Alcohol abuse is one of the greatest problems in the modern world. It touches on people of almost any age, social status, profession, and place of residence. Alcoholism is a significant cause of morbidity and mortality in spite of the progress relating to neurobiological studies revealing new pharmacological strategies for its treatment (Johnson, 2010).
Alcohol abuse is often associated with deviant behavior, posttraumatic stress disorder, risky driving, violence, and other social hazards. Every type of alcoholism has its causes, consequences, and treatments. Current paper will discuss a problem of alcohol abuse and dependence in the military, as well as define main reasons and explore the most effective treatments for this disease.
Several studies acknowledge increased consumption of alcohol in the military. The reasons for this phenomenon may be diverse, but the most common of them will be presented in the paper. Although many veterans are at the heightened risk of psychiatric disorders, limited studies have focused on alcohol use disorder (Kelsall et al., 2015). While the alcohol abuse can be the problem of any military staff, the risk grows with the pressure of stressful irritants (Bartone, Hystad, Eid, & Brevik, 2012).
Heavy drinking among military troops is related with auto crashes, violence, and self-harm. It is also linked to disruption of functioning and performance loss. Alcohol dependence is connected with violation such as physical and emotional problems impeding social life and causing the decline in work productivity (Hanwella, de Silva, & Jayasekera, 2012).
The impact of stress conditions such as military deployment can be related to both increase and reduction of alcohol consumption. However, few researches have explored the factors, which predict the use of alcohol after stressful situations. Alcohol abuse is a principal issue of mental health among the military staff. There are evidences that deployed soldiers are at the high risk of encountering problems associated with alcohol. In the large-scale study, 8.8% of interviewed soldiers reported heavy weekly drinking (Trautmann et al., 2015).
However, while there was an increase in alcohol consumption among mobilized troops, most soldiers did not show an increase in the level of alcohol consumption. Moreover, some groups of the deployed personnel showed a decrease in the alcohol intake. The psychological flexibility is inversely related to PTSD symptoms and social assistance influences the soldiers mental health positively. Trautmann et al. (2015) have examined changes in alcohol consumption after the deployment in their study. They have come to the following results:
- less educated and lower ranked deployed soldiers have increased their everyday alcohol consumption;
- growth in everyday alcohol intake influences sleeping problems, negative behavior, and the shortcoming of social support;
- the decrease in everyday alcohol use is related to the lower rate of PTSD symptoms before deployment and absence of emotional oppression in childhood.
Kelsall et al. (2015) in their research considered that Iraq/Afghanistan veterans and Gulf War veterans were at the higher risk of alcohol use disorder than those who were not deployed to combat areas. Moreover, reservists were more prone to alcohol abuse than the regular staff deployed to Iraq or Afghanistan. Obviously, the problem has psychological causes. Probably, if a soldier enters the combat spot, his psychic suffers from severe stress, but in the shock condition he instinctively acts with maximum effectiveness to perform a task or to survive. However, when the intensity of the conflict is reduced and shock passes, the psychological trauma manifests.
Thus, if a soldier does not receive psychological and social assistance, there is a high risk of alcohol abuse (and then alcohol dependence) used with the aim of reducing mental damage manifestations. The increasing totality of evidence concerning the influence of comorbidity on the curing of psychological disorders and the additional effect of alcohol consumption disorders and depression among suicide decedents emphasize the significance of early detection of alcohol intake problems and an integrated approach to healing veterans (Kelsall et al., 2015).
While the problem of the alcoholism has always existed in the military, recently there has been a tendency of increase in binge and heavy drinking. In 2008, the Department of Defense Health Behavior Survey found that heavy alcohol drinking had considerably risen between 1998 and 2008. The difference was 5%. During the research, the following facts were revealed:
- between 1980 and 1988 the heavy use decreased;
- between 1988 and 1998 there were some oscillations in heavy drinking;
- from 1998 to 2002 the level of alcohol consumption had risen significantly;
- from 2002 to 2008 the heavy drinking continued to rise gradually.
