Serving Substance Abuse Professionals Since 1993

Last Update: 06.03.12

C O R K O N L I N E

powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Military

53 citations. January 2010 to present

Prepared: March 2012

Alach ZJ. Policing and effects-based operations: Modelling methamphetamine. Policing 33(3): 490-505, 2010. (24 refs.)

Purpose - The aim of this paper is to identify a way by which the concepts of effects-based operations (EBO), an approach to problem solving derived from military thought, might be applied usefully to a law enforcement problem, namely methamphetamine in New Zealand. Design/methodology/approach - The study involved analysis of relevant literature in the fields of EBO and systems thinking to identify the core principles for the modelling stage, followed by a series of semi-structured discussions with subject matter experts to populate the model with relevant and accurate data. Findings - The methamphetamine ecosystem in New Zealand can be modelled using a system-of-systems approach, which is the first stage in a broader EBO approach. The model is complex, involves a broad range of processes, actors, and workflows, and can be constantly enhanced as new information comes to light. Follow-up stages are required to identify potential targeting opportunities, and will be the subject of later articles. Originality/value - This study is the first, or one of the first, to attempt to use the concept of EBO to attack police problems. It is thus highly original, and could be extremely useful to other analysts seeking new ways to conceptualise problems.

Barton CA; McGuire A; Waller M; Treloar SA; McClintock C; McFarlane AC et al. Smoking prevalence, its determinants and short-term health implications in the Australian defence force. Military Medicine 175(4): 267-272, 2010. (30 refs.)

The objectives of this study were to determine the prevalence of smoking, identify the effects of deployment on smoking behavior and risk factors for smoking, and determine the short-term health outcomes associated with smoking in Australian Defence Force (ADF) personnel. Participants were randomly sampled from ADF members who deployed to the Solomon Islands between 2003 and 2005 and from a nondeployed comparison group. In total, 435 of 995 (44%) eligible individuals completed the study questionnaires, The prevalence of current smoking was highest in those who had completed less formal education and those who served in the Navy. Nearly two-thirds (63%) of current or former smokers smoked more while on overseas deployment. Current smokers were more likely to report current wheeze, shortness of breath, and persistent cough compared with nonsmokers. The ADF should continue to address cigarette smoking through its health promotion and health review programs and implement activities to reduce cigarette smoking on deployment.

Blume AW; Schmaling KB; Russell ML. Stress and alcohol use among soldiers assessed at mobilization and demobilization. Military Medicine 175(6): 400-404, 2010. (15 refs.)

Excessive alcohol use may have negative consequences, including less force readiness among military personnel. The identification of variables associated with alcohol use may inform early intervention efforts to decrease negative consequences. This longitudinal prospective study examined the associations of demographic and stress variables with alcohol use among 876 soldiers that were mobilized and demobilized through an Army installation during a 9-month period in 2003. Participants reported a moderate level of general stress at mobilization and demobilization, and a minority reported significant combat stress. Alcohol use in the 2 weeks before the demobilization evaluation was associated with younger age, nonactive duty status before mobilization, and more general stress. Male gender was associated with more drinks per drinking day. The results suggest that younger, nonactive duty male personnel experiencing stress may be a group at risk for increased drinking after deployment and for whom intervention may be helpful.

Bray RM; Brown JM; Pemberton MR; Williams J; Jones SB; Vandermaas-Peeler R. Alcohol use after forced abstinence in basic training among United States Navy and Air Force trainees. Journal of Studies on Alcohol and Drugs 71(1): 15-22, 2010. (23 refs.)

Objective: The present study examined drinking rates of U.S. Navy and Air Force trainees during the month before attending basic training and after the ban on drinking alcohol was lifted during advanced training. Method: Surveys were obtained at five training bases (one US. Navy, four U.S. Air Force) from 6,298 persons for a response rate of 65%. Analyses were based on 4,962 young adults ages 18-25 (82% male) who gave valid responses about pre-basic drinking. Results: Findings showed a rate of 43.1% heavy episodic drinking during the month before basic training, 15.8% by infrequent heavy episodic drinkers (five or more drinks per occasion at least once, four or more for women), and 27.3% by frequent heavy episodic drinkers (five or more drinks per occasion, four or more for women, at least once a week). Pre-basic frequent heavy episodic drinkers averaged 7.9 drinks per occasion and nearly 15 heavy episodic drinking days during the month. In contrast, heavy episodic drinking following basic training was substantially lower: 12.0% for infrequent heavy episodic drinkers and 9.0% for frequent heavy episodic drinkers. Comparisons with the US. Department of Defense Health Related Behaviors Survey suggest that post-basic frequent heavy episodic drinking rates are likely to increase over time but not to pre-basic levels. Pre-basic infrequent and frequent heavy episodic drinkers were more likely than nondrinkers or non-heavy episodic drinkers to initiate or re-initiate frequent heavy episodic drinking. Frequent heavy episodic drinking after basic tended to occur 1-6 weeks after the ban on alcohol use was lifted. Conclusions: Selection and socialization help explain heavy episodic drinking of U.S Navy and US. Air Force trainees.

Brown DW. Smoking prevalence among US veterans. Journal of General Internal Medicine 25(2): 147-149, 2010. (19 refs.)

BACKGROUND/OBJECTIVE: Cigarette smoking is a significant health problem within the US military. Data from the 2003-2007 Behavioral Risk Factor Surveillance System (BRFSS) were used to estimate and compare the prevalence of smoking among US veterans with that of adults who did not serve in the US armed forces. METHODS: Data from the BRFSS, a state-based random-digit dialed telephone survey supported by the Centers for Disease Control and Prevention, were used to estimate the prevalence of current smoking among adults (aged >= 18 years) who reported ever serving on active duty in the United States Armed Forces. We compared, by birth cohort, age-adjusted smoking prevalence among veterans with that of adults who did not serve in the military. RESULTS: A total of 224,169 US veterans participated during 2003-2007. The age-adjusted prevalence of smoking during the period was 27.0% (standard error, 0.36) among veterans and 21% (0.12) among non-veterans. For both groups, the prevalence decreased across years from 29% (0.79) in 2003 to 25% (0.82) in 2007 among veterans and from 23% (0.29) in 2003 to 20% (0.26) in 2007 among non-veterans. Among veterans, smoking prevalence was highest among men born between 1975-1984 (36%; 90%CI=33.7-37.5) and those born between 1985-1989 (37%; 90%CI=31.7-48.2) with lower prevalences among men born between 1945-1954 (26%; 90%CI=25.1-26.3), 1955-1964 (33%; 90%CI= 32.3-34.3), and 1965-1974 (27%; 90%CI=26.0-28.1). The prevalence of smoking was 43% (90%CI=39.0-47.6) among veterans with self-reported coronary heart disease (CHD), greater than that for non-veterans with CHD (31%; 90%CI=28.6-33.1). CONCLUSIONS: Although the prevalence of smoking has declined among US adults, there are opportunities to further reduce smoking among US veterans, particularly young veterans for whom the prevalence of smoking is similar to that of the US adult population during the late 1960s/early 1970s. Continued work is necessary to target the high smoking prevalence among veterans with CHD, a group for which smoking cessation is especially important.

Brown JM; Bray RM; Hartzell MC. A comparison of alcohol use and related problems among women and men in the military. Military Medicine 175(2): 101-107, 2010. (25 refs.)

Using data from the 2002 Department of Defense Survey of Health Related Behaviors, we examined levels of drinking and alcohol-related problems (dependence symptoms, driving alter drinking, productivity loss, serious consequences) for enlisted men and women and male and female officers. Findings showed that men were more likely than women to be heavy Or binge drinkers and to experience alcohol-related problems. Similarly, enlisted men and women were more likely than male and female officers to be heavy or binge drinkers. Driving after drinking was more common among men than women and more common among officers than enlisted personnel. Officers had lower rates of dependence symptoms and other serious consequences than enlisted personnel. Despite men's heavier drinking, women showed equal or higher rates of dependence symptoms and productivity loss and appeared to be at risk for alcohol problems at lower levels of consumption.

Clinton-Sherrod AM; Barrick K; Gibbs DA. Soldier characteristics, alcohol abuse risk, and mental health risk as treatment predictors. Military Psychology 23(1): 22-35, 2011. (42 refs.)

