however, the author concluded that the effects of combat were small and that preservice alcohol and antisocial problems were stronger predictors.

Reifman and Windle (1996) conducted a secondary analysis of VES data on illicit drug use on the basis of self-reports from 2490 Vietnam veterans. The VES was conducted in 1985-1986. They found that combat exposure severity was significantly related to drug use in the preceding year (OR 1.01, 95% CI 1.01-1.02); the relationship remained even after controlling for PTSD.

Prigerson et al. (2002) conducted a secondary analysis of data from the 1990-1992 NCS, a national survey of mental health and substance abuse in the general population (Kessler et al. 1995). They found that combat exposure, mostly in the Vietnam war, contributed significantly and directly to 12-month substance abuse with an estimated relative risk of 2.22 (8.0% attributable to combat exposure; 95% CI 1.06-4.15) adjusted for age, race, urbanicity, and low socioeconomic status in the family of origin. An analysis of 641 Australian Vietnam veterans also found that severity of combat exposure based on a combat exposure scale developed for the study was significantly associated (p = 0.007) with current (1-month) alcohol abuse or dependence with ORs of 1.00, 1.21, 1.42, and 2.21 for increasing quartiles of combat exposure; no association with drug abuse or dependence was seen with ORs of 1.00, 2.83, 1.21, 1.74, respectively (O’Toole et al. 1996a).

Four surveys of Gulf War veterans also included items on alcohol and drug-abuse symptoms. In telephone interviews with 1545 Gulf War-deployed and 435 nondeployed veterans living in Kansas in 1998, Steele (2000) included “alcohol or drug dependence” as one of 37 conditions on a checklist. Veterans indicated whether they had been diagnosed or treated by a physician for any condition with new onset during 1990-1998. Prevalence was similar in the deployed (3%) and nondeployed (2%) groups for a nonsignificant OR of 1.47 (95% CI 0.65-3.31) adjusted for sex, age, income, and education level.

In 2002, Jones et al. (2006) mailed questionnaires to 1382 UK armed forces personnel that included three items from AUDIT (how often the person drank in the preceding 12 months, how many drinks are usually consumed when the person drinks, and whether a relative, friend, or doctor was ever concerned or suggested that the person cut down). They found that being deployed to more than one country (as opposed to never or to one country) within the preceding 5 years was significantly related to excessive alcohol intake (OR 2.3, 95% CI 1.5-3.6, p < 0.001).

McCauley et al. (2002b) conducted a telephone survey of 653 Gulf War-deployed troops who had been near the Khamisiyah munitions site in Iraq in March 1991, 610 troops deployed elsewhere in the gulf, and 516 troops not deployed to Southwest Asia. The questionnaire focused on medical conditions that had been diagnosed by a physician since the Gulf War. The comparison of deployed with nondeployed veterans was not significant for combined alcohol or substance abuse (OR 1.7, 95% CI 0.9-3.4).

Dlugosz et al. (1999) examined risk factors for hospitalization for a mental disorder after service in the Gulf War. In active-duty men (n = 1,775,236) and women (n = 209,760) in the U.S. Army, Air Force, Navy, and Marine Corps, the investigators identified 30,539 initial postwar hospitalizations. Adjusted incidence risk ratios showed that service in the Gulf War in a combat occupation was associated with an increased risk of hospitalization for alcohol-related disorders (risk ratio 1.13, 95% CI 1.04-1.23) although being in a combat support occupation was not (risk ratio 1.00, 95% CI 0.91-1.11). However, being in the war in a support occupation was associated with an increased risk of drug-related hospitalization (risk ratio 1.42, 95% CI 1.03-1.96), although being in a combat occupation was not (risk ratio 1.16, 95% CI 0.82-1.65).

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