identification of troops who may be at risk for stress-related alcohol problems. Effective screening is essential in order to target preventive assistance to those who need it most.
Current screening tools used in the Department of Defense Post Deployment Health Assessment (PDHA) are not sufficiently sensitive, failing to identify many at-risk soldiers. These tools, which ask directly about recent drinking behavior, yield many false-negatives because (1) troops tend to minimize or deny drinking problems for fear of negative repercussions; (2) many young troops with a drinking problem fail to recognize it as such; and (3) access to alcohol is restricted in theater, so those prone to alcohol abuse have no problem behavior to report when they return from deployment. Thus, screening tools that rely on direct questions about drinking behaviors may fail to identify many potential problem drinkers. On the other hand, indirect measures, which assess personal factors associated with alcohol risk, are not vulnerable to these same validity problems.
Psychological hardiness is one potential marker for alcohol risk being evaluated in this research. Hardiness is a measurable human trait composed of commitment, control, and challenge that distinguishes people who remain healthy under stress from those who develop various health and performance problems. Hardiness is also strongly linked to avoidance coping style—the tendency to avoid problems in life rather than working to solve them. In the present study, we measured hardiness, avoidance coping, and alcohol use patterns in U.S. National Guard troops recently returned from deployment to Afghanistan. A companion study looks at the same variables in a large sample of Norwegian defense workers.
Early logistic regression results looking at the first wave of U.S. data show that low hardiness and high avoidance coping predict alcohol abuse for these troops, after controlling for age and combat exposure. Risk of alcohol abuse increases 7 percent for each one-point drop in total hardiness levels (range = 10–43). Avoidance coping also independently predicts alcohol abuse, again controlling for age and combat exposure. In these analyses, combat exposure was not a significant predictor of alcohol abuse. These results were cross-validated in a large sample of Norwegian military personnel, where a similar pattern emerged. Future work will test the utility of hardiness and avoidance coping to predict alcohol abuse in U.S. troops over a longer time frame, seven months after returning from deployment. Results thus far suggest that military alcohol screening programs can be significantly improved by adding brief measures of hardiness and coping style.
Note. COL (Ret.) Paul Bartone is the principal investigator; Kathleen Jocoy is a research associate. Norwegian collaborators include Jarle Eid, Sigurd Hystad, John Brevik, Jon Christian Laberg, and Bjorn Helge Johnsen—all of the University of Bergen. The project is administered by the Henry M. Jackson Foundation for the Advancement of Military Medicine, with funding provided by the Military Operational Medicine Research Program of the U.S. Army Medical Research and Materiel Command.
More detailed results from the Norwegian portion of the study are available in the following article:
Bartone, P. T., Hystad, S. W., Eid, J., & Brevik, J. I. (2012). Psychological hardiness and coping style as risk/resilience factors for alcohol abuse. Military Medicine, 177, 517–524.