Why Alcohol Misuse Is so Rampant in the Military

Alcohol and Special Populations: Unique Problems and Considerations That Apply to the Military The military is a special population that has its own culture and its own code of ethics. Its veterans have their own VA hospital and society recognizes a distinct difference between civilian and military life. The effect of alcohol on the military, therefore, requires unique consideration outside the realm of investigations on the effects of alcohol on mainstream America.

This paper will describe the effect of alcohol on the military, identify unique problems and considerations that apply to the military, and compare and contrast the military to the overall U.S. population in terms of the problem of alcohol. It will conclude with a description of the best treatment practices for specific issues relevant to the military. The Effect of Alcohol on the Military The military population is not without its weakness for alcohol consumption. As Pemberton et al. (2011) note, "the U.S.

military has traditionally had high rates of alcohol misuse and alcohol-related problems" (p. 480). Why this should be so, however, is less clear. There are a number of related factors that add to the stresses of military life, in combat zones as well as in bases both abroad and domestic. Together they combine with a culture that is substantially different from civilian life (with its own military tribunals, laws, barracks, etc.) to give soldiers and military personnel a challenging time when it comes to managing sobriety.

The expansion of theaters of war since 9/11 and constant state of alert of the U.S. military also plays a role in the effect that alcohol has on military personnel. With no end in sight to recent conflicts, and, on the contrary, growing tensions between Russia and the West as multiple countries now attempt to "weigh in" on Syria and the terrorist threat running through Turkey, it appears that alcohol misuse has multiplied and gives no sign of abating.

Bray, Brown and Williams (2013) show that over a ten-year span from 1998 to 2008, military personnel "showed significant increases in heavy drinking (15% to 20%) and binge drinking (35% to 47%)" (p. 799). The impact on individuals participating in such heavy/binge drinking has been significant as well, with 9% of binge drinkers experiencing "serious consequences" and 19% of heavy drinkers suffering from sort of negative ramification as a result of over-consumption (p. 799).

Moreover, personnel with high combat exposure are reported as having even higher rates of binge and heavy drinking, indicating that alcohol consumption patterns are aggravated by a history of combat for military personnel. The "serious consequences" range from social to physical to psychological issues that can develop over time to localized incidents/accidents, such as fighting, injury to self, or physical sickness.

Furthermore, such consumption establishes a dependency upon alcohol while in the military that can stay with a member of the service even after he leaves the military and makes the transition back into civilian life, thus complicating the transition and adding to the sense of the isolation that the ex-serviceman can experience while attempting to navigate a new world with a different culture and customs than what he is used to in the military.

Yet, these habits are not always picked up in the military: sometimes they are brought into the military and simply made worse there as a result of having too much down time and not enough outlets or cultural stimulation for pursuits unrelated to alcohol consumption.

Hanwella, Silva and Jayasekera (2012) note that "alcohol misuse is more prevalent among military populations" because military personnel are "significantly influenced by alcohol consumption patterns among the general population" and also have "access to alcohol and attitudes about alcohol use" that are impacted by "poorer psychological health and functional impairment" (p. 1). In other words, the military can act as a haven for degenerate behaviors and habits already established in individuals prior to acceptance into the military. Indeed, the study by Hanwella et al.

(2012) identifies a number of unique considerations that must be understood when attempting to contextualize the problem of alcohol in the military. Unique Problems and Considerations The considerations that must be made are as Hanwella et al. (2012) note related to several factors. First off is the "general trend" of alcohol consumption in society. Considering that military personnel come from civilian life where these trends are already well-established, it is helpful to realize that these individuals come into the military already ingrained with alcohol consumption patterns.

Secondly, these patterns are reinforced and exaggerated due to the solitary and isolative nature of the military culture: there is little room for recreation aside from using alcohol, which is a predominant focus for escapist efforts on the part of personnel seeking some reprieve from the pressures of military life. Thirdly, access to alcohol is a major factor in the military's abuse of alcohol (if it is not as readily available there is likely to be less abuse).

Fourthly, personnel may suffer from psychological problems that aggravate the issue of alcohol use/misuse; these issues can range from anything as simple as immaturity to anything as complex as post-traumatic syndrome disorder (PTSD) or military sexual trauma (MST) (Johnson, 2012). Likewise, there is correlation between PTSD and heavy drinking (Hanwella et al., 2012), which illustrates how military culture has a unique impact on alcohol use as it is directly related to the role of active combat participation. Jakupcak et al.

(2010) find that PTSD symptoms develop in relationship to alcohol abuse in veterans of Middle East combat. Their study concludes with the assessment that there is a degree of "emotional numbing" that coincides with the alcohol abuse (p. 840).

In short, the precise military environment is what aggravates the problem of alcohol misuse within the military population -- though there are considerably more factors as well, such as the effects of depression following re-entry into civilian life, or the effects of early childhood trauma, which can lead to situations in which individuals seek admission to the military as a way of escaping a poor civilian environment (Lutwak, 2014). Moreover, that same culture plays a role in the link between alcohol misuse and intimate partner violence (Foran et al., 2012).

The cultivation of violent perceptions, as manifested in the expectations of military combat soldiers to kill the enemy, are extended to interpersonal relationships which can breed volatility especially when alcohol consumption is factored into the equation. When coupled with the already inherent tendency towards abuse by a significant percentage of the military population the risk of intimate partner violence trends upward.

