Changes in Alcohol Use and AlcoholRelated Problems in a Large Military Cohort: Prospective Investiga

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Changes in Alcohol Use and Alcohol-Related
Problems in a Large Military Cohort Prospective
Investigation Comparing Pre- and Post-Military
Combat Deployment

• Isabel G Jacobson, MPH
• for the Millennium Cohort Study Team
• US Department of Defense Center for Deployment
  Health Research
• Naval Health Research Center
• 17th Annual AMMA Conference

Jacobson IG, Ryan MAK, Hooper TI, Smith TC,
Amoroso PJ, Boyko EJ, Gackstetter GD, Wells TS,
Bell NS for the Millennium Cohort Study Team.
Alcohol use and alcohol-related problems before
and after military combat deployment. JAMA.
2008300(6)663-75.
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Background

• Studies have reported high rates of mental health
  outcomes post-deployment, including alcohol
  abuse1-3
• Past studies have been limited by the inability
  to control for baseline factors that might
  influence the relationship between deployment and
  alcohol use
• A longitudinal study documenting alcohol use
  before and after deployment would help address
  the research gap

1Hoge, et al, 2006 2Smith, et al, 2008
3Shipherd, et al., 2005
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Background

• The Millennium Cohort Study is a longitudinal
  study designed to evaluate long-term subjective
  health and chronic diagnosed health problems,
  especially in relationship to exposures of
  military concern and deployments
• A stratified random sample of the 2.2M US service
  personnel on duty was selected in Oct 2000
• Participants are re-surveyed at 3-year intervals
  through 2022
• New accession cohorts were added in FY2004 and
  FY2007

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Objectives

• To determine if deployment in support of the wars
  in Iraq and Afghanistan, with and without
  exposure to combat, was associated with changes
  in alcohol consumption, binge drinking, and/or
  alcohol-related problems

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Methods Population and Data Sources
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Alcohol Outcomes

• Heavy Weekly Drinking
• Drinking 14 drinks per week (men) or 7 drinks
  per week (women)
• Potential Binge Drinking
• Drinking 5 drinks on at least one day or
  occasion during the past year, or reporting
  drinking 5 drinks (men) or 4 drinks (women) on
  at least one day of the past week
• Alcohol-Related Problems
• Reporting at least one alcohol-related problem
  happening more than once in in the past year
• Drinking despite health problems, being
  alcohol-impaired while working, missing work due
  to drinking, problems getting along with people
  while drinking, or driving after drinking

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Results
New-Onset Rates of Alcohol Outcomes at Follow-up
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New-Onset Heavy Weekly Drinking,Adjusted Odds in
Multivariable Modeling
Models adjusted for sex, race/ethnicity, service
branch, history of a diagnosed or treated mental
disorder at baseline
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New-Onset Potential Binge Drinking,Adjusted Odds
in Multivariable Modeling
Models adjusted for sex, race/ethnicity, service
branch, history of a diagnosed or treated mental
disorder at baseline
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New-Onset Drinking-Related Problems,Adjusted
Odds in Multivariable Modeling
Models adjusted for sex, race/ethnicity, service
branch, history of a diagnosed or treated mental
disorder at baseline
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Limitations and Strengths

• Nondeployed reference group may not have been
  deployed due to health status, and may have been
  less healthy than our comparison groups,
  potentially biasing results towards the null
• Self-reported data are subject to recall and
  reporting bias
• Military personnel may be hesitant to report
  drinking behaviors for fear of hindering career
  progression
• However, data are drawn from a large cohort,
  including baseline attributes, with enough power
  to detect small differences among subgroups
• Analyses of drinking challenges are strengthened
  by using different metrics (quantity, binge, and
  alcohol-related problems) to capture diverse, but
  related, information

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Conclusions

• Reserve and National Guard personnel deployed
  with combat exposures at increased risk
• Stress of dealing with combat exposures
• Stress due to quickly changing home/work
  environments
• Younger service members at increased risk
• Possibly less resilient
• More likely to engage in risky behaviors
• Those reporting baseline potential alcohol
  dependence were consistently more likely to
  report new-onset drinking problems
• This likely represents return to heavy drinking,
  binge drinking, or other problems among those
  with reported past alcohol problems

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Conclusions and Impact

• These results are the first to prospectively
  quantify changes in alcohol use in relation to
  recent deployments
• These data have been used to inform leadership
  that certain subgroups, such as Reserve and
  National Guard personnel and younger service
  members who deploy to a combat environment may be
  at higher risk for alcohol use after deployment,
  which may lead to increased injury or other
  morbidities

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Acknowledgments
Study Team Isabel Jacobson, MPH Margaret Ryan,
MD, MPH Tomoko Hooper, MD, MPH Tyler Smith, MS,
PhD Paul Amoroso, MD, MPH Edward Boyko, MD,
MPH Gary Gackstetter, DVM, PhD, MPH Timothy
Wells, DVM, PhD, MPH Nicole Bell, ScD, MPH
Millennium Cohort Study Team COL Paul Amoroso
Edward Boyko, MD, MPH Gina Creaven, MBA James
Davies Lacy Farnell Gary
Gackstetter, PhD, DVM, MPH Maj Nisara Granado
Gregory Gray, MD, MPH Gia Gumbs, MPH Lesley
Henry Dennis Hernando Tomoko Hooper, MD, MPH
Isabel Jacobson, MPH Molly Kelton, MS Cynthia
LeardMann, MPH Travis Leleu Jamie McGrew James
Riddle, DVM, MPH
CAPT Margaret Ryan Amber Seelig Besa Smith,
MPH, PhD Tyler Smith, MS, PhD Josh Snell
Katherine Snell Steven Speigle Kari
Welch, MA Col Timothy Wells Martin White, MPH
James
Whitmer Charlene Wong, MPH Additional
Support Scott Seggerman, MS, DMDC COL Carl
Castro Joan Hall, PhD and MAJ Gregory Rule,
MOMRP COL Charles Hoge, WRAIR
Susan Proctor, DSc, USARIEM Anna Bukowinski,
MPH Ava Conlin, DO,
MPH and Carter Sevick, MS, DoD Birth and Infant
Health Registry

LtCol Christopher Phillips, Recruit Assessment
Program

• We are indebted to the Millennium Cohort Study
  members for their continued participation!

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