Binge-Drinking Is a Threat to Military Readiness, Health of Personnel
Click to Enlarge: Binge drinking by condition and follow-up time-point. Source: Society For The Study of Addiction
ANN ARBOR, MI — Risk drinking among reserve and active-duty military personnel is a threat not only to the health of the individuals, but also to their readiness if and when they are called to action.
That’s why researchers from the VA Ann Arbor, MI, Healthcare System and the University of Michigan sought to find ways to remedy the situation. Their intervention led to a drop by half in the number of days each month that guardmembers said they had been binge-drinking. Results were published in the journal Addiction.1
Guard members who had a reduction over a year in risky drinking participated in multiple brief online education sessions designed for members of the military and/or did an initial online education session followed by supportive phone calls every few months with veteran peers trained to talk about alcohol use.
Other guardmembers who were randomly assigned to receive no support beyond a pamphlet saw no decline by the end of the year on any of the measures.
“This is the first study of its kind to show the effectiveness of a relatively inexpensive e-health intervention for hazardous alcohol use in a component of our nation’s Army reserves,” said lead author Frederic Blow, PhD, director of the University of Michigan Addiction Center. “With risky drinking threatening the health and readiness of those who serve, we hope this approach could be useful in other National Guard units and beyond.”
In the randomized controlled trial, 793 Michigan Army National Guard members who reported recent hazardous alcohol use participants were assigned to either:
- web-based brief intervention (BI) with web-based boosters (BI + web),
- web-based BI with peer-based boosters (BI + peer) or
- enhanced usual care (EUC).
The guardmembers were 84% male, with a mean age of 28. Binge-drinking was defined as six or more drinks in one sitting by men, and four or more by women.
“The BI consisted of an interactive program guided by a personally selected avatar,” the study team explained. “Boosters were delivered either on the web or personally by a trained veteran peer. A pamphlet, given to all participants, included information on hazardous alcohol use and military-specific community resources and served as the EUC condition.”
In adjusted analyses, researchers found reduced binge-drinking compared with enhanced usual care with BI + peer [beta = -0.43, 95% confidence interval (CI) = -0.56 to -0.31, P < 0.001] and BI + web (beta = -0.34, 95% CI = -0.46 to -0.23, P < 0.001).
Background information pointed out that hazardous alcohol use is a major health concern among military members. “It adversely affects the psychological health and wellbeing of servicemembers and their families, as well as military readiness,” the authors wrote. “A Department of Defense Health-Related Behaviors Survey of active-duty personnel, conducted from 2015 to 2016, found high rates of hazardous drinking (35%) and binge-drinking (30%) Previous national surveys have found similarly high rates of hazardous alcohol use [with rates significantly higher among deployed reserve component members, including the National Guard, than among deployed active-duty members.”
Part of the problem, according to the researchers, is that misuse of alcohol is deeply rooted in the culture of the military and is often overlooked by leadership. “The attitude of acceptance of heavy, episodic drinking when off duty in the military was grounded in the belief that drinking together was a positive force for unit cohesion and camaraderie and built the trust that is essential to coordinated action,” the article suggested. “The official attitude changed when in the 1980s it became apparent that there was a significant drinking problem in the military.”
Drinking and Comradeship
Heavy, episodic drinking (binge-drinking) was still considered to be related to comradeship in recent conflicts in the Middle East, the researchers advised. The Mission Strong randomized controlled trial administered a large comprehensive assessment to 2,746 National Guard members who agreed to be screened for the study.
“We found that National Guard members with higher levels of drinking were significantly more likely to agree, on a unit drinking questionnaire, that drinking was an integral part of both being in one’s unit and the military, that alcohol was the primary recreation available at one’s unit and that leadership was tolerant of drunkenness,” they wrote. “The attitudes of many military members towards drinking underscores the importance of measuring both the amount of alcohol consumed and the frequency of binge episodes when assessing hazardous alcohol use in military populations. Binge-drinking can be particularly problematic as it can result in serious physical and social consequences, including citations or accidents from driving under the influence and aggressive behavior, which are significant issues in military populations.”
Mission Strong was developed based on promising efforts at the VA to use tailored education and peer support in reducing risking drinking among veterans, according to the authors.
The U-M team had also done a previous survey that showed that nearly a third of Michigan Army National Guard members who had deployed as part of their service showed signs of risky drinking.
The Mission Strong study involved members of 41 Michigan Guard units who took surveys about their alcohol use during one of their monthly drill weekends. Of the 2,746 screened, 832 (30%) scored high enough to be considered to have hazardous alcohol use.
Among the guardmembers in the study, 84% were employed full- or part-time, and 49% had ever been deployed as part of their service. Just more than half had an enlisted rank of private or corporal, with most of the rest having higher enlisted ranks; 6% were officers.
By the end of a year, 550 of them had completed all three follow-up surveys, including 142 who had taken part in three phone calls from peers, 120 who had completed three follow-up web-based sessions and the remainder who had only received the information pamphlet at the drill weekend and completed three follow-up surveys. All received a small amount of money for participating, to compensate them for their time.
At study inception, participants reported binge-drinking four to five days a month. By the end, those in the peer-support group had gone from 5.2 days to 2.6 days on average, while those in the online education only group had gone from 4.2 days to 2.8 days on average. Those in the third group were still binge-drinking 4 days a month by the end of the study period.
Researchers noted that, on the AUDIT scale of risky drinking, those who received the peer calls had a 3.6-point reduction over the course of the year on average, while those who received online-only contacts had a nearly 3-point drop—both considered significantly larger than the 2-point drop among those who only received a pamphlet and follow-up surveys.
On the SIP scale of the impacts of alcohol on a person’s life, those who received peer calls were the only ones to have a significant change from the start of the study to the end.
- Blow FC, Walton M, Ilgen M, Ignacio RV, et al. Peer- and web-based interventions for risky drinking among US National Guard members: Mission Strong randomized controlled trial. Addiction. 2023 Apr 11. doi: 10.1111/add.16172. Epub ahead of print. PMID: 37041669.
