Military at Increased Risk for Alcohol Abuse

Military service in a war zone increases service members' chances of developing post-traumatic stress disorder (PTSD), other anxiety disorders, and depression, says a new report from the Institute of Medicine. Serving in a war also increases the chances of alcohol abuse, accidental death, and suicide within the first few years after leaving the war zone, and marital and family conflict, including domestic violence, said the committee that wrote the report at the request of the U.S. Department of Veterans Affairs, which asked for a comprehensive analysis of the scientific and medical evidence concerning associations between deployment-related stress and long-term, adverse effects on health.

Drug abuse, incarceration, unexplained illnesses, chronic fatigue syndrome, gastrointestinal symptoms, skin diseases, fibromyalgia, and chronic pain may also be associated with the stresses of being in a war, but the evidence to support these links is weaker. For other health problems and adverse effects that the committee reviewed, the data are lacking or contradictory; the committee could not determine whether links between these ailments and deployment-related stress exist.

Although the report cannot offer definitive answers about the connections between many health problems and the stresses of war, it is clear that veterans who were deployed to war zones self-report more medical conditions and poorer health than veterans who were not deployed. Those who were deployed and have PTSD in particular tend to report more symptoms and poorer health, the committee found. PTSD often occurs in conjunction with other anxiety disorders, depression, and substance abuse; its prevalence and severity is associated with increased exposure to combat.

A persistent obstacle to obtaining better evidence that would yield clearer answers is lack of pre- and post-deployment screenings of physical, mental, and emotional status. The U.S. Department of Defense should conduct comprehensive, standardized evaluations of service members' medical conditions, psychiatric symptoms and diagnoses, and psychosocial status and trauma history before and after they deploy to war zones. Such screenings would provide baseline data for comparisons and information to determine the long-term consequences of deployment-related stress. In addition, they would help identify at-risk personnel who might benefit from targeted intervention programs during deployment -- such as marital counseling or therapy for psychiatric or other disorders -- and help DOD and VA choose which intervention programs to implement for veterans adjusting to post-deployment life.