Risk factors for relapse to problem drinking among current and former US military personnel: A prospective study of the Millennium Cohort

Williams, Emily C.; Frasco, Melissa A.; Jacobson, Isabel G.; Maynard, Charles; Littman, Alyson J.; Seelig, Amber D.; Crum-Cianflone, Nancy F.; Nagel, Anna

doi:10.1016/j.drugalcdep.2014.12.031

Cited by 32 publications

(35 citation statements)

References 61 publications

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“…Because participants in the intervention condition reported significantly greater decreases in alcohol use outcomes than those in the control condition (Pedersen, Parast, et al, 2017), intervention condition was included as a covariate in all analyses. Analyses also controlled for gender, age, combat severity, PTSD, and depression, all of which have been associated with alcohol use in military and veteran samples (Bray, 2013; Fuehrlein et al, 2014; Scott et al, 2013; Williams et al, 2015). Primary outcome analyses were conducted using hierarchical regression.…”

Section: Methodsmentioning

confidence: 99%

“…Specifically, 71.5% report difficulty falling or staying asleep and 72.3% report fewer than seven hours of sleep per night (Swinkels et al, 2013). Such sleep disturbances have been associated with increased odds of alcohol use and related problems among military personnel and veterans (Luxton et al, 2011; Swinkels et al, 2013; Williams et al, 2015). While the precise mechanisms underlying these associations are unclear, evidence suggests that chronic sleep restriction (which is functionally similar to the sleep patterns of individuals with insomnia) leads to deficits in attention and working memory (Alhola & Polo-Kantola, 2007; Benitez & Gunstad, 2012; Fortier-Brochu & Morin, 2014), which may then lead to a greater propensity for poor decision-making and increased risk of alcohol problems.…”

Section: Introductionmentioning

confidence: 99%

“…Consistent with research among college students (Kenney et al, 2012; Miller, DiBello, et al, 2016), we hypothesized that insomnia would moderate the association between alcohol use and consequences, such that drinking quantity would be associated with more alcohol-related consequences in the context of insomnia. To isolate the contribution of insomnia to alcohol use outcomes, we controlled for symptoms of depression and PTSD, which have been associated with alcohol use in this population (Fuehrlein et al, 2014; Williams et al, 2015). Results of this study are expected to inform intervention efforts for young adult veterans by identifying behavioral patterns that increase risk of alcohol problems.…”

Section: Introductionmentioning

confidence: 99%

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Insomnia moderates the association between alcohol use and consequences among young adult veterans

Miller

DiBello

Carey

et al. 2017

Addictive Behaviors

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Objective Symptoms of insomnia and heavy alcohol use tend to co-occur among military and veteran samples. The current study examined insomnia as a moderator of the association between alcohol use and related consequences among young adult veterans in an effort to extend and replicate findings observed in samples of civilian young adults. Method Young adult veterans (N = 622; 83% male; age M = 29.0, SD = 3.4) reporting alcohol use in the past year completed measures of insomnia severity, alcohol use, and alcohol-related consequences as part of a larger intervention trial. Participants were classified as screening ‘positive’ (n = 383, 62%) or ‘negative’ (n = 239, 38%) for insomnia using the Insomnia Severity Index. Hierarchical regression was used to examine the interaction between drinking quantity and insomnia on alcohol-related consequences. Predictor and outcome variables were measured concurrently. Results Both a greater number of drinks per week and a positive insomnia screen were associated with more alcohol-related consequences. Drinks per week and insomnia screen interacted to predict alcohol-related consequences, such that the effect of drinking on alcohol-related consequences was stronger in the context of a positive versus negative insomnia screen. Conclusion Drinking is associated with more alcohol-related consequences in the presence of clinically significant insomnia symptoms. These findings replicate those documented in civilian young adults and indicate that insomnia may be an appropriate target for alcohol prevention and intervention efforts among young adult veterans.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Insomnia moderates the association between alcohol use and consequences among young adult veterans

