Moreover, Gulf War veterans were not significantly different from their nondeployed counterparts with regard to psychiatric comorbidities at the time of initial hospitalization.

In 2003, Hoge et al. (2004) administered an anonymous survey to Army and Marine troops 1 week before a year-long (Army) or 6-month (Marines) deployment to Iraq or Afghanistan (n = 2530) and 3-4 months after return from combat duty (n = 3671). The survey asked two questions about problems related to the use of alcohol. The rates of alcohol misuse were lower before deployment than after. Specifically, before deployment to Iraq, 17.2% of the soldiers indicated using alcohol more than they meant to, after deployment to Iraq 24.2% did (OR 1.5, 95% CI 1.3-1.9) as did 24.5% after deployment to Afghanistan (OR 1.6, 95% CI 1.4-1.8). In addition, before deployment to Iraq, 12.5% of the soldiers said that they felt a need to cut down on their drinking, after deployment to Iraq, 20.6% indicated a need to cut down (OR 1.8, 95% CI 1.5-2.2) as did 18.2% after deployment to Afghanistan (OR 1.6, 95% CI 1.3-1.9). Although the before and after findings were not matched by individual, these results are consistent with greater problem drinking being associated with deployment to a war zone.

Thus, the findings from the Vietnam War, Gulf War, and OEF and OIF surveys that included screening measures of alcohol or drug problems are somewhat mixed, but the majority of studies point in the direction of increased substance problems as a function of deployment.

Posttraumatic Stress Disorder and Substance-Use Disorders

It is well established that alcohol use and drug use are comorbid with PTSD and other psychiatric conditions in clinical and nonclinical populations of veterans and nonveterans (Jacobsen et al. 2001; Kessler et al. 1995; Mellman et al. 1992; Sutker et al. 1993a). It has been suggested that the high rates of comorbidity between PTSD and substance-use disorders show that they may be functionally related to each other (Jacobsen et al. 2001). O’Toole et al. (1998) found that Australian Vietnam veterans with PTSD were at higher risk for alcohol abuse or dependence (OR 1.6, 95% CI 1.2-2.1) and for drug abuse and dependence (OR 5.4, 95% CI 1.9-15.5) than era veterans. Koenen et al. (2003a), in a study of Vietnam veterans from the NVVRS, found that combat-related PTSD unadjusted for combat exposure was significant only for drug dependence (OR 2.26, 95% CI 1.05-4.88) but not for alcohol or cannabis dependence (OR 1.39, 95% CI 0.76-2.56 and OR 2.24, 95% CI 0.95-5.31, respectively).

An analysis of data from the Fort Devens Gulf War cohort (n = 1006) indicated that alcohol and drug use were significantly associated with the cardinal PTSD symptoms of avoidance, re-experiencing, and hyperarousal (Shipherd et al. 2005). A 1999 study of 1101 Canadian male peacekeepers using AUDIT and the PTSD Checklist-Military Version found significantly more alcohol problems in those with PTSD and a significant trend for AUDIT scores to increase with level of PTSD (none, subthreshold, and full) (Yarvis et al. 2005). Furthermore, Ouimette et al. (1996) found a positive correlation between severity of PTSD symptoms and severity of substance-abuse symptoms in 52 women who served overseas during the Vietnam era.

Summary and Conclusions

Studies of troops deployed to Vietnam and the Persian Gulf have consistently found higher rates of substance-use problems than in nondeployed controls. Of the six primary studies, three are of Vietnam veterans and three are of Gulf War veterans. Data from the VES and the NVVRS showed that deployment was associated with alcohol use, although only the NVVRS



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