Combat exposure and other factors associated with military service may place soldiers at increased risk of substance use and mental health issues. We examine the importance of soldier characteristics and risk for alcohol abuse and mental health issues in predicting entry into treatment for alcohol abuse and treatment for mental health issues among active duty soldiers (n = 43,342). Results indicated that soldiers were more likely to be referred for mental health issues than alcohol abuse issues and that marital status, race/ethnicity, and pay grade were predictive of the likelihood of entering treatment. We discuss the implications of our findings with regard to the referral and treatment of alcohol abuse and mental health issues within the military environment.

Cowell AJ; Brown JM; Wedehase BJ; Masuda YJ. Costs of using motivational interviewing for problem drinking in the U.S. Air Force. Military Medicine 175(12): 1007-1013, 2010. (40 refs.)

Despite the popularity of motivational interviewing (MI) to address heavy drinking, limited evidence exists on the costs of using MI to address heavy drinking. This study examines the costs of using MI to address heavy drinking at four U.S. Air Force (USAF) bases. Clients were referred to and assessed at a base program to address their drinking as a result of an incident; those who were not alcohol dependent were invited to participate in the study. Participants: consented and were randomly assigned to one of three intervention arms: individual MI (IMI), group MI (GMI), and Substance Abuse Awareness Seminar (SAAS). Three cost perspectives were taken: USAF, client, and the two combined. Data were collected from bases and public sources. The start-up cost per base ranged from $1,340 to $2,400 per provider staff member. Average implementation costs across bases were highest for the SAAS intervention ($148 per client).

de Granda-Orive JI; Lopez-Aguilar JC; Garcia-Rio F; Solano-Reina S; Jimenez-Ruiz CA; Roig-Vazquez F. Changing patterns in tobacco consumption among Spanish military personnel under stressful conditions. Journal of the Royal Army Medical Corps 157(2): 160-163, 2011. (19 refs.)

Objective: A study is made to determine the prevalence of smoking and its variation over time in a group of Spanish military personnel (MP) under stressful conditions. Methods: A questionnaire specifically designed for this study was administered to the entire MP contingent assigned to Banghis province (Afghanistan) between July and October 2009. A descriptive analysis was made (p < 0.05, 95%CI). Results: The study sample comprised 254 MP (males 239; mean age 32 years (SD 9)). A total of 39.8% (95%CI; 33.7 - 45.8) were smokers, while 3.1% (95%CI; 1.0 - 5.3%) were former smokers. Regarding smoking habit before and at the end of deployment, one-half (50.5%) of the smokers declared that they smoked the same as before, 20.8% more than before, and 18.8% less than before. In turn, 5.9% of the smokers claimed to have started to smoke in the course of deployment, while 4% of the former smokers declared that they had quit smoking. The MP who quit smoking were younger than those who began to smoke (24 +/- 5 vs 39 +/- 9 years, p = 0.038). Moreover, the heavy smokers (>= 15 cigarettes/day) reduced tobacco consumption, while the less heavy smokers increased the habit (p < 0.0001). Conclusions: The prevalence of daily smokers is high among MP. The majority of smokers smoke the same at the end of deployment. Those who quit smoking during the mission are significantly younger than those who begin to smoke. In turn, heavy smokers reduced their habit, while less heavy smokers increased smoking.

Ely BR; Ely MR; Cheuvront SN. Marginal effects of a large caffeine dose on heat balance during exercise-heat stress. International Journal of Sport Nutrition and Exercise Metabolism 21(1): 65-70, 2011. (37 refs.)

The use of caffeine supplements in athletic and military populations has increased in recent years. Excessive caffeine consumption in conjunction with exercise in a hot environment may predispose individuals to heat illness. Purpose: To examine heat balance induced by a large dose of caffeine during exercise in a hot environment. Methods: Ten men, not heat acclimated and not habitual caffeine users, consumed either caffeine (CAF; 9 mg/kg) or placebo (PLA) before performing cycle-ergometer exercise for 30 min at 50% VO2peak in a 40 degrees C, 25% relative humidity environment while body temperature (core and skin) and ratings of thermal comfort (TC) were monitored. Heat-exchange variables were calculated using partitional calorimetry and thermometry. Results: Mean body temperature (T-b) was higher (p < .05) with CAF (37.18 +/- 0.15 degrees C) than with PLA (36.93 +/- 0.15 degrees C) at the start of exercise. Heat production was slightly higher (similar to 8 W, p < .05) with CAF. There were no differences in heat storage, dry heat gains, TC, or T-b during exercise. Conclusions: A caffeine dose of 9 mg/kg does not appreciably alter heat balance during work in a hot environment. The small increase in T-b observed with CAF was undetected by the participants and is unlikely to increase physiological strain sufficiently to affect endurance performance or risk of heat illness.

Fear NT; Horn O; Hull L; Murphy D; Jones M; Browne T et al. Smoking among males in the UK Armed Forces: Changes over a seven year period. Preventive Medicine 50(5-6): 282-284, 2010. (9 refs.)

Objectives. We assessed socio-demographic and military factors associated with smoking among males in the UK Armed Forces; made comparisons with the general population; and, tested the hypothesis that smoking has declined in the Armed Forces. Methods. Using data from two cross-sectional studies (conducted in 1998 and 2004), we examined the patterns of smoking among regular male UK Service personnel aged 20-49 years and made comparisons with general population data from England. Scotland and Wales. Results. In 2004, the prevalence of smoking among military males aged 20-49 years was 30% (n = 2276), compared to 33% within the general population. Among current smokers, the mean number of cigarettes smoked per day was 15 for the military and 14 for the general population. The prevalence of smoking has decreased in lower ranks between 1998 and 2004 by 5.1% in 20-24 year olds to 6.3% in 35-49 year olds. These decreases are similar to those seen within those in the routine, manual or intermediate socioeconomic group. Conclusions. Smoking among males in the UK military is associated with similar factors to those in the general population. As these factors are clustered in younger personnel, policies to decrease smoking should be targeted at younger recruits.

Fontana A; Rosenheck R. War zone veterans returning to treatment: Effects of social functioning and psychopathology26. Journal of Nervous and Mental Disease 198(10): 699-707, 2010. (26 refs.)

Patients with mental illness often return for further treatment after an initial episode of care. Two processes that may contribute to the return for further treatment are the severity of patients' initial social and clinical status; and/or deterioration in their status over time, regardless of their initial status. This study examined these processes in an administrative database of war zone veterans who had received outpatient treatment from a Veterans Affairs specialized posttraumatic stress disorder program. The results suggest that both initial severity and deterioration of status contribute to return to treatment and involve changes in both social functioning and psychopathology. Determination of the direction of effects between social functioning and psychopathology showed that psychopathology in the form of PTSD, other Axis I disorder or violent behavior generally affected subsequent social functioning, but not vice versa. Psychopathology in the form of alcohol or drug abuse/dependence, however, showed reciprocal effects with social functioning. These results point to the importance of emphasizing interventions that address social dysfunction and that address psychopathology, from the beginning of treatment as a way of maximizing the benefits and minimizing the need for recurrent care.

Foran HM; Heyman RE; Slep AM; USAF. Hazardous drinking and military community functioning: Identifying mediating risk factors. Journal of Consulting and Clinical Psychology 79(4): 521-532, 2011. (67 refs.)

Objective: Hazardous drinking is a serious societal concern in military populations. Efforts to reduce hazardous drinking among military personnel have been limited in effectiveness. There is a need for a deeper understanding of how community-based prevention models apply to hazardous drinking in the military. Community-wide prevention efforts may be most effective in targeting community functioning (e.g., support from formal agencies, community cohesion) that impacts hazardous drinking via other proximal risk factors. The goal of the current study is to inform community-wide prevention efforts by testing a model of community functioning and mediating risk factors of hazardous drinking among active duty U.S. Air Force personnel. Method: A large, representative survey sample of U.S. Air Force active duty members (N = 52,780) was collected at 82 bases worldwide. Hazardous drinking was assessed with the widely used Alcohol Use Disorders Identification Test (Saunders, Aasland, Babor, de la Fuente, & Grant, 1993). A variety of individual, family, and community measures were also assessed. Structural equation modeling was used to test a hypothesized model of community functioning, mediating risk factors and hazardous drinking. Results: Depressive symptoms, perceived financial stress, and satisfaction with the U.S. Air Force were identified as significant mediators of the link between community functioning and hazardous drinking for men and women. Relationship satisfaction was also identified as a mediator for men. Conclusions: These results provide a framework for further community prevention research and suggest that prevention efforts geared at increasing aspects of community functioning (e. g., the U.S. Air Force Community Capacity model) may indirectly lead to reductions in hazardous drinking through other proximal risk factors.

