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Military research has focused on relationships between combat trauma and servicemembers’ mental health, alcohol use, and other outcomes (e.g., Griffith, 2022; Larson et al., 2012; Milliken et al., 2007; Shen et al., 2012; Vest, Heavey, et al., 2018), but the relationships between alcohol use and other potentially traumatic events experienced before, during, or post-military service have been given less consideration. An increased risk of alcohol use has been found to be associated with multiple types of traumatic exposures, including adverse childhood experiences (Rogers et al., 2022), intimate partner violence (IPV; Devries et al., 2014; Sparrow et al., 2017), combat exposure (Larson et al., 2012), and natural disasters (Keyes et al., 2011). Understanding the full scope of potentially traumatic events experienced by servicemembers may provide further insight into how these experiences correlate to health-related outcomes, with implications for health care services, screenings, and treatments of current soldiers and veterans. 

We used data from 478 soldiers involved in the baseline wave of Operation: SAFETY, an ongoing longitudinal study of U.S. Army Reserve and National Guard (R/NG) soldiers and their spouses. Sample demographics included 387 males and 91 females with the average age of 31.6 years and an average of 9.2 years of military service. Using robust measures of baseline childhood, adult, and military-related potentially traumatic events, latent profile analyses (O'Donnell et al., 2017) identified mutually exclusive trauma exposure profiles, assigning all soldiers to a unique profile.

The four mutually exclusive trauma exposure profiles among soldiers included: 1. Low trauma; 2. High combat trauma; 3. High intimate partner violence and combat trauma; and 4. High childhood trauma. 

Female soldiers were more likely to have been the victim of a violent crime, experienced childhood physical or sexual assault, had an unwanted sexual experience as an adult, and have been in an abusive adult relationship. Male soldiers were more likely to have witnessed mutilation, injury, or death, felt their life was in danger, and experienced higher levels of combat exposure and negative relationship interactions. Our results indicate that soldiers with high levels of intimate partner violence exposure, in combination with slightly higher than average combat exposure, are most at risk for problematic alcohol use. The relationship between partner violence, combat exposure, and alcohol misuse is especially important for male soldiers, as men in our sample reported comparable rates of intimate partner violence victimization as their female counterparts. Male soldiers with high rates of partner violence exposure were more likely to engage in frequent heavy drinking compared to female soldiers also exposed to partner violence.

Soldiers in our sample experienced a wide range of non-military and military traumatic exposures; these results indicate that researchers and health care providers should screen for the full range of traumatic events across an individual’s life course, regardless of gender. Screenings should include military exposures, as well as other sources of trauma experienced prior to and after military service. Intimate partner violence may be a particularly important risk to screen for. While the military health system recognizes the importance of intimate partner violence screening among military populations (Kwan et al., 2020), these efforts have been targeted particularly towards women (e.g., Dichter et al., 2017; Iverson et al., 2015). Further, our findings suggest that an inclusive, trauma-informed approach to healthcare and service provision is needed. As others have proposed, this type of approach can be implemented in both primary care and specialty settings, and involves broad screening and recognition of trauma, followed by patient-centered care that considers trauma health sequelae, emphasizes patients’ emotional needs, and refers to trauma-specific treatment as warranted (Roberts et al., 2019). 

Target Article

Vest, B. M., Weiss-Laxer, N. S., Homish, D. L., & Homish, G. G. (2022). Lifetime trauma exposure profiles and alcohol use over time among U.S. Reserve and National Guard soldiers. Journal of Traumatic Stress, 00, 1– 14. https://doi.org/10.1002/jts.22867.  https://onlinelibrary.wiley.com/doi/10.1002/jts.22867

Discussion Questions

  • Why is it important think about broader assessment of trauma exposures (beyond just combat exposure) among military populations?
  • What else do we need to understand and research to better address the relationship between trauma across the lifespan and alcohol use among military populations? 

About the Authors

Bonnie M. Vest, PhD: Dr. Vest is a medical anthropologist and Research Associate Professor in the Department of Family Medicine at the University at Buffalo. Her research focuses on the use of mixed methods to understand the complex relationships between identity, substance use, mental health, and social-environmental factors that impact healthcare utilization and the overall well-being of military populations.
Nomi S. Weiss-Laxer, PhD: Dr. Weiss-Laxer is a Research Assistant Professor in the Departments of Orthopaedics and Family Medicine at the University at Buffalo. Her research translates clinical and epidemiological research to improve health services and public health strategies. Her training and program of research integrates a life course lens to target when and how best to intervene to improve population outcomes across the lifespan.
D. Lynn Homish, MS: Ms. Homish is a project director within the Community Health and Health Behavior Department at the University at Buffalo. She has extensive knowledge of recruiting, enrollment, and longitudinal follow-up on various special populations, as well as expertise with epidemiological research methods. 
Gregory G. Homish, PhD: Dr. Homish is Professor and Chair of the Department of Community Health and Health Behavior at the University at Buffalo. His research focuses on social and environmental influences on changes in health and health behaviors over time.

