Of the 1,073,840 Post Deployment Health Assessment (PDHA) forms completed with responses to the Alcohol Use Disorders Identification Test—Consumption (AUDIT—C) screens, 3.4 percent indicated severe risk for alcohol abuse—as defined by a score of 8 or higher—during the surveillance period between January 1, 2008, and December 31, 2014, according to a report published in the July issue of the Medical Surveillance Monthly Report (MSMR) by the Armed Forces Health Surveillance Center(AFHSC).
Of those PHDA screenings, another 4.8 percent indicated high risk for alcohol abuse, as defined as an AUDIT—C score of 6 or 7. Among the 936,475 Post Deployment Health Reassessment (PDHRA) forms that were completed, the numbers were even higher, with 4.8 percent indicating severe risk for alcohol abuse, and 8.1 percent indicating high risk, the report said. The percentages of forms with responses categorized as severe risk were highest among deployed service members who were white non-Hispanics and Hispanics, those aged 20–24 years, Marines, junior enlisted, and those working in combat-related occupations, when compared to their respective counterparts.
Heavy drinking by military service members is a concern because it may adversely affect military readiness and individuals’ short- and long-term health. Military service members may face increased risk for alcohol abuse associated with factors such as experiences of trauma, separation from family, combat-related mental health conditions, and discounted prices for alcohol on military installations.4
Service members are required to complete the PDHA questionnaires within 30 days of the end of an overseas deployment, and a PDHRA form approximately 90-180 days after returning. Both of these assessments contain the AUDIT—C screens.
In fact, the annual percentages of PDHA and PDHRA forms that indicated high or severe risk for alcohol abuse decreased steadily between 2008 and 2014. For example, 9.1 percent of PDHRA forms completed in 2008 indicated severe risk, but only 1.9 percent of forms in 2014 indicated severe risk (Table 2) .
The report also analyzed the PDHA/PDHRA forms to identify service members who were already under care for alcohol abuse, as indicated by positive responses by the healthcare providers who reviewed and certified the forms.
Only 1.7 percent of PDHA and 5.0 percent of PDHRA forms for service members at severe risk had healthcare provider annotations that service members were already under care (Table 3). Among service members who were not already under care, the percentages provided with relevant referrals increased with increasing risk for alcohol abuse. For those in the severe risk category, 26.3 percent of PDHA and 21.7 percent of PDHRA forms indicated that the service member had been referred to primary care or family practice.
Much lower percentages of service members in the severe risk category were referred for specific types of specialized care, such as behavioral health in primary care, mental health specialty care, or a substance abuse program (Table 3). Overall, the forms indicated that among those not already under care but at severe risk, only about 37 percent received a relevant referral. Put another way, the forms of a majority of service members completing forms that indicated severe risk for alcohol abuse had no documentation of a relevant referral for follow-up care (PDHA: 63.3 percent; PDHRA: 62.3 percent).
There were also significant trends of increasing frequencies of subsequent injury and alcohol-related conditions as alcohol risk levels increased. Service members who experienced one or more injury medical encounters after their deployments increased from 25.3 percent among low-risk individuals to 29.9 percent among those with the most severe risk of alcohol abuse (Table 5) .
Click here to read the entire report. The MSMR is the flagship publication for the AFHSC, featuring articles on evidence-based estimates of the incidence, distribution, impact, and trends of illness in service members and associated populations.
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