Foran HM; Slep AMS; Heyman RE. Hazardous alcohol use among active duty Air Force personnel: Identifying unique risk and promotive factors. Psychology of Addictive Behaviors 25(1): 28-40, 2011. (65 refs.)

Hazardous drinking is a significant public health concern and an important target for prevention efforts within both military and civilian populations. For such efforts to be maximally effective, comprehensive information regarding factors that increase or decrease risk for hazardous drinking is necessary. This is the first study to investigate risk and promotive factors across individual, family, community, and organizational levels in a representative sample of Air Force personnel (N = 52,780). Unique predictors of men's and women's hazardous drinking were identified both within and across ecological levels. Predictors that accounted for the most variance in predicting hazardous versus non-hazardous drinkers included family income, number of children, depressive symptoms, religious involvement, and perceived financial stress for men and women; and years in the military for men. Among hazardous drinkers, a different set of predictors best explained variance in severity of drinking problems. Results of the current study help identify key targets for prevention efforts operating at different levels (e.g., individual therapy, community-wide programs).

Freeman MD; Woodruff SI. Incidence and predictors of mental health hospitalizations in a cohort of young US Navy women. Military Medicine 176(5): 524-530, 2011. (41 refs.)

Purpose: This prospective cohort study analyzed hospitalization data over a 7-year period for 5,503 female Navy recruits first assessed in 1996-1997. Methods: Participants' age, education, race/ethnicity, occupation, and traditionality of military occupation were analyzed as predictors of hospitalization for mental health diagnoses occurring 7-8 years after entry into the Navy. Results: 5.2% of women was hospitalized at least once for a mental health disorder over the 7-8 year follow-up period. Thirteen percent of all hospitalizations for the cohort were for mental health reasons. Adjustment reaction/acute stress reaction and personality disorders were the 2 most frequent mental disorders. Asian/Pacific Islanders with more than a high school education and those in the younger age ranges were significantly less likely than others to be hospitalized for a mental disorder. Conclusions: Results underscore that mental health issues among young military women during peacetime are not a trivial source of morbidity.

Gaume J; Gmel G; Faouzi M; Bertholet N; Daeppen JB. Is brief motivational intervention effective in reducing alcohol use among young men voluntarily receiving it? A randomized controlled trial. Alcoholism: Clinical and Experimental Research 35(10): 1822-1830, 2011. (32 refs.)

Background: Heavy drinking is one of the leading causes of morbidity and mortality in young men. Brief motivational intervention (BMI) has shown promising results for young people, but has never been tested in young men in the community who volunteered to receive an intervention. Methods: We evaluated the effectiveness of BMI in reducing alcohol use among heavy episodic users and in maintaining low-risk drinking among nonheavy episodic users. Participants were French-speaking young men attending the mandatory Swiss army conscription process. They were offered the opportunity to receive a 20-minute BMI, and those interested were randomized into an intervention group (BMI immediately) or into a control group (BMI after the 6-month follow-up assessment, in a waiting list design). Analyses were conducted separately for heavy and nonheavy episodic users (separated using baseline heavy episodic use frequency) as the hypotheses tested were different between both groups (primary vs. secondary prevention intervention). Results: From a pool of 6,085 young men invited to receive BMI, 727 (11.9%) showed up and 572 were included in the study (after exclusions related to organizational aspects of the conscription process). Among nonheavy episodic users, there was a protective effect of BMI on weekly alcohol use (p < 0.05). Among heavy episodic users, there were no significant effects of BMI. Conclusions: About 12% of young men were interested in addressing their drinking within the BMI framework, suggesting that there is some need for easily accessible alcohol intervention. The present intervention did have a preventive effect among low-risk young drinkers in helping them maintain their patterns of alcohol use. An explanation for the lack of effectiveness among heavy episodic users might be that those individuals interested in BMI had patterns of more severe alcohol use, thereby making change more difficult.

Gibbs DA; Olmsted KLR; Brown JM; Clinton-Sherrod AM. Dynamics of stigma for alcohol and mental health treatment among army soldiers. Military Psychology 23(1): 36-51, 2011. (23 refs.)

Stigma associated with substance abuse is less understood than stigma of mental health. Moreover, neither issue has been studied in depth within the military. We conducted focus groups with soldiers at six installations to explore how perceptions regarding substance abuse and mental health issues influenced attitudes toward treatment of these issues. Analyses indicate that negative attitudes toward treatment for alcohol abuse are based on their association with infractions that precipitate treatment and acceptance for soldiers with deployment-related mental health issues. However, the military context appears to moderate the influence of perceived responsibility and danger on stigmatization. Our data suggest several strategies that may useful in reducing stigma associated with alcohol abuse treatment in the military.

Gore RK; Webb TS; Hermes EDA. Fatigue and stimulant use in military fighter aircrew during combat operations. Aviation, Space, and Environmental Medicine 81(8): 719-727, 2010. (24 refs.)

Introduction: Fatigue in military aviation is a significant safety and operational problem resulting in diminished alertness and performance. Research demonstrates that stimulant medications maintain alertness and performance in sleep-deprived aircrew. However, these studies control many of the variables present during combat operations. Few studies have evaluated fatigue or the factors and effects associated with stimulant use in fighter aircrew during combat operations. Methods: The study consisted of three questionnaires administered to 29 deployed F-15E aircrew participants. An initial questionnaire compiled demographic and sleep behavior data. Pre- and postflight questionnaires for each sortie collected substance use, fatigue, and physical symptoms data. Regression analysis identified variables associated with in-flight stimulant use. Results: Surveys were completed for 111 sorties averaging 7.6 h in duration. Stimulants were used on 35% of sorties an average of 2.8 h after takeoff. Stimulant use was associated with a decrease in in-flight and postflight fatigue without significant differences in postflight symptoms. Sorties airborne during the circadian trough, longer sortie durations, and preflight hypnotic use displayed statistically significant associations with in-flight stimulant use. Conclusions: In-flight stimulants decrease fatigue during combat operations without significant postflight symptoms. During combat, stimulants were used earlier, at lower doses, and on shorter sorties than previously thought. The factors associated with stimulant use are potentially modifiable by improving training and aircrew scheduling practices. Furthermore, current policies authorizing stimulant use, based primarily on sortie duration, should also consider hypnotic use, inconsistent aircrew scheduling, and circadian disruption.

Grier T; Knapik JJ; Canada S; Canham-Chervak M; Jones BH. Tobacco use prevalence and factors associated with tobacco use in new US army personnel. Journal of Addictive Diseases 29(3): 284-293, 2010. (41 refs.)

This study examined the prevalence of tobacco use and factors associated with pre-military service cigarette and smokeless tobacco use. From January 2000 to December 2006, military students arriving for Advanced Individual Training at the U.S. Army Ordnance School completed a questionnaire that asked about their use of tobacco products. The prevalence of smokeless tobacco use from 2000 to 2006 for women generally decreased, as did the number of cigarettes smoked per day by men. For men and women, factors associated with cigarette use included younger age, Caucasian race, and use of smokeless tobacco. Factors associated with smokeless tobacco use among men included younger age, Caucasian race, and cigarette use. For women, cigarette use was the only factor associated with smokeless tobacco use. The identified factors in this study could be used to establish strategies in the future to reduce tobacco use in the military.

Grier TL; Morrison S; Knapik JJ; Canham-Chervak M; Jones BH. Risk factors for injuries in the U.S. Army Ordnance School. Military Medicine 176(11): 1292-1299, 2011. (40 refs.)

Objective: To investigate risk factors for time-loss injuries among soldiers attending U.S. Army Ordnance School Advanced Individual Training. Methods: Injuries were obtained from an injury surveillance system. A health questionnaire provided data on age, race, rank, current self-reported injury and illness, and tobacco use. Fitness data was obtained from operations office. Results: Cumulative time-loss injury incidence was 31% for men and 54% for women. For men, higher risk of injury was associated with race, a current self-reported injury, smoking before entering the Army, lower sit-up performance, and slower 2-mile run times. For women, higher risk of injury was associated with race, a current self-reported injury, and slower 2-mile run times. Conclusion: Smoking cessation and fitness training before entry are potential strategies to reduce injuries among soldiers in the Ordnance School.

Heltemes KJ; Dougherty AL; MacGregor AJ; Galameau MR. Alcohol abuse disorders among US service members with mild traumatic brain injury. Military Medicine 176(2): 147-150, 2011. (34 refs.)