Indeed there is a distinct dulling of sensitivity as part of the course of training of combatants who are taught to adopt a kill or be killed way of thinking, albeit one that incorporates safety practices, caution, and norms of behavior regarding engagement, etc. At the same time, the military culture promotes a herd mentality, which helps to explain why the percentage rates of heavy and binge drinkers are so high compared to the overall U.S. population. The Military Compared to the Overall U.S.

Population The study by Hoerster et al. (2012) reports that the military population is more likely to engage in heavy drinking than the civilian population and the same goes for veterans as well. The reasons for this disparity are numerous. First of all, there is a significantly larger problem impacting the health of civilians, which is related to eating -- not drinking. Among the civilian population, however, obesity is the top problem as it relates to cardiovascular disease and diabetes (Tabish, 2007).

Second of all, civilian lifestyles are far more conducive to accommodating stress relievers (such as vacations) that military life cannot accommodate for obvious reasons. The civilian life is centered around work and pleasure and is essentially consumerist, with a focus on achieving wealth, prosperity, comfort and leisure. Military life is almost the complete opposite. It is centered around a devotion to duty in which one's life is at risk; it centers on the inevitable conflict between persons on opposing sides, in which enemy fire is exchanged.

This duty is inherently self-sacrificing and dependent upon the collective doing its job as a single entity or unit. There is no sense of the individualism that suffuses civilian life and allows for persons to quite when they want, leave when they want, join when they want or pursue their own course or agenda when they want. In the military, orders are always given and expected to be obeyed. This rigid populace, driven by selflessness is also driven by a sense of senselessness and meaninglessness.

In centuries past before materialism and consumerism became the dominating ethos of modern society, military personnel had something of a noble reason to enlist. Today, the nobility is more difficult to effect as a sense of patriotism, nationalism, pride and social or religious belief have dissipated over the years, with many military personnel doubting the capacity for leadership of their elected officials. Civilians must worry less about such issues, as in the end their lives are not on the line the same way that members of service are.

Thus one can see that there are essentially two very different cultures at work in each population. In the overall U.S. population, the culture promotes ease of living and leisure, which results in over-eating and obesity. In the military population, the culture promotes a militaristic attitude that fosters dulled sensitivity and numbness to others, which results in alcohol misuse/abuse, making possible the consequences stemming from that.

The problem is exacerbated in the military as a result of PTSD, MST, and other issues that stem from military conflict and the radicalization of military barracks with the allowance of female combatants in the modern era (a point which complicates the gender issues and complexities of military life) (Burns, Grindlay, Holt, 2014). While alcohol misuse and abuse is also found in the civilian population, there are cultural differences related to its cause.

At the same time, there are different methods of treating alcohol misuse in military personnel than there are in civilians, which stems from the two different cultures of the populations. As Ray (2013) notes, military personnel are brought up in a very specific and highly-tuned culture that is more likely to have psychological effects and ramifications related to combat stresses as well as to the military culture itself and how different it is from civilian culture.

These differences require special attention from counselors and therapists trained in working with military personnel, because civilian counselors are not as aware of the special needs of this population. Best Treatment Practices for Alcohol Misuse in the Military Several positive treatment practices are available for alcohol abuse in the military. One of them is the web-based alcohol intervention used on college campuses for civilians and here "adapted for U.S. military personnel" (Pemberton, 2011, p. 480).

Notably, the Drinker's Check-Up intervention has resulted in "reductions in multiple measures of alcohol use" over a period of 6 months (Pemberton, 2011, p. 480). This modern, web-based system of moderating alcohol consumption can thus have a positive impact on the treatment of alcohol misuse in the military. Another good treatment method is to effect a new workplace environment or culture within the military -- one that does not promote the consumption of alcohol. As Hanwell et al.

(2012) observe, "workplace culture can influence beliefs about acceptable drinking contexts as well as drinking behavior" (p. 6). Creating and maintaining an environment in which the pressure to drink is lessened through positive discourse and training is one a first step in combating the problem in this population. Cognitive behavior therapy (CBT) is also a treatment modality that can be effective in reducing the negative impact of alcohol in the military.

CBT is a type of therapy that is based on directing the patient's thought and activity patterns towards modes of behavior and thinking that are more in line with positive and responsible life styles.

For example, an individual that drinks out of peer pressure, boredom, depression, to fit in, or social custom, may be able to identify with the CBT therapist why he tends to drink heavily or binge drink and how this behavior can be modified by adopting a set of thinking skills that focus on more positive activities that one could do with one's time. Instead of losing sobriety, one might take up a hobby that is more conducive to one's health, such as reading or writing.

What is important in this treatment is that the patient see how his life is being negatively impacted not only by alcohol but by modes of behavior that are both cognitive and emotional that trigger in him an inclination to want to indulge in the dangerous activity. Morean and Cooney (2015) state that one of the best treatment methods is "motivational interviewing," which is helpful in effectively treating alcohol misuse in the military.

Motivational interviewing is helpful because it can effect "client change talk" which has an impact on the client's behavior (Miller, Rose, 2009, p. 531). This method of interviewing is especially helpful because it provides the support that the patient can need in order to work through issues within himself, whereas otherwise he would not receive in the necessary motivation.

The motivation itself is not overwhelming or forceful and in a sense the client provides most of it just by showing up and committing to the therapy, but the therapist must also commit to bringing a desire to see the client transform for the better and that is where motivational interviewing can come into practice and be a game changer. What makes it work is its focus on the patient and its establishment of a link "between client change talk and subsequent behavior change" (Miller, Rose, 2009, p. 531).

This link acts as a bridge between the talking/thinking aloud and the doing that follows. The motivational viewing gives the patient access to the awareness of the "other side" of himself that can be reached, the more positive, successful side, and allows the client.