On returning from deployment to regular civilian life, everyday stresses like marriage problems or healthcare issues could trigger a drinking problem, according to a new study.
Stresses in regular life seemed to matter more than traumatic events during deployment in predicting which National Guard members would begin abusing alcohol, researchers found.
"I think the big takeaway message is that in the long term mental health for National Guard members, what matters is what happens after they come home," said lead author Magdalena Cerdá.
"Financial difficulties, re-integrating, difficulties accessing quality health care, all of those seem to matter," she told Reuters Health by phone.
These findings apply specifically to reserve service members, and the question still remains whether the same would be true in other branches, said Cerdá, an epidemiologist at the Columbia University Mailman School of Public Health in New York.
Cerdá and her team recruited more than 1,000 Ohio Army National Guard soldiers who had been deployed at least once by 2009 and interviewed them three times over three years.
The phone interviews included questions about civilian stressors like job loss or seeing fights among family members and about deployment-related events like receiving incoming fire, seeing severely wounded enemy soldiers or experiencing unwanted groping or other sexual harassment while deployed.
More than half of the soldiers experienced combat-related traumatic events, 36 percent experienced civilian stressors and 17 percent reported sexual harassment during the most recent deployment, according to results published in the American Journal of Preventive Medicine.
In the first year of interviews, 13 percent of the soldiers met the criteria for an alcohol use disorder, and the number declined with each subsequent year.
Having civilian stressors increased the risk of new alcohol abuse, but not the recurrence of an existing alcohol problem, according to the study team.
They found that civilian stresses, and not deployment-related stresses, predicted alcohol misuse. But that doesn't mean deployment stress has no influence, Cerdá said.
"It's important to keep in mind that the more traumatic events they are exposed to during or after combat, the more problems they have in daily life when they come home," Cerdá said.
According to national data from 2012, 14 percent of reserve-component soldiers in the U.S. experienced alcohol misuse or abuse, compared to only seven percent of the general population.
“When I see patients in my clinic there is clearly not just one factor alone that’s important, it’s often a combination,” said Dr. Jitender Sareen, a consulting psychiatrist for the Veterans Affairs Canada Operational Stress Injury Clinic at Deer Lodge Hospital in Winnipeg, Canada.
Experiencing trauma in combat in addition to stresses at home may add together to increase risk of alcohol abuse, he said. Research in the UK and in Canada has found that combat stressor themselves are associated with an increased risk of alcohol misuse later.
“Often in our Canadian veterans’ clinics, we see people who present with alcohol problems who have deployment trauma and civilian stress together,” he said.
The new findings may not be generalize since only 40 percent of the soldiers contacted agreed to participate in the study, Sateen told Reuters Health by phone.
“We’ve done some work showing that there are additive effects, there is a higher risk of mental health problems later in life with adverse childhood events, for example,” he said.
Working with the families to prepare for reintegration issues they may face even before deployment may help mitigate some of the risk of substance abuse, Cerdá said.
"There were a few stressor that had a particularly strong effect, like having a family member with a serious alcohol problem, or serious financial problems, and the strongest was (not) having access to adequate healthcare," she said.
She suggested making VA medical services more accessible to returning military regardless of where they live.