Miller

DiBello

Carey

et al. 2017

Addictive Behaviors

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“…Symptoms of depression and PTSD, for example, have been associated with relapse to problematic drinking among service members and Veterans who had remitted naturally over time (Williams et al, 2015). They have also been associated with a greater number of drinking-related symptoms among Veterans with alcohol use disorders (Fuehrlein et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…Insomnia severity has also been associated cross-sectionally with alcohol-related consequences among those exposed to combat (Wright et al, 2011). In longitudinal studies, decreased pre-deployment sleep has been associated with higher risk of post-deployment depression and PTSD (Seelig et al, 2010), and difficulty falling/staying asleep has been found to predict relapse to problem drinking up to three years later among military personnel and Veterans who had naturally remitted (Williams et al, 2015). …”

Section: Introductionmentioning

confidence: 99%

Insomnia severity as a mediator of the association between mental health symptoms and alcohol use in young adult veterans

Miller

DiBello

Carey

et al. 2017

Drug and Alcohol Dependence

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Purpose Prior research has documented associations between mental health and alcohol use, mental health and insomnia, and insomnia and alcohol use. This study examined insomnia severity as a mediator of the association between mental health and alcohol-related outcomes in young adult veterans. Procedures Veterans aged 18 to 34 years (N = 622, 83% male) who reported drinking in the past year completed assessments at baseline and one-month follow-up as part of a larger intervention trial. Participants reported symptoms of depression and posttraumatic stress disorder (PTSD) at baseline, insomnia severity at one month, and alcohol use and related consequences at baseline and one month. Mediation analyses using bootstrapped confidence intervals were used to examine the indirect effects of baseline mental health symptoms on alcohol-related outcomes at one month via insomnia severity. Main Findings Insomnia severity was associated with both drinking quantity and alcohol-related consequences. Greater depressive (but not PTSD) symptoms were associated directly with more alcohol-related consequences. Neither depressive nor PTSD symptoms had direct effects on drinking quantity when controlling for the other mental health symptoms (e.g., depressive symptoms did not predict drinking quantity when controlling for symptoms of PTSD). However, symptoms of depression and PTSD predicted drinks per week and alcohol-related consequences indirectly through insomnia severity. Conclusions Symptoms of depression and PTSD increase risk for alcohol use and related consequences in part by increasing symptoms of insomnia. Findings suggest that insomnia may be an appropriate target for prevention and intervention efforts among heavy-drinking Veterans reporting symptoms of depression or PTSD.

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Patterns of Smoking and Unhealthy Alcohol Use Following Sexual Trauma Among U.S. Service Members

Seelig

Rivera

Powell

et al. 2017

Journal of Traumatic Stress

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In the first known longitudinal study of the topic, we examined whether experiencing sexual assault or sexual harassment while in the military was associated with increased risk for subsequent unhealthy alcohol use and smoking among U.S. service members in the Millennium Cohort Study (2001-2012). Adjusted complementary log-log models were fit to estimate the relative risk of (a) smoking relapse among former smokers (men: n = 4,610; women: n = 1,453); (b) initiation of unhealthy alcohol use (problem drinking and/or drinking over recommended limits) among those with no known history of unhealthy alcohol use (men: n = 8,459; women: n = 4,816); and (c) relapse among those previously reporting unhealthy alcohol use (men: n = 3,487; women: n = 1,318). Men who reported experiencing sexual assault while in the military had sixfold higher risk for smoking relapse: relative risk (RR) = 6.62; 95% confidence interval (CI) [2.34, 18.73], than men who did not. Women who reported experiencing sexual assault while in the military had almost twice the risk for alcohol relapse: RR = 1.73; 95% CI [1.06, 2.83]. There were no other significant associations. These findings suggest that men and women may respond differently following sexual trauma, and support future concerted policy efforts by military leadership to prevent, detect, and intervene on sexual assault.

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Risk factors for relapse to problem drinking among current and former US military personnel: A prospective study of the Millennium Cohort

Cited by 32 publications

References 61 publications

Insomnia moderates the association between alcohol use and consequences among young adult veterans

Insomnia moderates the association between alcohol use and consequences among young adult veterans

Insomnia severity as a mediator of the association between mental health symptoms and alcohol use in young adult veterans

Patterns of Smoking and Unhealthy Alcohol Use Following Sexual Trauma Among U.S. Service Members

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