title: The Impact of Hazardous Alcohol Use on Behavioral Healthcare Utilization Among National Guard Service Members.
abstract: BACKGROUND
  Prior research suggests that both posttraumatic stress disorder (PTSD) and alcohol abuse affect behavioral healthcare utilization among combat-exposed military populations. However, their interactive effect is not well documented, especially after experiencing psychological trauma.
  
  
  OBJECTIVE
  This study examined the role of hazardous alcohol use (i.e. repeated patterns of drinking which lead to harmful consequences) on behavioral healthcare utilization among service members stratified by past-year combat exposure.
  
  
  METHODS
  This study utilized a sample of National Guard service members who participated in an in-depth survey 2-4 months after returning from Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn deployments (2011-2013) (n = 467). We examine the marginal effect (the change in the probability) of hazardous alcohol use on utilization while controlling for trauma exposure, PTSD and other potential covariates.
  
  
  RESULTS
  In the unadjusted logistic model, hazardous alcohol use reduced the probability of behavioral healthcare utilization by 77% among service members who had been exposed to combat within the past year. In the adjusted model, which controlled for socio-demographics (age, gender, and race), health status (PTSD symptoms, depression and physical health), and measures of stigma (perception of services as embarrassing or harmful to one's career or social networks), hazardous alcohol use further reduced the utilization probability by 302%. CONCLUSION/IMPORTANCE: Although these findings require replication, they appear to demonstrate that when combat-exposed service members engaged in hazardous alcohol use at postdeployment, they were much less likely to utilize behavioral healthcare to manage their posttraumatic stress symptoms during this period.
authors.affiliation: a Department of Psychiatry , Washington University School of Medicine , St. Louis , Missouri , USA.
authors.forename: Carissa
authors.initials: C
authors.lastname: van den Berk-Clark
authors.affiliation: a Department of Psychiatry , Washington University School of Medicine , St. Louis , Missouri , USA.
authors.forename: Sundari
authors.initials: S
authors.lastname: Balan
authors.affiliation: a Department of Psychiatry , Washington University School of Medicine , St. Louis , Missouri , USA.
authors.forename: Manan V
authors.initials: MV
authors.lastname: Shroff
authors.affiliation: a Department of Psychiatry , Washington University School of Medicine , St. Louis , Missouri , USA.
authors.forename: Greg
authors.initials: G
authors.lastname: Widner
authors.affiliation: a Department of Psychiatry , Washington University School of Medicine , St. Louis , Missouri , USA.|b VA St. Louis Health Care System , St. Louis , Missouri , USA.
authors.forename: Rumi Kato
authors.initials: RK
authors.lastname: Price
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000437:Alcoholism / Q000523:psychology*; D003130:Combat Disorders / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology; D014728:Veterans / Q000523:psychology
keywords: Hazardous alcohol use; US National Guard; behavioral healthcare utilization; combat trauma; posttraumatic stress disorder (PTSD)