Exploration of the association of selected pain diagnoses with risky alcohol use among active duty soldiers

Abstract

Background

Pain and its consequences remain of concern, particularly in high-risk occupations such as the military. Alcohol is a legal and accessible means of self-medication, and risky alcohol use is associated with potentially serious consequences. This exploratory analysis aimed to better understand the association of selected pain diagnoses with risky alcohol use among soldiers returning from deployment. Methods: Analysis of data from active duty soldiers returning from Afghanistan or Iraq deployments in fiscal years 2008–2011 who completed Department of Defense health questionnaires after deployment (n = 267,100). Each questionnaire included self-reported alcohol consumption and items yielding AUDIT-C screening scores. Military Health System data were used to identify diagnoses of pain-related conditions. Results: About 70% of soldiers had none of the selected pain diagnoses either pre- or post-deployment. 10% had incident pain diagnoses (only post-deployment), 7% had persistent pain diagnoses (both pre- and post-deployment), and 13% had remitted pain diagnoses (only pre-deployment). On the AUDIT-C, 39% screened positive for at-risk drinking and 6% were likely to have severe alcohol problems. Half of the respondents reported any binge drinking; 20% at least monthly binge drinking. Logistic regression analyses found reduced odds of risky alcohol use post-deployment in association with incident and persistent pain diagnoses, compared to no pain diagnoses pre- or post-deployment. Conclusions: Pain diagnoses, binge drinking, and risky alcohol use were prevalent among this sample of Army soldiers. An inverse relationship was found between pain diagnosis (incident, persistent) and risky alcohol use post-deployment. Attention should continue to be paid to risky alcohol use in this population, yet these exploratory findings do not suggest that soldiers with the pain diagnoses used in this study are at greater risk. Combat exposure, traumatic brain injury, and psychological health were more important predictors, and should continue to warrant enhanced alcohol screening.

Keywords:

• Military personnel
• pain
• alcohol drinking
• alcohol-related disorders

Acknowledgements

We thank Beth Mohr Dana and Sue Lee for statistical programing. We acknowledge Kennell and Associates, Inc. for compiling the data files used in these analyses. Chester Buckenmaier, III, M.D., of the Uniformed Services University is the Department of Defense (DoD) data sponsor. Thomas V. Williams, Ph.D., formerly of the Defense Health Agency, was the data sponsor at the time these analyses were conducted. The Defense Health Agency’s Privacy and Civil Liberties Office provided access to DoD data. The opinions and assertions herein are those of the authors and do not necessarily reflect the official views of the Uniformed Services University, the DoD or the National Institutes of Health. Preliminary versions of these results were presented at the American Pain Society annual conference May 2016 and the Research Society on Alcoholism annual meeting May 2016.

Disclosure statement

The authors declare no conflicts of interest.

Author contributions

SR developed the research questions and plan for this paper, and led analyses, interpretation, and writing of the manuscript. RSA participated in development, analysis, interpretation and writing. GAR oversaw the analyses, participated in interpretation, and reviewed the manuscript. MJL led the overall study from which these data were drawn, and participated in development, analysis, interpretation and writing for these analyses.

Additional information

Funding

This study was funded by the National Center for Complementary and Integrative Health [NCCIH; R01 AT008404], with support to develop the study cohort from the National Institute on Drug Abuse [NIDA; R01 DA030150]. The funding agencies had no role in study design, data collection, analysis or interpretation of data, writing or review of the manuscript, or decision to submit the manuscript for publication.