U.S. military personnel and veterans have a reputation for drinking heavily, but as with any stereotype, the characterization is more complex than that, new research has found.
While studies have shown that active-duty troops drink more days a year than workers in any other industry, and an estimated 14% of all veterans abuse alcohol, a new study from the Lerner Center for Public Health Promotion at Syracuse University has found a subset of veterans drink more than others on a daily basis: those who have had a traumatic brain injury or been diagnosed with a psychiatric disorder.
According to the research, veterans considered "harmed by their military service" -- defined in the study as either having a TBI or mental health condition -- are about twice as likely to be current daily drinkers than peers who escaped injury as well as non-veterans.
The researchers said they wanted to drill down within the veteran population to see if differences in drinking behaviors existed.
They previously had discovered that veterans with TBI or mental health conditions experienced sleep disturbances at rates higher than other veterans, and wanted to see if the patterns were the same for drinking, according to Andrew London, a professor of Sociology at Syracuse's Maxwell School of Citizenship & Public Affairs.
"We found it very closely aligned to the pattern, which led us to conclude that this might be a form of self-medication, the daily drinking aspect of this," London said.
Using survey data from eight states in the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, the researchers sought to determine how frequently veterans consumed alcohol and if patterns emerged.
Veterans with mental health issues or traumatic brain injury are especially at risk because if they are medicating themselves with alcohol, they may not be seeking health treatments tailored to their needs, London said.
Surprisingly, the research found that veterans who had never seen combat and combat veterans who did not suffer a TBI or mental health issues were less likely to drink daily than people who had never been in the military.
"A lot of discussion about alcohol and veterans or military service talks about veterans as a large homogenous group. What we found was that a statement like, ‘veterans are more likely to drink than non-veterans' would be an overgeneralization and a mischaracterization, according to our results," London said.
"Some veterans drink less and some veterans drink more," he said.
The researchers noted that more study is needed to determine whether daily drinking by this cohort of veterans is actually a form of self-medication, if it is related to military service or simply a lifestyle choice.
But, London added, based on his research, health care providers should consider asking about alcohol consumption and daily drinking as a signifier of an underlying condition.
"Veterans may benefit from other kinds of health care services that may be more efficacious than alcohol consumption. There may be unmet needs that could be met," London said.
The non-profit think tank RAND Corp. released a report Wednesday that said post-9/11 veterans who abuse alcohol, opioids or other substances face challenges getting proper treatment for concurrent mental health conditions.
According to the report, programs that can present a barrier to veterans receiving quality mental health or substance abuse treatment include those that aren't tailored to veterans' unique needs, address only one condition at a time or require abstinence from alcohol, marijuana or pain medications prior to acceptance.
The study, conducted with Wounded Warrior Project analysts, noted that 11% to 24% of recent veterans struggle with substance abuse, while 13% struggle with depression and 11% to 20% report having post-traumatic stress disorder.
"Mental health disorders and substance use disorders don't exist separately -- you see a lot of overlap. Estimates of concurrence between PTSD and substance use disorder range from 34% to 88%. Veterans with a substance use diagnosis are three to four times more likely to also receive a diagnosis of PTSD and or depression," said Eric Pedersen, a RAND adjunct researcher and associate professor of psychiatry and behavioral sciences at the Keck School of Medicine at the University of Southern California.
The study found that, while most veterans live accessibly near centers that can provide treatment -- within 16 minutes of a private provider or 60 minutes of a Veterans Affairs treatment program -- veterans with overlapping health conditions frequently don't seek care.
"This may be because both issues are not addressed concurrently and/or with evidence-based approaches," the RAND report noted.
The researchers recommended that more veterans be screened for multiple behavioral health disorders and that treatment programs provide veteran-centric offerings as well as treatments that target substance abuse and mental health conditions at the same time.
"With appropriate and effective treatment veterans can significantly improve their symptoms, reduce their substance use behaviors, achieve an overall sense of well-being and improve functioning in multiple areas of their lives," Pedersen said.