Traumatic brain injury (TBI) has emerged as a preeminent injury in Iraq and Afghanistan. The relationship between TBI and post-injury alcohol use in military personnel has not been clearly defined. The aim of this study was to examine the prevalence of alcohol abuse disorders among combat-injured service members with mild TB! (MTBI). Male U.S. service members with combat injuries were identified from the Expeditionary Medical Encounter Database (n = 3,123). Diagnoses of alcohol abuse disorders were collected from the standard inpatient and ambulatory data records. Overall, a slightly higher proportion of service members with MTBI were diagnosed with an alcohol abuse disorder compared to those with other injury (6.1% vs. 4.9%). In a multivariate analysis, however, it was found that MTBI was not associated with higher levels of alcohol abuse (odds ratio, 1.24; 95% confidence interval, 0.90, 1.70). To better define the consequences of MTBI, future research should include other alcohol dependency measures along with comorbid mental health disorders.

Hoffman KM; Poston WSC; Jitnarin N; Jahnke SA; Hughey J; Lando HA et al. A content analysis of tobacco control policy in the US Department of Defense. Journal of Public Health Policy 32(3): 334-349, 2011. (32 refs.)

We conducted a content analysis of the US military tobacco policies at the Department of Defense, each respective military service (Army, Air Force, Navy, and Marine Corps), and their Major Commands (MAJCOM). Ninety-seven policies were evaluated using the Military Tobacco Policy Rating Form (MTPRF). More than three quarters addressed the following domains: (1) deleterious health effects of tobacco use; (2) environmental tobacco smoke; (3) designation of smoking areas; (4) tobacco prevention/cessation programs; and (5) smokeless tobacco. Few policies (21 per cent) mentioned relevant Department of Defense and respective service tobacco use prevalence statistics. Smoking as non-normative or incompatible with military service, the impact of tobacco use on military readiness, and the tobacco industry were addressed infrequently (6.2. per cent, 33.0 per cent, and 8.2 per cent, respectively). Future military tobacco policies should address important omissions of critical information such as the current service tobacco use prevalence, effects on readiness, and smoking as non-normative.

Jahnke SA; Haddock CK; Poston WSC; Hoffman KM; Hughey J; Lando HA. A qualitative analysis of the tobacco control climate in the US military. Nicotine & Tobacco Research 12(2): 88-95, 2010. (27 refs.)

Introduction: Rates of tobacco use in the U.S. military have traditionally been higher than in the general U.S. population. While the military has experienced decreases in tobacco use over the past two decades, recent surveys suggest a trend of increased use. Given the negative impact of tobacco on both the readiness and the long-term health of military members, it is important to understand what factors may be related to the increased use rates. It has been suggested that there is a culture that supports tobacco use in the military. Methods: We examined perceptions about the climate of tobacco control among military installation Tobacco Control Managers and Service Policy Leaders from all four branches of the military (n = 52) using semistructured interviews. Results: The primary strength of the military's tobacco control program, according to the participants, was mandating the provision of treatment services on every military installation. Any military member can receive both counseling and pharmacotherapy for tobacco. Opinions vary on the most promising new strategies for tobacco control. Many have pushed for a completely tobacco-free Department of Defense, including requiring troops to be tobacco-free and banning tobacco sales on military installations. However, a number of tobacco control experts within the military worry about unintended consequences of a complete ban. Discussion: While several benefits of the current tobacco control program were identified, opportunities for improvement were identified at both the installation and service level.

Jones E; Fear NT. Alcohol use and misuse within the military: A review. (review). International Review of Psychiatry 23(2): 166- 172, 2011. (49 refs.)

Traditionally alcohol has been used by the military to cope with the intense stress of battle but also as a way of mediating the transition from the heightened experience of combat to routine safety. The use of alcohol has divided medical opinion. Some doctors viewed it as wholly harmful to both social and occupational function and to health, while others argued that alcohol had a specific role in lifting morale, aiding unit cohesion and protecting soldiers from adjustment disorders. Although alcoholism has always been identified as incompatible with military service, the effects of habitual heavy drinking among military personnel are less well understood. Recent studies have suggested that young single males and those who have undergone particularly stressful experiences are at greatest risk of misusing alcohol. These associations, observed in the aftermath of recent conflicts in Iraq and Afghanistan, have again raised questions about the place of alcohol in military culture.

Klesges RC; Mittleman DS; Ebbert JO; Talcott GW; Debon M. Tobacco use harm reduction, elimination, and escalation in a large military cohort. American Journal of Public Health 100(12): 2487-2492, 2010. (30 refs.)

Objectives: We evaluated changing patterns of tobacco use following a period of forced tobacco abstinence in a US military cohort to determine rates of harm elimination (e g tobacco cessation) harm reduction (e g from smoking to smokeless tobacco use) and harm escalation (e g from smoking to dual use or from smokeless tobacco use to smoking or dual use). Methods: Participants were 5225 Air Force airmen assigned to the health education control condition in a smoking cessation and prevention trial. Tobacco use was assessed by self report at baseline and 12 months. Results: Among 114 baseline smokers initiating smokeless tobacco use after basic military training most demonstrated harm escalation (87%) which was 54 times more likely to occur than was harm reduction (e g smoking to smokeless tobacco use). Harm reduction was predicted in part by higher family income and belief that switching from cigarettes to smokeless tobacco is beneficial to health. Harm escalation predictors included younger age, alcohol use, longer smoking history and risk taking. Conclusions: When considering a harm reduction strategy with smokeless tobacco the tobacco control community should balance anticipated benefits of haim reduction with the risk of harm escalation and the potential for adversely affecting public health.

Kuzmarov J. The Myth of the Addicted Army: Vietnam and the Modern War on Drugs.. Amherst MA: University of Massachusetts Press, 2009

This book addresses the image of the drug-addicted American soldier disheveled, glassy-eyed, his uniform adorned with slogans of antiwar dissent has long been associated with the Vietnam War. More specifically, it has persisted as an explanation for the U.S. defeat, the symbol of a demoralized army incapable of carrying out its military mission. The author documents that many popular assumptions about drug use in Vietnam are based more on myth than fact. Alcohol the intoxicant of choice for most GIs, and the prevalence of other drugs was quite varied. Marijuana use among troops increased over the course of the war, but was largely was confined to rear areas. The use of highly addictive drugs like heroin was never as widespread as suggested. The book says that similar to other cultural myths that emerged from the war, the concept of an addicted army was first advanced by war hawks seeking a scapegoat for the failure of U.S. policies in Vietnam. In this instance this failure to seen as linked to permissive liberal social policies and the excesses of the counterculture. Ironically, some in antiwar movement also promoted the myth, based on the belief that there was an alliance between Asian drug traffickers and the Central Intelligence Agency. This claim was not without foundation, but the book demonstrates from archival evidence that the left exaggerated the scope of addiction for its own political purposes. Drawing upon the bipartisan concern over the perceived drug crisis, the Nixon administration in the early 1970s launched a bold new program of federal antidrug measures, especially in the international realm. Initially, the War on Drugs helped divert attention away from the failed quest for peace with honor in Southeast Asia. But once institutionalized, it continued to influence political discourse as well as U.S. drug policy in the decades that followed.

Maani CV; DeSocio PA; Jansen RK; Merrell JD; McGhee LL; Young A et al. Use of ultra rapid opioid detoxification in the treatment of us military burn casualties. Journal of Trauma, Injury, Infection and Critical Care 71(supplement 1): S114-S119, 2011. (18 refs.)

Background: The purpose of this case series was to review the management of burn patients who requested ultrarapid opioid detoxification under anesthesia after extended duration of narcotic use for chronic pain related to burn injury. Methods: The treatment plan of six opioid-dependent burn patients was analyzed to assess the effectiveness of our detoxification practice to date. Demographic and clinical information was used to characterize the patient population served: age, burn size, injury severity, duration of narcotic use before detoxification intervention, and length of hospitalization stay. Daily narcotic consumption, in morphine equivalent units, was noted both before and after detoxification. Results: Six burn patients (average age, 31 years) underwent detoxification at the Burn Center during a hospitalization lasting between 1 day and 2 days. Average burn size was 38% total body surface area (range, 17-65); average Injury Severity Score was 30 (range, 25-38). Mean duration of narcotic use was 672 days (range, 239-1,156 days); average use of narcotics at time of detoxification was >200 units daily. Mean outpatient consumption for opioids after the intervention was minimal (<25 units/d). No complications were noted during any procedures. Conclusions: The results of ultrarapid opioid detoxification under anesthesia suggests that it is safe and effective for treating opioid addiction in military burn casualties when a coordinated, multidisciplinary approach is used. Safety and effectiveness to date validate current practice and supports incorporation into clinical practice guidelines. Further clinical research is warranted to identify those patients who may benefit most from detoxification and to determine the timing of such treatment.

