title: Risk factors for relapse to problem drinking among current and former US military personnel: a prospective study of the Millennium Cohort.
abstract: BACKGROUND
  Military service members may be prone to relapse to problem drinking after remission, given a culture of alcohol use as a coping mechanism for stressful or traumatic events associated with military duties or exposures. However, the prevalence and correlates of relapse are unknown. We sought to identify socio-demographic, military, behavioral, and health characteristics associated with relapse among current and former military members with remittent problem drinking.
  
  
  METHODS
  Participants in the longitudinal Millennium Cohort Study who reported problem drinking at baseline (2001-2003) and were remittent at first follow-up (2004-2006) were included (n=6909). Logistic regression models identified demographic, military service, behavioral, and health characteristics that predicted relapse (report of ≥1 past-year alcohol-related problem on the validated Patient Health Questionnaire) at the second follow-up (2007-2008).
  
  
  RESULTS
  Sixteen percent of those with remittent problem drinking relapsed. Reserve/National Guard members compared with active-duty members (odds ratio [OR]=1.71, 95% confidence interval [CI]: 1.45-2.01), members separated from the military during follow-up (OR=1.46, 95% CI: 1.16-1.83), and deployers who reported combat exposure (OR=1.32, 95% CI: 1.07-1.62, relative to non-deployers) were significantly more likely to relapse. Those with multiple deployments were significantly less likely to relapse (OR=0.73, 95% CI: 0.58-0.92). Behavioral factors and mental health conditions also predicted relapse.
  
  
  CONCLUSIONS
  Relapse was common and associated with military and non-military factors. Targeted intervention to prevent relapse may be indicated for military personnel in particular subgroups, such as Reservists, veterans, and those who deploy with combat exposure.
authors.affiliation: Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research Development, Department of Veterans Affairs Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA; Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St., Magnuson Health Sciences Center, Room H-664, Box 357660, Seattle, WA 98195-7660, USA. Electronic address: emily.williams3@va.gov.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Williams
authors.affiliation: Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106-3521, USA. Electronic address: Frasco.Melissa@gmail.com.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Frasco
authors.affiliation: Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106-3521, USA. Electronic address: isabeljacobson@yahoo.com.
authors.forename: Isabel G
authors.initials: IG
authors.lastname: Jacobson
authors.affiliation: Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research Development, Department of Veterans Affairs Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA; Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St., Magnuson Health Sciences Center, Room H-664, Box 357660, Seattle, WA 98195-7660, USA; Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, 1600 S Columbian Way MS-152E, Seattle, WA 98108, USA. Electronic address: cmaynard@u.washington.edu.
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.affiliation: Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, 1600 S Columbian Way MS-152E, Seattle, WA 98108, USA; Department of Epidemiology, University of Washington School of Public Health, 1959 NE Pacific Street, Health Sciences Building F-250, Box 357236, Seattle, WA 98195-7236, USA. Electronic address: Alyson.Littman@va.gov.
authors.forename: Alyson J
authors.initials: AJ
authors.lastname: Littman
authors.affiliation: Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, 1600 S Columbian Way MS-152E, Seattle, WA 98108, USA. Electronic address: Amber.Seelig@va.gov.
authors.forename: Amber D
authors.initials: AD
authors.lastname: Seelig
authors.affiliation: Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106-3521, USA; Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA. Electronic address: nancy32red@yahoo.com.
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Crum-Cianflone
authors.affiliation: Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106-3521, USA. Electronic address: anna.nagel@med.navy.mil.
authors.forename: Anna
authors.initials: A
authors.lastname: Nagel
authors.affiliation: Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, 1600 S Columbian Way MS-152E, Seattle, WA 98108, USA; Department of Epidemiology, University of Washington School of Public Health, 1959 NE Pacific Street, Health Sciences Building F-250, Box 357236, Seattle, WA 98195-7236, USA; Department of Medicine, University of Washington School of Medicine, RR-512 Health Sciences Building, Box 356420, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA. Electronic address: Edward.Boyko@va.gov.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000523:psychology / Q000639:trends; D019973:Alcohol-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health / Q000639:trends; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology*; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: Alcohol use disorders; Military; Millennium Cohort Study; Problem drinking; Relapse prospective study; Risk factors