References Cited

Devries, K. M., Child, J. C., Bacchus, L. J., Mak, J., Falder, G., Graham, K., Watts, C., & Heise, L. (2014). Intimate partner violence victimization and alcohol consumption in women: A systematic review and meta‐analysis. Addiction, 109(3), 379-391. https://doi.org/10.1111/add.12393
Dichter, M. E., Haywood, T. N., Butler, A. E., Bellamy, S. L., & Iverson, K. M. (2017). Intimate partner violence screening in the Veterans Health Administration: Demographic and military service characteristics. American Journal of Preventive Medicine, 52(6), 761-768. https://doi.org/10.1016/j.amepre.2017.01.003
Griffith, J. (2022). Postdeployment Alcohol Use and Risk Associated With Deployment Experiences, Combat Exposure, and Postdeployment Negative Emotions Among Army National Guard Soldiers. Journal of Studies on Alcohol and Drugs, 83(2), 202-211. https://doi.org/10.15288/jsad.2022.83.202 
Iverson, K. M., King, M. W., Gerber, M. R., Resick, P. A., Kimerling, R., Street, A. E., & Vogt, D. (2015). Accuracy of an intimate partner violence screening tool for female VHA patients: a replication and extension. Journal of Traumatic Stress, 28(1), 79-82. https://doi.org/10.1002/jts.21985
Keyes, K. M., Hatzenbuehler, M. L., & Hasin, D. S. (2011). Stressful life experiences, alcohol consumption, and alcohol use disorders: the epidemiologic evidence for four main types of stressors. Psychopharmacology, 218(1), 1-17. https://doi.org/10.1007/s00213-011-2236-1 
Kwan, J., Sparrow, K., Facer-Irwin, E., Thandi, G., Fear, N., & MacManus, D. (2020). Prevalence of intimate partner violence perpetration among military populations: A systematic review and meta-analysis. Aggression and Violent Behavior, 53, 101419. https://doi.org/10.1016/j.avb.2020.101419
Larson, M. J., Wooten, N. R., Adams, R. S., & Merrick, E. L. (2012). Military combat deployments and substance use: Review and future directions. Journal of Social Work Practice in the Addictions, 12(1), 6-27. https://doi.org/10.1080/1533256X.2012.647586
Milliken, C. S., Auchterlonie, J. L., & Hoge, C. W. (2007). Longitudinal Assessment of Mental Health Problems Among Active and Reserve Component Soldiers Returning From the Iraq War. Journal of the American Medical Association, 298(18), 2141-2148. https://doi.org/10.1001/jama.298.18.2141 
O'Donnell, M. L., Schaefer, I., Varker, T., Kartal, D., Forbes, D., Bryant, R. A. A., Silove, D., Creamer, M., McFarlane, A., Malhi, G., Felmingham, K., Van Hoof, M., Hadzi-Pavlovic, D., Nickerson, A., & Steel, Z. (2017). A systematic review of person-centered approaches to investigating patterns of trauma exposure. Clinical Psychology Review, 57, 208-225. https://doi.org/10.1016/j.cpr.2017.08.009 
Roberts, S. J., Chandler, G. E., & Kalmakis, K. (2019). A model for trauma-informed primary care. Journal of the American Association of Nurse Practitioners, 31(2), 139-144. https://doi.org/10.1097/jxx.0000000000000116 
Rogers, C. J., Pakdaman, S., Forster, M., Sussman, S., Grigsby, T. J., Victoria, J., & Unger, J. B. (2022). Effects of multiple adverse childhood experiences on substance use in young adults: A review of the literature. Drug and Alcohol Dependence, 109407. https://doi.org/10.1016/j.drugalcdep.2022.109407
Shen, Y. C., Arkes, J., & Williams, T. V. (2012). Effects of Iraq/Afghanistan deployments on major depression and substance use disorder: analysis of active duty personnel in the US military. American Journal of Public Health, 102 Suppl 1, S80-87. https://doi.org/10.2105/AJPH.2011.300425
Sparrow, K., Kwan, J., Howard, L., Fear, N., & MacManus, D. (2017). Systematic review of mental health disorders and intimate partner violence victimisation among military populations. Social Psychiatry and Psychiatric Epidemiology, 52(9), 1059-1080.  https://doi.org/10.1007/s00127-017-1423-8
Vest, B. M., Heavey, S. C., Homish, D. L., & Homish, G. G. (2018, Apr 16). Alcohol Misuse in Reserve Soldiers and their Partners: Cross-Spouse Effects of Deployment and Combat Exposure. Substance Use and Misuse, 53(5), 800-807. https://doi.org/10.1080/10826084.2017.1385632