Objective To determine whether combat-acquired traumatic brain injury (TBI) is associated with post-deployment frequent binge drinking among a random sample of active duty military personnel (ADMP). Participants ADMP who returned home within the past year from deployment to a combat theater of operations and completed a survey health assessment (N = 7,155). Methods Cross-sectional observational study with multivariate analysis of responses to the 2008 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel, an anonymous, random population-based assessment of the Armed Forces. Main Measures Frequent binge drinking: five or more drinks on the same occasion, at least once per week, in the past 30 days. TBI-AC: self-reported altered consciousness only; loss of consciousness of less than 1 minute (TBI-LOC<1); and LOC of 1 minute or greater (TBI-LOC 1+) after combat injury event exposure. Results Of ADMP who had a past year combat deployment, 25.6% were frequent binge drinkers and 13.9% reported experiencing a TBI on the deployment, primarily TBI-AC (7.5%). In regression models adjusting for demographics and positive screen for posttraumatic stress disorder, ADMP with TBI had increased odds of frequent binge drinking compared to those with no injury exposure or without TBI: TBI-AC (AOR 1.48, 95% CI, 1.18–1.84); TBI-LOC 1+ (AOR 1.67, 95% CI, 1.00–2.79). Conclusions TBI was significantly associated with past month frequent binge drinking after controlling for posttraumatic stress disorder, combat exposure, and other covariates.

Iraq and Afghanistan veterans experience extreme stressors and injuries during deployments, witnessing and participating in traumatic events. The military has organized prevention and treatment programs as a result of increasing suicides and posttraumatic stress disorder among troops; however, there is limited research on how to intervene with alcohol misuse and drug use that accompany these problems. This review presents statistics about post-deployment substance use problems and comorbidities, and discusses the military’s dual role in 1) enforcing troop readiness with its alcohol and drug policies and resiliency-building programs, and 2) seeking to provide treatment to troops with combat-acquired problems including substance abuse.

T he Centers for Disease Control and Prevention reported that the number of opioid deaths in 2016 was five times that in 1999, 1 prompting the United States Department of Health and Human Services to declare the opioid crisis a public health emergency. Long-term opioid use is associated with risk for opioid use disorder (OUD), overdose, and death. 2 In 2017, > 40% of suicide and overdose deaths involved known opioid use, which is likely an underestimate. 3 The economic cost of the opioid crisis is estimated at $504 billion or 2.8% of the gross domestic product. 4 OUD most commonly starts with a prescription written by a trusted physician, 5,6 and the uniquely addictive properties of opioid medications have led to disastrous consequences for people of all ages, races, ethnic groups, and income classes, and from all geographic areas. 7-9 Considerable investments have been made by federal agencies to investigate risk factors, develop prevention programs, and promote evidence-based treatments for OUD, but relatively little work has been done to identify subgroups at heightened risk for OUD. Injury prevention requires a detailed understanding of risk factors, contributing factors, and treatment needs.Individuals with traumatic brain injury (TBI) are disproportionately represented in marginalized groups including those who are homeless, incarcerated, and struggling with substance use disorders (SUD), [10][11][12][13][14] and are 10 times more likely to die of an accidental poisoning than the general population. 15 Growing evidence suggests that individuals with TBI may be uniquely susceptible to opioid misuse and the consequences of OUD. 16 Multiple independent risk factors (e.g., high rates of chronic pain, [17][18][19] pre-and post-injury substance misuse, [20][21][22] injury-related neurobehavioral changes, 23,24 overprescribing of opioids, 25,26 and barriers in access to care 27 ) converge for some individuals with TBI, creating a perfect storm of risk for OUD. Each of these factors is independently associated with OUD risk and adverse outcomes, but their convergence in this population makes people who have had a TBI uniquely vulnerable to opioid misuse and its devastating consequences.Acute and chronic pain are prevalent among individuals with TBI, [17][18][19] and poorly managed pain is a common pathway to longterm opioid utilization and OUD. 6,28 Individuals with disabilities in general tend to have high rates of poorly managed or intractable pain, [29][30][31][32] and evidence suggests that persons with TBI are no exception. Data from the TBI Model Systems National Database

Substantial baseline differences between the NIDILRR and VA TBIMS participants warrant caution when comparing rehabilitation outcomes. A substantive number of NIDILRR enrollees had a history of military service (>13%) warranting further focused study. The TBIMS participant data collected across cohorts can be used to help evidence-informed policy for the civilian and military-related healthcare systems.

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SUPIC will examine whether early detection and intervention for post-deployment problems among Army Active Duty and National Guard/Reservists returning from Iraq or Afghanistan are associated with improved long-term substance use and psychological outcomes. This paper describes the rationale and significance of SUPIC, and presents demographic and deployment characteristics of the study sample (N=643,205), and self-reported alcohol use and health problems from the subsample with matched post-deployment health assessments (N=487,600). This longitudinal study aims to provide new insight into the long-term post-deployment outcomes of Army members by combining service member data from the Military Health System and Veterans Health Administration.

These data provide a deeper understanding of pain diagnoses and burden of pain among active duty soldiers. A substantial proportion of soldiers with pain diagnoses were seen for pain self-reported as only mild, or that did not result in significant restrictions in military duty limitations. However, given the prevalence of multiple pain diagnoses and common reports of moderate or severe pain and long duration, complex interventions may be required to minimize the effect of pain on force readiness. This encounters-based analysis is likely an underestimate of presence of pain, and does not include contextual factors that could better describe the true effect of pain among this population.

Background South Carolina (SC) ranks 10th in opioid prescriptions per capita - 33% higher than the national average. SC is also home to a large military and veteran population, and prescription opioid use for chronic pain is alarmingly common among veterans, especially those returning from Afghanistan and Iraq. This paper describes the background and development of an Academic Detailing (AD) educational intervention to improve use of a Prescription Drug Monitoring Program (PDMP) among SC physicians who serve military members and veterans. The aim of this intervention was to improve safe opioid prescribing practices and prevent prescription opioid misuse among this high-risk population. Methods A multidisciplinary study team of physicians, pharmacists, psychologists, epidemiologists, and representatives from the SCs Prescription Monitoring Program (PMP) utilized the Medical Research Council (MRC) complex interventions framework to guide the development of the educational intervention. The theoretical and modelling phases of the AD intervention development are described and preliminary evidence of feasibility and acceptability is provided. Results Ninety-three physicians consented to the study from 2 practice sites. Eighty-seven academic detailing visits were completed, and 59 one-month follow-up surveys were received. Participants rated the academic detailing intervention high in helpfulness of information, intention to use information, and overall satisfaction with the intervention. The component of the intervention felt to be most helpful was the academic detailing visit itself. Characteristics of the participants and the intervention, as well as anticipated barriers to behavior change are detailed. Conclusions Preliminary results support the feasibility of AD delivery to veteran and community patient settings, the feasibility of facilitating PDMP registration during an AD visit, and that AD visits were generally found satisfying to participants and helpful in improving knowledge and confidence about safe opioid prescribing practices. The component of the intervention felt to be most helpful to the participants was the actual academic detailing visit, and most participants rated their intentions high to use the information and tools from the visit. Intervention key messages, preliminary outcome measures, as well as successes and challenges in developing and delivering this intervention are discussed in order to advance best practices in developing educational interventions in this important area of public health.