Alcohol misuse, alcohol-related risky behaviors, and childhood adversity among soldiers who returned from Iraq or Afghanistan

• Soldiers were surveyed three months after return from Iraq or Afghanistan.
• Outcomes assessed were alcohol misuse and alcohol-related risk behaviors.
• The associations of adverse childhood experiences and the outcomes were examined.
• Sexual abuse was the strongest independent predictor of both outcomes.

BackgroundSoldiers face a great number of traumatic combat exposures while deployed, which research has shown to contribute to the development of alcohol misuse. In addition to this known risk factor, we hypothesize that adverse childhood experiences (ACEs) also contribute to the likelihood that soldiers will engage in these behaviors, even after adjusting for deployment-related factors (mental health problems and combat exposure).MethodsSoldiers were surveyed anonymously approximately 3 months upon return from Operation Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF) from 2003 to 2006. Six brigade combat teams were included in the analyses (n = 7849). Participants were asked about ACEs, mental health symptoms, alcohol misuse, risky behaviors related to alcohol misuse, and combat exposure.ResultsOf the 7849 soldiers in the sample, 31.5% screened positive for alcohol misuse and of those almost half also screened positive for risky behaviors related to alcohol misuse (43.3%). Having an alcoholic in the household and experiencing sexual abuse were significantly associated with screening positive for alcohol misuse and alcohol misuse with risky behaviors. Experiencing sexual abuse was a strongly associated ACE item, with an almost 2-fold increase in risk of both outcomes even after adjusting for mental health problems and combat exposure.ConclusionsFindings suggest that ACEs are a substantial risk factor for alcohol misuse with and without risky behaviors among soldiers returning from deployments and should be considered when directing prevention efforts.