With the intensity of drinking, serious consequences increase. Besides, the military staff, which were deployed and subjected to combat conditions, had significantly higher level of binge drinking, heavy drinking, and harmful alcohol use than those who did not have combat pressure (Bray, Brown, & Williams, 2013).
Another factor influencing alcohol abuse in the army is psychological characteristics of each person. Most deployed and combat-exposed soldiers do not discuss stress-associated problems, which enables alcohol abuse and dependence. In fact, the majority of the military personnel overcomes and adjusts rather well. The question is then what serves as the cause of these personal distinctions in vulnerability to alcohol abuse influenced by stress conditions. One eventual explanation lies in psychological qualities generalized as hardiness.
Hardiness was first determined as a set of interconnected attributes or individual trends that differentiated people who stayed healthy in acute shortage of jobs and stress from those who fell ill. These qualities are generalized as: unfailing confidence that life is interesting and worth living; conviction that one can control or affect results; and an adventurous, exploring approach to life. Hardiness also can be defined as a lifestyle, which includes ones self-esteem, world outlook, and fundamental approach to coping with life situations.
Since the hardy style of life is connected with resistance under stress conditions, it has been defined as the hardy-resistant style. In addition, the hardy-resistant style individual shows a strong future orientation and the trend to be optimistic about the future while learning from the past. Moreover, the hardy-resistant human is virile in front of new experiences and frustrations, is active and competent, and has a good sense of humor (Bartone et al., 2012).
Traumatic Brain Injury
According to Heltemes, Dougherty, MacGregor, and Galarneau (2011), mild traumatic brain injury (MTBI) may be the factor affecting the level of alcohol abuse in the U.S. Army. They considered that a higher number of soldiers with MTBI was diagnosed with the alcohol use disorder than the number of the members with other injuries. The correlation between traumatic brain injury (TBI) and post-injury alcohol consumption in civilians and military staff has not been clearly determined.
In civilians with TBI, alcohol consumption before trauma (or intoxication during the trauma) is usual, but has a tendency of reducing after the wound. This mood variation among civilians may be caused by identification of alcohol consumption as a problem. Unlike civilians, combat-linked TBI, which occurs amidst the military staff, does not take place in relation to alcohol intoxication during the wounding; alcohol is largely governed and inaccessible in military combat areas (Heltemes et al., 2011).
This difference between civil and military situations can be explained from a psychological position. While for a civilian injury can be an outcome of alcoholism, it can help to realize damning consequences of alcohol abuse. For the military personnel, the reason of the injury is war and alcohol is a way to drown out the psychological trauma. In other words, death threat can stop alcohol consumption, but the military have developed a resistance to this threat.
Therefore, this psychological treatment method will not achieve the desired effect. Besides, heavy drinking can be linked with restrictions caused by health problems or poor social functioning after deployment (Waller, McGuire, & Dobson, 2015). Nonetheless, alcohol abuse is spread after the deployment and is a substantial catalyst of morbidity in the U.S. Army.
The main conditions and causes of alcohol abuse and dependence in the military have been described. As a result, it can be concluded that the main causes have a psychological character and are related with stresses in combat zones. The first step in the determination of alcohol abuse or alcohol dependence is for the physician to collect patient's anamnesis efficiently during hospital visits, as well as in the ambulatory or municipal hospitals (Johnson, 2010).
Obviously, the psychologically caused disease needs primarily psychological treatment. Despite this, psychological dependence on alcohol may be closely connected with physical dependence. Thus, pharmacological treatment may also have a positive effect on the treatment of alcohol dependence. The measures of social rehabilitation can be used for treatment as a part of psychological therapy. In cases of sudden cessation of alcohol consumption, detoxification is used, whereby measures are taken to prevent the abstinence syndrome. A description of these methods is the following.
The methods of psychological influence on patients help to secure the negative attitude of the patients to alcohol consumption and prevent the recurrence of the disease. The first step in curing should be to reach the agreement in the drinking aim with the patient. Whilst the gold standard for a positive healing exodus is total abstinence, some patients require assistance towards the objective by setting lower levels of drinking (Johnson, 2010).
