Missed opportunity for alcohol problem prevention among army active duty service members postdeployment

Abstract

Objectives: We identified to what extent the Department of Defense postdeployment health surveillance program identifies at-risk drinking, alone or in conjunction with psychological comorbidities, and refers service members who screen positive for additional assessment or care.

Methods: We completed a cross-sectional analysis of 333 803 US Army active duty members returning from Iraq or Afghanistan deployments in fiscal years 2008 to 2011 with a postdeployment health assessment. Alcohol measures included 2 based on self-report quantity-frequency items-at-risk drinking (positive Alcohol Use Disorders Identification Test alcohol consumption questions [AUDIT-C] screen) and severe alcohol problems (AUDIT-C score of 8 or higher)-and another based on the interviewing provider's assessment.

Results: Nearly 29% of US Army active duty members screened positive for at-risk drinking, and 5.6% had an AUDIT-C score of 8 or higher. Interviewing providers identified potential alcohol problems among only 61.8% of those screening positive for at-risk drinking and only 74.9% of those with AUDIT-C scores of 8 or higher. They referred for a follow-up visit to primary care or another setting only 29.2% of at-risk drinkers and only 35.9% of those with AUDIT-C scores of 8 or higher.

Conclusions: This study identified missed opportunities for early intervention for at-risk drinking. Future research should evaluate the effect of early intervention on long-term outcomes.

FIGURE 1—

Postdeployment behavioral health screening and referral results in US Army active duty members with an index deployment ending in fiscal years 2008 to 2011: Substance Use and Psychological Injury Combat Study. Note. BH = behavioral health; MH = mental health. Alcohol indicates a score of 8 or higher (severe alcohol problems) on the Alcohol Use Disorders Identification Test alcohol consumption questions (AUDIT-C). BH indicates either MH or alcohol. MH refers to a positive screen for past-month posttraumatic stress disorder, depression (2-item Patient Health Questionnaire), or harmful thoughts. Referred indicates referred to be seen for care within 30 days of postdeployment screen to any of the following: primary care, BH in primary care, MH specialty care, or substance abuse program.

FIGURE 2—

Predicted percentage of US Army active duty members with an index deployment ending in fiscal years 2008 to 2011 referred to be seen for care within 30 days: Substance Use and Psychological Injury Combat Study. Note. AUDIT-C 8+ = severe alcohol problems on the Alcohol Use Disorders Identification Test alcohol consumption questions; MH = mental health. Base case indicates negative screen for AUDIT-C 8+ and negative screens for MH. Injured indicates self-report of being wounded, injured, assaulted, or otherwise hurt during index deployment. MH refers to a positive screen for past-month posttraumatic stress disorder, depression (2-Item Patient Health Questionnaire), or harmful thoughts. Referred indicates referred to be seen for care within 30 days of postdeployment screen to any of the following: primary care, behavioral health in primary care, MH specialty care, or substance abuse program. Predicted percentages were estimated from multivariate logistic regression model of odds of referral and adjusted for demographic, deployment, and combat characteristics and health status. Each characteristic was set to modal value of sample: enlisted rank, male, White, married, residing in southern region, index deployment lasting 1–11 months, high combat exposure (saw wounded, injured, or killed; engaged in combat and discharged weapon; and felt in danger of being killed), and self-reported excellent or very good health in past month.