title: Civilian stressors associated with alcohol use disorders in the National Guard.
abstract: BACKGROUND
  Alcohol use disorders are a serious public health concern among soldiers. Although deployment-related exposures have been linked with alcohol use disorders in soldiers, less is understood about the link between modifiable, civilian stressors and post-deployment alcohol use disorders.
  
  
  OBJECTIVE
  To (1) compare the influence of civilian stressors and deployment-related traumatic events and stressors on post-deployment alcohol use disorders among Army National Guardsmen primarily deployed to Afghanistan and Iraq; and (2) evaluate whether civilian stressors influence a different set of alcohol use disorder phenotypes than deployment-related traumatic events and stressors.
  
  
  METHODS
  A cohort of Ohio National Guard soldiers was recruited in 2008-2009 and interviewed three times over 3 years. The analytic sample included Ohio National Guard soldiers who had been deployed by 2008-2009, had participated in at least one follow-up wave, had reported consuming at least one alcoholic drink in their lifetime, and had non-missing data on alcohol use disorders (n=1,095). Analyses were conducted in 2013.
  
  
  RESULTS
  In a model including measures of civilian stressors and deployment-related traumatic events, only civilian stressors (OR=2.07, 95% CI=1.46, 2.94) were associated with subsequent alcohol use disorder. The effects of civilian stressors were only present among people with no history of alcohol use disorder.
  
  
  CONCLUSIONS
  Independent of deployment-related exposures, post-deployment civilian stressors are associated with the onset of alcohol use disorder among reserve-component soldiers. Concerted investment to address daily civilian difficulties associated with reintegration into civilian life may be needed to prevent new cases of alcohol use disorders among returning military personnel.
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York. Electronic address: mc3226@columbia.edu.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Cerdá
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
authors.forename: Catherine
authors.initials: C
authors.lastname: Richards
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
authors.forename: Greg H
authors.initials: GH
authors.lastname: Cohen
authors.affiliation: Department of Psychiatry, Case Western Reserve University, Cleveland.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Calabrese
authors.affiliation: Department of Psychology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Israel
authors.initials: I
authors.lastname: Liberzon
authors.affiliation: Department of Psychiatry, University of Toledo, Toledo, Ohio.
authors.forename: Marijo
authors.initials: M
authors.lastname: Tamburrino
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
authors.forename: Karestan C
authors.initials: KC
authors.lastname: Koenen
mesh_terms: D055826:Afghan Campaign 2001-; D019973:Alcohol-Related Disorders / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D009820:Ohio; D013315:Stress, Psychological / Q000150:complications* / Q000453:epidemiology / Q000209:etiology
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