With the positive outcome of the psychological methods, the patients worldview attitude is formed. This worldview attitude implies that the patient can live and cope with problems and difficulties without the "help" of alcohol, other methods, and techniques. The measures of the social rehabilitation of the patient are intended to restore the patient as a person and reintegrate him into the structure of the society.
Posttraumatic Stress Disorder
The problem of alcohol abuse and dependence in the military is strongly associated with posttraumatic stress disorder acquired in combat zones. The PTSD is the major psychological cause of alcoholism in the military. Therefore, in many cases, patients with alcoholism should be treated from the PTSD as the main reason for alcohol use disorder. Posttraumatic stress disorder (PTSD) is a widespread and often incapacitating condition. Luckily, effective psychological treatments for the PTSD are approachable (Ronconi, Shiner, & Watt, 2014).
The results of the research article A Multidimensional Meta-Analysis of Psychotherapy for PTSD by Bradley Greene, Russ, Dutra, and Westen (2005) demonstrate that psychotherapy for the PTSD causes a great positive enhancement as compared with basic conditions. Most patients who have finished the treatment with different forms of cognitive behavior therapy or eye movement desensitization and reprocessing have felt better. Most patients cured with the help of psychotherapy for the PTSD recuperate or rectify, making these approaches some of the most effective psychosocial treatments. Most patients still have significant residual symptoms after the therapy.
Drug Treatment Called Aversive Therapy
Drug treatment is used for the suppression of alcohol dependence and eliminates disturbances caused by chronic alcohol intoxication. In fact, all drug treatment methods are based on fixing patients fear of dying because of incompatibility of the entered drug and alcohol consumption and the resulting substance formed in the organism leading to serious health consequences, including death.
This method of treatment is called aversive therapy. Johnson (2010) in the article Medication Treatment of Different Types of Alcoholism offers some drugs that influence neural pathways, which modulate the activity of the cortico-mesolimbic dopamine system and change drinking behavior. Ondansetron, naltrexone, topiramate, and baclofen are in the list of these drugs.
Ondansetron is used to improve drinking results in patients with early-onset alcohol dependence. Side effects are mellow and the initial dosage of 4 g/kg twice daily is necessary during the therapy. Unfortunately, ondansetron is not presently available for sale at the therapeutic dose for alcohol dependence, which is why it is not a practical alternative beyond study treatment settings (Johnson, 2010).
Naltrexone is used to minimize the desire for alcohol consumption, encourages abstinence, and reduces pleasurable effects of alcohol. Naltrexone is also prescribed during the continuation of the use of alcohol. The positive reaction to the action of naltrexone should be increased among those with a family history of alcohol dependence. Naltrexone ought to be procured at a dosage up to 100 mg/day after the patient has been abstinent for 3 to 5 days. Treatment ought to be continued for as long as possible (Johnson, 2010).
Topiramate appears to improve all drinking results, including a decline of heavy drinking and maintenance of abstinence. Topiramate produces anti-drinking effects by cortico-mesolimbic dopamine system modulation. Topiramate also reduces the medical aftermath of alcohol dependence, including adiposity, hypertension, liver impairment, and high cholesterol. Topiramate is generally well-tolerated. Topiramate has an additional benefit, which is a reduced risk of developing liver impairment since it is excreted mostly unchanged by the kidneys (Johnson, 2010).
Baclofen can be helpful in treating alcohol dependence, especially in patients with a liver disorder. Baclofen is eliminated from the organism mainly by the kidneys. In contrast to topiramate, baclofen is injected to patients who have already become abstinent. While baclofen can help in decreasing abstinence symptoms, its discontinuation ought to be gradual to prevent appearance of abstinence symptoms of its own (Johnson, 2010).
Disulfiram causes heavy sickness with alcohol and a joint reception with cyanamide of calcium leads to the cessation of alcohol consumption in more than fifty percent of cases. It is also possible to receive only a calcium cyanamide, which has the action similar to disulfiram, but has the advantage of the absence of hepatotoxicity and drowsiness.