Mansfield AJ; Bender RH; Hourani LL; Larson GE. Suicidal or self-harming ideation in military personnel transitioning to civilian life. Suicide and Life-Threatening Behavior 41(4): 392-405, 2011. (71 refs.)

Suicides have markedly increased among military personnel in recent years. We used path analysis to examine factors associated with suicidal/self-harming ideation among male Navy and Marine Corps personnel transitioning to civilian life. Roughly 7% of men (Sailors = 5.3%, Marines = 9.0%) reported ideation during the previous 30 days. Results suggest that combat exposure, substance abuse, and resilience are associated with suicidal ideation/self-harming thoughts through the mediation of posttraumatic stress disorder symptoms and/or depression symptoms. Substance abuse plays a moderating role. Resilience had a direct effect only among the Marines. Implications for improving the transition to civilian life are discussed.

Marimoutou C; Queyriaux B; Michel R; Verret C; Haus-Cheymol R; Mayet A et al. Survey of alcohol, tobacco, and cannabis use in the French Army. Journal of Addictive Diseases 29(1): 98-106, 2010. (26 refs.)

The aim of the current study is to describe the consumption rate of alcohol, tobacco, and cannabis in the French Army. A cross-sectional two strata randomized survey was performed between October 2006 and March 2007 using self-report questionnaires (n = 990) to collect individual characteristics, consumption, and addictive behaviors with urinal tests for cannabis (n = 985). The surveyed sample comprised 59% privates, 26% non-commissioned officers, and 6% officers, was predominantly male (89%) and young (median age: 29 years), and had a low level of education (60% attended secondary school). The consumption rate was high: 54.1% were active tobacco smokers, 56.0% were heavy drinkers, 20.5% declared drunkenness more than once per month, 52.6% at least experienced cannabis while 12.3% were occasional users, 8.2% were regular users, and 15.0% displayed multi-risk behaviors. Consumption was higher in the younger age (18 to 25 years) and lower educational group, leading to a high prevalence among privates and suggesting an "army effect." However, large scale behavioral social studies may help distinguish between personal and peer effect among the targeted population.

Martin SL; Gibbs DA; Johnson RE; Sullivan K; Clinton-Sherrod M; Walters JLH et al. Substance use by soldiers who abuse their spouses. Violence Against Women 16(11): 1295-1310, 2010. (35 refs.)

Data on 7,424 soldier spouse abuse offenders were analyzed to determine the prevalence of substance use during abusive incidents, and to examine differences between substance-using and non-substance-using offenders. Results showed that 25% of all offenders used substances during abusive incidents, with males and non-Hispanic Whites being more likely to have used substances. Substance-using offenders were more likely to perpetrate physical spouse abuse and more severe spouse abuse. These findings underscore the importance of educating military personnel (including commanders) about links between substance use and domestic violence, and of coordinating preventive and therapeutic substance abuse and violence-related interventions.

Mattiko MJ; Olmsted KLR; Brown JM; Bray RM. Alcohol use and negative consequences among active duty military personnel. Addictive Behaviors 36(6, special issue): 608- 614, 2011. (22 refs.)

Aims: An examination of alcohol use patterns in the active duty military to determine the relations of drinking levels and self-reported negative outcomes. Design:: A population-based cross-sectional study design using two-stage complex sampling methodology. Setting: Paper and pencil surveys were administered anonymously in groups at 64 U.S. military installations worldwide. Participants: Randomly selected active duty members (28,546) at major military installations representing the total active force, with the exception of recruits, cadets, and incarcerated personnel. Measures: Personnel were classified into five drinking levels ranging from abstainer to heavy drinker based on quantity and frequency of alcohol intake. Negative outcomes were measured as self-reported serious consequences of alcohol use and alcohol-related productivity loss. Risk for other alcohol related problems was assessed by the Alcohol Use Disorders Identification Test (AUDIT). Findings: Alcohol negative outcomes showed a curvilinear dose-response relationship with drinking levels. Higher levels of drinking were associated with higher rates of alcohol problems, but problem rates were notably higher for heavy drinkers. Heavy alcohol users showed nearly three times the rate of self-reported serious consequences and over twice the rate of self-reported productivity loss than moderate/heavy drinkers. Heavy drinkers also had the highest risk for alcohol problems on the AUDIT. One fifth of military personnel were heavy drinkers and were most likely aged 18 to 35. Conclusions: Prevention and clinical interventions should include a major focus on heavy drinkers. Commanders and peers should be trained in recognizing signs of heavy alcohol use and in approaching heavy alcohol users in a way that will foster positive attitudes as opposed to defensiveness and stigma.

Mc Carthy PM; O'Sullivan D. Efficacy of a brief cognitive behavioral therapy program to reduce excessive drinking behavior among new recruits entering the Irish navy: A pilot evaluation. Military Medicine 175(11): 841-846, 2010. (28 refs.)

This pilot study evaluated the efficacy of a brief cognitive behavioral therapy (CBT) intervention program designed to reduce excessive pre-enlistment drinking behaviors in a sample of Irish Navy recruits undergoing a 16-week basic training course. Participants were randomly allocated to either a treatment (TG) or control group (CG) (N = 13 each). The program was conducted over four consecutive 1.5-hour weekly sessions. Data were collected at pre and post intervention as well as at a 2-month follow-up. In comparison to those in the control group, participants who received the intervention reported increased scores (p < 0.05) in readiness to change drinking at time 2 and reduced scores in binge drinking (p < 0.05) at time 3. There were also marginal changes in self-efficacy and risky drinking behavior. This work adds to the evidence of the emerging efficacy of a workplace CBT intervention for unhealthy drinking.

McClellan SF; Olde BA; Freeman DH; Mann WF; Rotruck JR. Smokeless tobacco use among military flight personnel: A survey of 543 aviators. Aviation, Space, and Environmental Medicine 81(6): 575-580, 2010. (20 refs.)

Introduction: Although there has been a steady decline in smoking rates among adults in the United States in recent years, the consumption of smokeless tobacco (ST) continues to increase. Moreover, ST use in the U.S. military is far higher than in the general population. This study was designed to determine the extent of ST use in a military aviation population and measure users' attitudes toward elements of a proposed cessation program. Methods: A study was conducted at two naval aviation training wings in western Florida. The target population (N = 2233) included flight instructors, students, and staff/support personnel who were rated aviators or flight officers. A total of 543 usable questionnaires were returned, yielding a response rate of 24.3%. Results: There were 71 respondents who reported using ST in the last 30 d (13.1%). This group responded favorably to questions regarding the involvement of both medical and dental health professionals as critical components of an effective ST cessation program. Discussion: This survey provides evidence for a rate of ST use among military aviators that is much higher than the U.S. national civilian average of 3.5%. Drawing upon the background of previous dental health-based studies, we propose augmenting existing tobacco cessation resources by creating separate ST cessation programs to reduce ST use among U.S. military aviators.

Meis LA; Erbes CR; Polusny MA; Compton js. Intimate relationships among returning soldiers: The mediating and moderating roles of negative emotionality, PTSD symptoms, and alcohol problems. Journal of Traumatic Stress 23(5): 564-572, 2010. (55 refs.)

Research examining relationship quality among combat veterans largely focuses on the role of posttraumatic stress disorder (PTSD), with less attention devoted to other correlates of PTSD and relationship quality, such as personality and problematic drinking. In a sample of combat-exposed National Guard soldiers recently returned from Iraq (N = 308), we examined (a) a meditational pathway from negative emotionality, to elevated postdeployment PTSD symptoms, to poorer relationship quality; and (b) the moderating role of problematic drinking. Moderated mediation regression strategies supported the mediating role of postdeployment PTSD symptoms, but not the moderating role of problematic drinking on soldiers' relationship quality. Findings suggest negative emotionality creates a vulnerability to more severe early postdeployment PTSD symptoms and poorer early postdeployment relationship quality.

