Tuesday, 31 March 2015

The prevalence of alcohol and substance abuse amongst Gulf War, Iraq War and Afghanistan military personnel versus non-deployed military personnel

Drs Helen Kelsall, Dean McKenzie, Matthew Page, and Supun Wijesinghe and Professors Andrew Forbes and Malcom Sim from SPHPM have co-authored a paper with Dr Mark Creamer from the University of Melbourne to explore if alcohol and other substance use disorders were more common in veterans who were deployed in the Gulf War, Afghanistan and Iraq War than in military personnel who were not deployed to these conflict areas.

Research has previously highlighted that war veterans are at increased risk of developing a psychological disorder following deployment, due to their time spent in war or war-like conditions and other risk factors associated with exposure to the combat environment. These factors include deployment stressors, the status of deployed troops, unit cohesion, the degree to which veterans were exposed to combat and traumatic brain injury.

During the Gulf War (1990-1991), a large force of troops from several countries was deployed to the region due to Iraq’s invasion of Kuwait. September 11 2001 saw attacks in the United States. In response, forces from Australia, United Kingdom, Germany, France and other nations who were supporting the United States commenced an invasion of Afghanistan. This was followed by the Iraq War (US Operation Iraqi Freedom) (2003-2011), when the United States, United Kingdom, Australia and Poland began the invasion of Iraq.

Veteran health studies following these deployments have explored the relationship between deployment to these regions and health outcomes of veterans. The findings indicate that military personnel who were deployed to these conflicts have a higher likelihood of developing a psychological disorder in comparison with personnel who did not deploy. However, there has been less research which has focused on alcohol and substance use disorders, as the majority of research has explored anxiety and affective disorders including posttraumatic stress disorder. Yet alcohol use is a concern in defence forces. The prevalence rate of US active duty military personnel who engage in heavy or binge drinking has seen an increase from 1998-2008. Those who are more susceptible to engaging in these behaviours are military personnel with higher combat exposure.

There have been systematic reviews conducted, exploring the health outcomes of veterans from the Gulf War, but with little emphasis on alcohol or substance use disorders save for one review conducted in 2003 which examined psychological disorders of Gulf War veterans. This review noted the lack of data on alcohol use disorders. There has been a surge in new research on these issues since this review, with new findings available in Australian Gulf War veterans which had not previously been included. This research has also expanded to encompass studies of the mental health of veterans who were deployed to Afghanistan and/or Iraq War, and was part of the rationale for conducting a systematic review to summarise the existing research in this field. The current systematic review sought to conduct a quantitative review of the current literature and a meta-analysis to determine the odds of experiencing an alcohol use disorder, other substance use disorders and lastly, any substance use disorder in Gulf War, Afghanistan and Iraq War veterans compared with nondeployed military personnel.

Literature was searched from 1990 till 2014 across several electronic databases. Studies were assessed for eligibility and quality, including risk of bias. Through this assessment, 18 studies were included. The researchers utilised a random effects meta-analysis. They found no statistically significant associations between alcohol or substance use disorders and the theatre of war. However, they found that veterans of Afghanistan/Iraq War or Gulf War were at higher risk of developing alcohol use disorder, and Afghanistan/Iraq War veterans were at increased risk of substance use disorders than their nondeployed counterparts. They also suggest that there is a need for further research to determine the risk of substance use disorder development in veterans of the Gulf War.

This systematic review and meta-analysis was conducted as part of a series of systematic reviews on the psychological and physical health of 1990-1991 Gulf War, Afghanistan and Iraq War veterans by the Monash Centre for Occupational and Environmental Health (MonCOEH), and funded by the Department of Veterans’ Affairs. However, the views expressed do not necessarily represent the views of the Minister for Veterans’ Affairs or the Department of Veterans’ Affairs.

The article is available here.

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