Detoxification means intravenous-drip injections of the medication to correct the physical condition during the sudden cessation of alcohol intake. As a rule, detoxification is performed in conjunction with drugs such as benzodiazepines, which have a similar effect to alcohol and are used to prevent the abstinence syndrome (a group of symptoms that occur after the cessation of alcohol).
Persons who are at risk of only mild to moderate withdrawal symptoms can undergo detoxification at home. Afterwards, there should be organized a treatment program for alcohol dependence to reduce the risk of recurrence. Benzodiazepines are used to cause abrupt cessation of alcohol consumption and their long-term use can lead to the deterioration of alcoholism. Alcoholics constantly using benzodiazepines rarely achieve abstinence from alcohol.
Complex methods combine several techniques. These methods may include use of drugs and psychotherapy or psychological impact and social rehabilitation. One of these methods is "Spanish" and it includes psychotherapy, drug therapy, and work with people who surround the alcoholic. An example is the research of Foa et al. (2013) Concurrent Naltrexone and Prolonged Exposure Therapy for Patients with Comorbid Alcohol Dependence and PTSD: A Randomized Clinical Trial. During the study, treatment with naltrexone was performed along with a simultaneous long-term therapy of psychological support.
Prolonged impact therapy composed of 12 weekly 90-minute sessions followed by with six biweekly sessions, revision of traumatic recollections, and discussion of thoughts and feelings related to the revision of the recollections. Patient's homework composed of re-listening to the recording of reinterpretation made at the time of the session and repeated in safe situations to ensure a positive impact previously unattainable because of the trauma-associated distress. When the patient showed no or minimal distress during reinterpretation of the traumatic recollections, the following sessions focused on other psychosocial issues (Foa et al., 2013).
Saint Leo Universitys core values, if implicated as the primary principles of the alcohol abuse and dependence treatment, will become a foundation of a successful healing outcome. The value of the community creates favorable psychological conditions for easier and more effective treatment of alcohol disorder issues. It contributes an ambiance of belonging, cohesion, and interdependence based on reciprocal credibility and esteem to create socially responsible surroundings that encourage to listen, to study, and to improve.
The excellence core value makes physicians, who conduct psychological therapy of patients dependent on alcohol, morally responsible for their job and encourages them toachieve excellent results. The value of respect enables to appreciate features of every patient and regard them with the respect. The core value of personal development promotes an individual approach to each patient with the simultaneous development of the best qualities. Individual development awakens in the patient the thirst for life and becomes a profitable alternative to alcohol. The direction of all the methods and principles of the treatment in implementation of the single mission of getting rid of alcohol addiction in the military realizes the core value of integrity.
The Problem of Military Alcoholism
The problem of alcohol abuse and dependence in the military has been discussed in the paper. The military alcoholism has particular reasons, often distinct from common causes of civil alcoholism due to professional features. It is primarily related to the post-traumatic stress syndrome, which deployed soldiers develop while being located in combat zones. Based on the data obtained from the study, it can be stated that the tense situation in combat areas impacts greatly the soldiers psychological health and alcohol becomes a way to drown out the psychological trauma.
However, surrounding conditions are not always the determining factor in the acquisition of alcohol dependence and abuse. The researches show that personal characteristics of every soldier are a significant factor preventing or aggravating alcohol consumption during and after the deployment. Taking into account the specificity of the problem of alcoholism in the army, psychological therapy can be considered as the most effective treatment for alcohol abuse and dependence in the military. This statement can be substantiated with the fact that the reasons for the military alcoholism are mostly psychological.
Therefore, treatment of the cause must be psychological as well. Pharmacologic treatment can be useful to neutralize consequences of alcohol abuse such as physiological affection, intoxication, withdrawal syndrome, disruption of the liver, and delirium tremens. However, during the treatment the main emphasis should be on the psychological improvement. Additionally, the program of social adaptation is important and even necessary for the demobilized military as a part of psychological therapy.