Najavits LM; Norman SB; Kivlahan D; Kosten TR. Improving PTSD/substance abuse treatment in the VA: A survey of providers. American Journal on Addictions 19(3): 257-263, 2010. (23 refs.)

We surveyed 205 Veterans Affairs (VA) staff on treatment of posttraumatic stress disorder (PTSD), substance use disorder (SUD), and the combination (PTSD/SUD). The survey was anonymous and VA-wide. PTSD/SUD was perceived as more difficult to treat than either disorder alone; gratification in the work was stronger than difficulty (for PTSD, SUD, and PTSD/SUD); and difficulty and gratification appeared separate constructs. Respondents endorsed views that represent expert treatment for the comorbidity; however, there was also endorsement of "myths." Thus, there is a need for more training, policy clarifications, service integration, and adaptations for veterans returning from Iraq and Afghanistan. Limitations are described.

Offen N; Arvey SR; Smith EA; Malone RE. Forcing the Navy to sell cigarettes on ships: How the tobacco industry and politicians torpedoed navy tobacco control. American Journal of Public Health 101(3): 404-411, 2011. (32 refs.)

In 1986, the US Navy announced the goal of becoming smoke-free by 2000. However, efforts to restrict tobacco sales and use aboard the USS Roosevelt prompted tobacco industry lobbyists to persuade their allies in Congress to legislate that all naval ships must sell tobacco. Congress also removed control of ships' stores from the Navy. By 1993, the Navy abandoned its smoke-free goal entirely and promised smokers a place to smoke on all ships. Congressional complicity in promoting the agenda of the tobacco industry thwarted the Navy's efforts to achieve a healthy military workforce. Because of military lobbying constraints, civilian pressure on Congress may be necessary to establish effective tobacco control policies in the armed forces.

Olmsted KLR; Bray RM; Guzman CMR; Williams J; Kruger H. Overlap in use of different types of tobacco among active duty military personnel. Nicotine & Tobacco Research 13(8): 691-698, 2011. (19 refs.)

Objective: To describe the prevalence and overlapping combinations in past thirty-day cigarette use, smokeless tobacco use, and cigar use in the active duty U.S. military. Methods: Data were taken from the 2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel. A total of 28,546 service members participated for a response rate of 70.6%. Results: Analyses showed that 41.2% of active duty service members used one or more forms of tobacco in the past month. Cigarette use only was most prevalent (21.3%); other combinations were much lower ranging from 0.7% to 13.5%. Multinomial regression modeling yielded no consistent patterns in sociodemographic groups with higher risk of using one or more types of tobacco concurrently. Frequency and quantity of cigarette use were related to tobacco use patterns. From 60% to 67% of smokers were daily users of cigarettes only or cigarettes in combination with other tobacco types. The majority of cigarette users (54%-69%) smoked 15 or fewer cigarettes/day regardless of tobacco use patterns, but those who smoked at heaviest levels were most likely to use all 3 tobacco types (19%). Conclusions: Four of 10 service members place themselves at increased risk of tobacco-related illness and disease by using one or more types of tobacco. Daily cigarette smokers and very heavy smokers are at highest risk of using multiple tobacco types. Further research is needed to better understand the levels of use and the reasons for use of multiple types of tobacco.

Poston WSC; Suminski RR; Hoffman KM; Jitnarin N; Hughey J; Lando HA et al. Military line leadership and tobacco control: Perspectives of military policy leaders and tobacco control managers. Military Medicine 175(10): 811-816, 2010. (29 refs.)

Despite progress in policy changes, tobacco use rates are still high in the military. Little is known about the views of those who create and implement tobacco control policies within the Department of Defense. These individuals determine what policy initiatives will be developed, prioritized, and implemented. We conducted key informant interviews with 16 service-level policy leaders (PLs) and 36 installation-level tobacco control managers (TCMs). PLs and TCMs believed that line leadership view tobacco control as a low priority that has minimal impact on successful mission completion. They also identified cultural factors that perpetuate tobacco use, such as low cost and easy accessibility to tobacco, smoke breaks, and uneven or unknown enforcement of current tobacco policies.

Ramchand R; Miles J; Schell T; Jaycox L; Marshall GN; Tanielian T. Prevalence and correlates of drinking behaviors among previously deployed military and matched civilian populations. Military Psychology 23(1): 6-21, 2011. (46 refs.)

We examined drinking behaviors (frequency of use, quantity of use, and frequency of binge drinking) and correlates of frequency of use and binge drinking in a representative sample of previously deployed personnel from the U. S. military (n = 1,887). Drinking behaviors were compared with a matched sample of adults in U. S. households (n = 17,533). Comparable patterns of alcohol consumption were reported in both samples: 70% of previously deployed personnel and 69% of U. S. adults reported drinking alcohol in the past 30 days, though civilians drank on average more drinks on the days that they drank than did previously deployed military personnel. Regression analyses indicated that, among previously deployed military personnel, deployment-related experiences (e.g., combat-related traumas) and psychological distress (e.g., symptoms associated with posttraumatic stress disorder) were associated with frequency of drinking behaviors. We discuss the implication of our findings for developing interventions to modify drinking behaviors for military personnel.

Rasmussen N. Medical science and the military: The allies' use of amphetamine during World War II. Journal of Interdisciplinary History 42(2): 205-233, 2011. (114 refs.)

Although amphetamine was thoroughly tested by leading scientists for its effects in boosting or maintaining physical and mental performance in fatigued subjects, the results never provided solid grounds for approving the drug's use, and, in any case, came too late to be decisive. The grounds on which amphetamine was actually adopted by both British and American militaries had less to do with the science of fatigue than with the drug's mood-altering effects, as judged by military men. It increased confidence and aggression, and elevated "morale."

Reisen CA; Bianchi FT; Cohen-Blair H; Liappis AP; Poppen PJ; Zea MC et al. Present and past influences on current smoking among Hiv-positive male veterans. Nicotine & Tobacco Research 13(8): 638-645, 2011. (52 refs.)

Introduction: Cigarette smoking has become an important influence of morbidity and mortality for HIV-positive individuals in the era of highly active antiretroviral therapy. Although smoking is common among military personnel and veterans, the lasting impact of military service on smoking at a later stage of life has not been examined. The current study investigated present and past influences on current smoking among HIV-positive male veterans. Methods: Participants were 200 HIV-positive men served by the Veterans Affairs Medical Center. A survey was administered via audio-enhanced computer-assisted self-interview, and additional information was extracted from the computerized patient record system. Results: Logistic regression was performed to test hypotheses concerning the participants' current situations as well as characteristics of their past military service. Having smokers in one's environment, being more depressed, and having used alcohol or drugs were associated with having smoked in the previous 30 days, whereas stronger endorsement of attitudes stating adverse effects of smoking was linked to lower likelihood of smoking. Neither having been in a military conflict nor the length of the military service was significantly related to current smoking. Conclusions: Remote experiences in the military did not have a sustained effect on smoking behavior years later. Implications of this study for the development of smoking cessation programs targeting HIV-positive veterans include the importance of altering attitudes about tobacco, treating underlying depression, addressing social influence, decreasing substance use, and increasing awareness of the heightened vulnerability to a variety of negative consequences of smoking among infected individuals.

Rigod V; Pilard M; Paul F; Deparis X; Marimoutou C. Alcohol and cannabis consumption in the French Army: Determination of consumer profiles to focus on prevention and care. Military Medicine 176(7): 805-810, 2011. (28 refs.)

Objective: To ascertain the different profiles of alcohol and cannabis consumers in the French Army to improve prevention measures. Method: A representative sample of 990 French Army staff filled in self-questionnaires in 2006. A multiple correspondence analysis identified associations between consumption and consumer profiles. Results: The multiple correspondence analysis found three main consumer profiles: non-consumers (women and officers), moderate consumers (non-commissioned officers >30-years old, single parents with children), and occasional multi-consumers (18-25-years-old enlisted males, who occasionally consumed cannabis and high levels of alcohol, also tobacco-addicts). Two minor profiles emerged: daily alcohol drinkers (men, >= 30 years) and regular dependent cannabis users (identical profile to multi-consumers). Conclusion: Our results favor targeting the youngest to prevent the risks of high alcohol intake and cannabis consumption and addiction linked to repeated binge drinking. Systematic questionnaires on consumption habits and addiction self-evaluations during medical consultations could lead to early care.

Robins LN; Helzer JE; Hesselbrock M; Wish E. Vietnam Veterans three years after Vietnam: How our study changed our view of heroin. American Journal on Addictions 19(3): 203-211, 2010. (3 refs.)

