New Screening Tools for Early Detection of Alcohol Abuse Risk in the Military

INTRODUCTION:  A major problem facing military personnel and veterans is alcohol abuse, which can devastate individual lives, and also drives up health care costs and degrades the readiness of military forces. Alcohol and substance abuse in turn contribute to a range of other negative outcomes including depression, family violence and suicide. Effective screening is essential for early identification of soldiers at high risk for stress-related alcohol problems, in order to target preventive assistance to those who need it most. Current screening tools used in the U.S. Department of Defense are not sufficiently sensitive, failing to identify many at-risk soldiers. These tools ask directly about recent drinking behavior, yielding multiple false-negatives because: (1) troops tend to minimize or deny drinking problems for fear of negative repercussions; (2) many young troops with a drinking problem fail to recognize it as such; and (3) access to alcohol is often highly restricted in theater, so reports of drinking behavior are uniformly low for returning troops, despite individual risk profiles. Thus, screening tools that rely on direct questions about drinking behaviors fail to identify many potential problem drinkers. Other nations also screen for alcohol abuse risk with direct questions, as with the AUDIT and CAGE instruments. On the other hand indirect measures, which assess personal factors associated with alcohol risk, are not vulnerable to these same validity problems. The present research evaluates psychological hardiness and avoidance coping as potential markers for alcohol abuse risk in military personnel following deployments.

METHODS: In the present study, we measured hardiness (15-item DRS scale), avoidance coping (10-item scale), and alcohol use patterns in US National Guard troops recently returned from deployment to Afghanistan. Alcohol use was assessed with traditional measures (eg AUDIT, CAGE) at Time 1 immediately upon return, and again 7-8 months later.  A companion study examines the same variables in a large sample of Norwegian defense workers using data from a multi-year national defense health survey.

RESULTS: Logistic regression results for the Time 1 US data show that low hardiness and high avoidance coping independently predict alcohol abuse in returning soldiers, even after controlling for age and combat exposure (final model Nagelkerke R-square = .14). Odds ratios show that risk of alcohol abuse increases 7% for each one point drop in total hardiness levels (hardiness score range = 10 to 43). Avoidance coping also independently predicts alcohol abuse, again controlling for age and combat exposure. At Time 2, avoidance coping but not hardiness predicted alcohol abuse.  In the Norwegian sample, both hardiness and avoidance coping independently predicted risk for alcohol abuse, again using logistic regression..

CONCLUSIONS:  Findings indicate that hardiness and avoidance coping predict alcohol abuse in solders following deployment.  Alcohol screening programs for stressed populations such as the military can thus be improved by including brief measures of hardiness and coping style.