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Topics: Alcohol

Alcohol use and abuse in the UK Armed Forces

Alcohol article

Dr Nicola Fear, King's College, London

Alcohol abuse is currently a major concern in the UK. This has been reflected in a tide of tabloid headlines such as "Boozy Britain" and we are continually being warned of the short and long-term adverse effects of excessive alcohol use.

Given their socio-demographics, pre-service background, and access to subsidised alcohol, it is perhaps unsurprising that members of the UK Armed Forces are also the subject of similarly unflattering media reports.

Compared to the general population the levels of drinking are higher in those who are currently serving or have served in the military. Drinking at a level considered by the World Health Organization (WHO) to be harmful to one's health was found to occur in 67% of men and 49% of women in the UK Armed Forces, compared to 38% of men and 16% of women in the general population, even after accounting for age.

Heavy drinking (defined by the WHO as being at severe risk of drinking problems) was also shown to be more prevalent in the UK military compared to the general population (men: 17% vs. 6%; women: 9% vs. 1%, respectively).

Alcohol dependence (e.g. morning drinking) and alcohol-related harm (e.g. blackouts) are also more common in UK Armed Forces personnel than in the general population. [Alcohol dependence - in men: 6% military vs. 3% general population; in women: 5% military vs. 1% general population; alcohol-related harm - in men: 24% military vs. 15% general population; in women: 16% military vs. 8% general population].

Risk factors for heavy drinking and binge drinking (defined as drinking 6 or more units in one sitting on a daily or weekly basis) in the regular UK Armed Forces are similar to those in the general population, these include being young, smoking, having a parent with a substance (alcohol/drug) abuse problem, not having children at home and not being in a relationship. Specific military risk factors include serving in the Naval Services and the Army, holding a lower rank, having a combat role and deployment to the 2003 Iraq War.

Specific aspects of deployment to the Iraq War that predicted subsequent alcohol misuse have been examined in UK military personnel. Poorer unit leadership and greater exposure to combat risk events (such as coming under artillery fire, or thinking that they might be killed) are associated with heavy drinking. While higher levels of comradeship and deployment alongside one's parent unit are also associated with heavy drinking, suggesting that factors acting to increase the bonding of troops also act to increase the levels of alcohol use following deployment.

Occupational mortality statistics (for England and Wales, 2001-2005) show that Non-Commissioned Officers and Other Ranks (males aged 20-64 years) are the 11th highest occupational group when looking at alcohol-related deaths (e.g. alcoholic liver disease). The highest levels of alcohol-related mortality were found among bar staff and publicans.

Among the military, those who are defined as heavy drinking are also more likely to be risky drivers (i.e. drive without a seat belt or speed); thus putting themselves and others at risk of death and disability from road traffic accidents.

Other health effects which have been examined within military populations and found to be associated with alcohol use include self harm and suicide.

What impact does Service life have on drinking behaviours of those who have left the military? It is important to note that the prevalence of heavy drinking (men: 16% serving vs. 18% ex-serving) and binge drinking (men: 48% serving vs. 46% ex-serving) were similar among serving and ex-serving military personnel. Thus the patterns of drinking do not change when people leave the services.

What can be done? Alcohol has traditionally played a central role in military life, in particular with regards to cohesion and bonding. Thus any changes in drinking behaviours in the UK military require a profound cultural shift and actions taken should reflect those being undertaken within the general population. All three Services are proactive in their attempts to encourage sensible drinking and tackle alcohol misuse, with each Service having its own "alcohol guidelines".

Particular attention should be paid to Service personnel's drinking patterns and behaviours at the time of discharge to ensure sensible drinking is facilitated at this key transition. Sensible attitudes towards drinking within the military and the general population can only be beneficial.

Background reading:

Browne T et al (2008) How Do Experiences In Iraq Affect Alcohol Use Amongst Male UK Armed Forces Personnel? Occupat Environ Med, 65: 628-633

Fear NT et al (2007) Patterns of drinking in the UK Armed Forces, Addiction, 102: 1749-1759

Fear NT et al (2008) Risky driving among regular armed forces personnel from the United Kingdom, Am J Prevent Med, 35: 230-236

Iversen A et al (2007) Factors associated with heavy alcohol consumption in the U.K. armed forces: data from a health survey of Gulf, Bosnia, and era veterans, Mil Med, 172: 956-961

Micklewright S (2002) Deliberate self harm in the Royal Navy. An audit of cases presenting to the Department of Community Mental Health, RH Haslar between 1 March 1999 and 28 February 2002, J Royal Naval Med Ser, 91: 12-25

Romeri E et al (2007) Alcohol-related deaths by occupation, England and Wales, 2001-05, Health Stat Quart, 35: 6-12

Rossow I and Amundsen A (1995) Alcohol abuse and suicide: a 40-year prospective study of Norwegian conscripts, Addiction, 90: 685-691

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