This is a reprint of a paper originally published in 1977, in the Proceedings of the Thirty-Ninth Annual Scientific Meeting of the Committee on Problems of Drug Dependence. It is a seminal article based on follow-up of Vietnam Veterans who tested positive for heroin use upon their return from Vietnam. A number of the findings were wholly unexpected, such as the ease of ceasing heroin use without treatment and without signficant problems. The conclusion was that in late 1974 was no more likely to be used regularly or daily if used at all than were marijuana or amphetamines. It was more likely to be used regularly than other narcotics and other non-narcotic drugs. As compared with marijuana and amphetamines, what is distinctive about heroin is not its liability for daily use, but the fact that daily users perceive themselves as dependent. Despite their dependence, they manage to quit use much more often than anyone would have guessed and can often even return to use without becoming dependent again. Heroin users are polydrug users of an extreme kind, who use a greater variety of other drugs than do less regular heroin users. People who use heroin are highly disposed to have serious social problems even before they touch heroin. Heroin probably accounts for some of the problems they have if it is used regularly, but heroin is "worse" than amphetamines or barbiturates only because worse people use it. What are the policy implications of our findings? It would seem that our society has overemphasized the importance of treatment for heroin per se, failing to pay attention to the multiple other problems that heroin addicts have. Heroin addicts are deeply involved with a great variety of other drugs at the same time they are involved with heroin, and they have all kinds of social adjustment difficulties that are not entirely attributable to heroin. It is small wonder that our treatment results have not been more impressive, when they have focused so narrowly on only one part of the problem.

Schiff M; Levit S; Schori M; Lawental E. Anxiety symptoms and need for help among Israeli methadone patients in a war zone. Journal of Loss & Trauma 16(2): 135-149, 2011. (49 refs.)

This study examined the levels of Israeli methadone patients' distress and need for help from methadone staff following exposure to war events. At the end of the war in the Gaza strip, 102 patients (67.7% males) were interviewed on the extent of their exposure to war events, anxiety, and perceived need for help. Illicit drug use postwar was assessed by urine test results. Findings revealed that patients' perceived need for help was associated with their acute anxiety level and later illicit drug use. Therefore, self-reported need for help may serve as a screening tool for vulnerable populations following exposure to war or other disasters.

Selic P; Serec M; Petek D; Rus-Makovec M. Intra-and inter-personal factors of psychosocial status in Slovenian military personnel with regard to their traumatic event experience. Zdravstveno Varstvo 50(3): 201-211, 2011. (34 refs.)

Problem: The main objectives of this study were to identify differences in the psychosocial status of military personnel who had and who had no traumatic event experience, and to screen for potential mental health vulnerability related to post-traumatic stress. Methods: 390 military personnel were included in the study, with 103 of them reporting traumatic event experience. The Mini-International Neuropsychiatric Interview Screening for Post-Traumatic Stress Disorder, the CAGE instrument, the Eysenck Personality Scales, the Folkman-Lazarus Ways of Coping Questionnaire, the Rosenberg Self-Esteem scale and self-evaluative questions about important relationships were administered. Results: The respondents who reported traumatic event experience (TEE) also reported a significantly higher frequency of other stressful events, a significantly more frequent past history of depression (16.5 % of respondents with TEE and 6.2 % of respondents without TEE) and significantly higher risky alcohol drinking; the latter, however, is not higher than the estimate for the total Slovenian population (10.7 % of respondents with TEE and 2.7 % of participants without TEE). Respondents with TEE smoke less frequently than respondents who reported no TEE (46.6 % vs. 60.1 %), and more often rely on self in stressful situations. There was no significant difference between the respondents with reported TEE and those without TEE in their personality traits, coping styles, and self-esteem, or in the majority of job-and family-related factors. No difference was found between male and female personnel as concerns intra-personal factors and in stress-related behaviour. Conclusions: Intra-personal factors (personality, coping styles, and self-esteem) of military personnel indicate good personal potential for resilience. Stress-related substance (ab) use, especially smoking rates well above the Slovenian average, need further attention. Professional support needs to be promoted, especially in female personnel, who are less likely than men to seek social support in times of stress, and in military personnel exposed to cumulative stressors.

Shah AN; Arnold MJ. The clinical implications of a smoking ban on submarines in the U.S. Navy. Military Medicine 176(2): 222-227, 2011. (36 refs.)

By the end of calendar year 2010, a total smoking ban on submarines is expected to be implemented throughout the submarine force because of the negative health effects of environmental tobacco smoke and the recently demonstrated exposure of nonsmoking submariners to measurable levels of nicotine during submarine deployments. Historically, smoking has been highly prevalent in the military, but new data on the negative health effects of tobacco have led the military to change its policies, restricting its use in certain environments. A number of research studies have examined the effect of smoking on the military, cessation and prevention interventions, effect of environmental tobacco smoke onboard the submarine, and treatment modalities aimed at smokers attempting to quit. With the potential for considerable physical and psychological effects, a mass tobacco cessation program is being implemented to support the prohibition onboard the submarine. Recommendations for a successful implementation program are included.

Skidmore WC; Roy M. Practical considerations for addressing substance use disorders in veterans and service members. Social Work in Health Care 50(1): 85-107, 2011. (80 refs.)

Support and treatment for military veterans and active duty service members is a national priority. Furthermore, there is increased need for professionals with experience and interest in working with these brave individuals. Veterans and service members face significant challenges both during their service and after transitioning back to civilian settings. One such challenge for some veterans is substance use and its multidimensional effects on mental and physical health. The current article presents a brief but comprehensive overview of the prevalence and comorbidity of substance use disorders in veterans and service members. It also reviews practical information about assessment, treatment, and general clinical issues from the authors' clinical experience that is relevant to providers working with veterans and service members with substance use disorders. This information may be of particular interest to professionals with an interest in helping veterans, those who have limited experience working with veterans, or those who may work outside of standard military or Department of Veterans Affairs settings. Finally, future directions in this important area are discussed.

Slep AMS; Foran HM; Heyman RE; Snarr JD. Unique risk and protective factors for partner aggression in a large scale Air Force survey. Journal of Community Health 35(4): 375-383, 2010 , 2010. (45 refs.)

The objective of this study is to examine risk factors of physical aggression against a partner in a large representative Active Duty Air Force sample. A stratified sample of 128,950 United States Active Duty members were invited to participate in an Air Force-wide anonymous online survey across 82 bases. The final sample (N = 52,780) was weighted to be representative of the United States Air Force. Backward stepwise regression analyses were conducted to identify unique predictors of partner physical aggression perpetration within and across different ecological levels (individual, family, organization, and community levels). Relationship satisfaction, alcohol problems, financial stress, and number of years in the military were identified as unique predictors of men's and women's perpetration of violence against their partner across ecological levels. Parental status, support from neighbors, personal coping, and support from formal agencies also uniquely predicted men's but not women's perpetration of violence across ecological levels. This study identified specific risk factors of partner violence that may be targeted by prevention and intervention efforts aimed at different levels of impact (e.g., family interventions, community-wide programs).

Spera C; Thomas RK; Barlas F; Szoc R; Cambridge MH. Relationship of military deployment recency, frequency, duration, and combat exposure to alcohol use in the Air Force. Journal of Studies on Alcohol and Drugs 72(1): 5-14, 2011. (22 refs.)

Objective: With today's new military deployment environment, characterized by more frequent and longer deployments, significant attention has focused on the effects of deployment on problem behaviors, including alcohol use. The current study examined the relationship between aspects of deployment and alcohol use. Method: The data for the current study were collected as part of the Air Force Community Assessment survey, an anonymous Web-based survey of Air Force members. The survey was administered to a stratified random sample of 56,137 active duty Air Force members across 80 bases worldwide; 78% were male and 22% were female. The Alcohol Use Disorders Identification Test measured the rate of alcohol problems. Deployment histories were collected using a series of questions that asked respondents about various aspects and characteristics of their recent deployments. Results: Logistic regression was used to examine the impact of various aspects of deployment on problem drinking. After controlling for demographic variables related to the likelihood of problem drinking, both a higher frequency of deployment and a greater total cumulative length of time deployed since September 11, 2001, were associated with a higher likelihood of problem drinking. For each increase in deployment frequency category the odds that an Air Force member was a problem drinker increased by 14%, and for each additional year spent deployed the odds increased by 23%. Conclusions: These findings indicate a significant relationship between deployment and problem drinking. However, most members who deployed multiple times remained resilient. This points to the need for future research on protective factors that foster resiliency.

Snelders S; Pieters T. Speed in the Third Reich: Metamphetamine (Pervitin) use and a drug history from below. Social History of Medicine 24(3): 686-699, 2011. (62 refs.)

This article is an analysis of the use of Pervitin (metamphetamine) in National Socialist Germany after the introduction of the drug in 1938. Whereas earlier studies have focused on the supply of the drug, this study focuses on demand. Both an iatrogenic and a 'Nazigenic' interpretation of the history of metamphetamine use are reviewed. It is concluded that the use of Pervitin in the Third Reich was not only 'pushed' on the population by the Nazi political and military authorities, but also became endemic in German society as it addressed the needs and problems of various users including employees, housewives, and soldiers. The drug was a cultural ambiguity of life in Nazi Germany, integrated in everyday life, notwithstanding its regulation by drug laws.

Swedler DI; Knapik JJ; Williams KW; Grier TL; Jones BH. Risk factors for medical discharge from united states army basic combat training. Military Medicine 176(10): 1104-1110, 2011. (40 refs.)

Past studies indicated that overall Basic Combat Training (BCT) attrition (discharge) was associated with various risk factors. BCT has changed considerably since many of these studies were conducted. This study examined Soldiers medically attrited from BCT. Potential attrition risk factor data on recruits (n = 4,005) were collected from medical records, BCT unit records, and questionnaires. Attrition data from Fort Jackson, South Carolina, showed 203 medical discharges. Cox regression (univariate and multivariate) obtained hazard ratios and 95% confidence intervals for attrition risk factors. Higher attrition risk was associated with female gender. Higher attrition risk for men was associated with cigarette smoking, injury during BCT, and less exercise before BCT. Higher attrition risk for both genders was associated with failure on the initial 2-mile run test and separated or divorced marital status. Attrition risk factors found in this study were similar to those previously identified despite changes in BCT.

Tai Zixue; Tao SP; Hung YJ. Peer influence and smoking relapse among active-duty military personnel in Taiwan. Tobacco Control 20(6): 444-445, 2011. (9 refs.)

Our findings showed that social etiquette in the form of cigarette offers from peer smokers acts as a palpable deterrent to ongoing smoking abstinence attempts. This is highly congruent with well-established evidence that being in the company of smokers is a major cause of smoking uptake and recidivism. In the particular context of the Asian culture, it is customary and generally considered socially desirable to make a cigarette offer to all those who are present while smoking cigarettes (whether out of courtesy or sincerity). On the other hand, being offered a cigarette may create the unanticipated normative pressure for the targeted individuals to conform (by joining in the smoking) in order to build rapport and camaraderie. This has an important practical implication for the design and delivery of culture-specific anti-smoking messages in the Taiwanese military in particular and in Asian countries in general.

Tien HCN; Acharya S; Redelmeier DA. Preventing-deaths in the Canadian military. American Journal of Preventive Medicine 38(3): 331-339, 2010. (52 refs.)

Background: Combat fatalities are reported by the media as a frequent cause of military deaths, yet they may not reflect the most common and preventable ways that soldiers die. Purpose: The purpose of this study was to quantify the leading causes of death in the military and to identify modifiable behaviors that potentially contributed to death. Methods: This was a retrospective chart review of all Canadian Forces members who died during the past quarter century (January 1, 1983, to December 31, 2007) and included autopsy reports, death certificates, coroner reports, hospital records, military reports, and other miscellaneous sources. Underlying cause of death and modifiable behaviors potentially contributing to death were determined. Results: A total of 1889 individuals died during the study period, and a cause of death was identified for 1710 cases (91%). Traumatic injuries caused 57% of deaths, and medical disease was responsible for 43%. The four leading specific causes of death were motor-vehicle crashes (384 deaths, 22%); neoplasms (374 deaths, 22%); suicide (289 deaths, 17%); and cardiovascular disease (285 deaths, 17%). Combat deaths accounted for less than 5% of all deaths (70 deaths). Approximately 35% of all deaths were attributable to potentially modifiable behaviors, which included suicide (219 non-alcohol-related deaths, 13%); smoking (159 deaths, 9%); and alcohol use (186 deaths, 11%). Conclusions: Public attention focuses on combat fatalities, yet most military members die from other causes. Avoiding future deaths requires targeting suicide, smoking, and alcohol consumption, in addition to trauma care for combat injuries.

Widome R; Joseph AM; Polusny MA; Chlebeck B; Brock B; Gulden A et al. Talking to Iraq and Afghanistan War veterans about tobacco use. Nicotine & Tobacco Research 13(7): 623-626, 2011. (19 refs.)

Introduction: Our goal in this study was to examine beliefs and attitudes about tobacco use in the newest generation of combat veterans, those who served in Afghanistan (Operation Enduring Freedom [OEF]) and Iraq (Operation Iraqi Freedom [OIF]). Methods: We held 5 focus groups (n = 17) with Minnesota Army National Guard soldiers who had recently returned from combat deployment in support of OEF/OIF. Sessions were audiorecorded, transcribed, coded, and analyzed using a grounded theory approach. Results: We found that it is common to use tobacco in the combat zone for stress and anger management and boredom relief. Tobacco was also a tool for staying alert, a way to socialize, and provided a chance to take breaks. Participants recognized the culture of tobacco use in the military. Stress, nicotine dependence, the tobacco environment at drill activities, and perceived inaccessibility of cessation tools perpetuated use at home and served as a barrier to cessation. Repeatedly, participants cited tobacco policies (such as increased taxes and smoke-free work-spaces) as motivators for quitting. Conclusions: There are specific circumstances common to combat zones that promote tobacco use. Results suggest that environmental changes that address the prominence of tobacco in military culture, the acceptance of nonsmoking breaks, and cessation programs that address stress issues and make cessation aids available may be effective in reducing tobacco use.

Williams J; Jones SB; Pemberton MR; Bray RM; Brown JM; Vandermaas-Peeler R. Measurement invariance of alcohol use motivations in junior military personnel at risk for depression or anxiety. Addictive Behaviors 35(5): 444-451, 2010. (63 refs.)

Measurement invariance is typically assumed when assessing drinking-related constructs across distinct groups of respondents. However, measurement properties of motivations related to mood maintenance and stress relief may differ in those experiencing symptoms of depression or anxiety. Invariance of social and coping drinking motives were explored with a sample of 4133 junior enlisted Air Force and Navy personnel. Measurement did not differ in those with depression symptoms. In contrast, those with anxiety symptoms differed in measurement of both motives. The impact of non-equivalence was demonstrated with a mediation model in which anxiety and depression predicted drinking motives, which in turn predicted heavy drinking. Incorporation of the partial invariance of the social motives factor attenuated the estimate of the mediated effect of social drinking motives by almost half compared to the estimate with invariance assumed. These results suggest that lack of measurement invariance could seriously bias or alter conclusions from tests of theoretical models and highlight the need for researchers to carefully consider the measurement properties of their constructs prior to model estimation.

Woodruff SI; Conway TL; Shillington AM; Clapp JD; Lemus H; Reed MB. Cigarette smoking and subsequent hospitalization in a cohort of young US Navy female recruits. Nicotine & Tobacco Research 12(4): 365-373, 2010. (55 refs.)

Tobacco use is of particular concern to the U.S. Department of Defense because the military historically has had higher and heavier rates of tobacco use than civilians. Few prospective studies have examined the association of cigarette smoking with medical outcomes, particularly among initially healthy female military personnel. This prospective cohort study followed over 5,000 young U.S. Navy female recruits varying in their smoking status at entry into the Navy and collected their subsequent hospitalization data (i.e., International Classification of Diseases, Ninth Revision codes) for up to 7-8 years of service. Results: indicated that after adjusting for differences in time at risk and sociodemographic variables, daily smokers (compared with never-and other smokers) had higher rates of hospitalization for any reason and for musculoskeletal conditions. Daily smokers also had higher rates than never- and other smokers for non-pregnancy-related hospitalizations and for mental disorders, although only the daily/other differences reached statistical significance. Daily smokers' average number of days hospitalized was significantly longer than that of never- and other smokers. Results suggest that young women do not have to wait decades to experience the harmful effects of smoking. A recent history of cigarette smoking is an important determinant of hospitalization risk for even young healthy women in the U.S. Navy.