Prevalence and correlates of alcohol use in a military setting in Sri Lanka

Abstract

Introduction: Operational readiness is an integral aspect of all military organizations and hence all personnel should achieve and maintain optimal physical and mental health. However, unique stressors in the military milieu can give rise to a myriad of mental health problems and the alcohol-related issue [High-risk drinking (HRD) and binge drinking (BD)] is one out of many. This study aims to explore the extent of alcohol consumption and the existing risk factors for HRD, BD or both in the Sri Lanka army.Methodology: This was a cross-sectional descriptive survey, done among 147 officers (selected by systematic random sampling) and 3519 other ranks (ORs) (selected by multistage extension cluster sampling), in 2019 in the Army (Security Forces Head Quarters-East). A self-administered questionnaire was used, which included, questions on socio-demographic variables, WHO Alcohol Use Disorder Identification Test (AUDIT) for HRD and BD, 9-Item Patient Health Questionnaire (PHQ-9) for probable depression, PTSD Checklist Military Version (PCL- M) for PTSD, Chalder Fatigue Scale for fatigue, and questions ascertaining the degree of unit cohesion, aggression, cigarette smoking, cannabis use, family history of psychiatric disorders and exposure to childhood abuse. The psychosocial functioning was assessed by the tenth question of the PHQ-9.Results: The mean age was 31.7 years (SD±6.686 years), ranging from 19 years to 57 years. Among the respondents, 56.7% were not GCE /OL qualified, 66.1% were married and 50.4% were exposed to battle. Current alcohol consumption was 76.5% and among them, 43% were in HRD [i.e., 35.2% hazardous, 5.5% harmful, and 2.3% dependent drinkers] and 15.5 % (95% CI 14.1 %- 16.7%) were in BD category. Among the correlates of HRD and BD were younger age, being single, employment in the Infantry and Elite, probable depression, fatigue, PTSD, smoking, cannabis use, exposure to childhood abuse, aggression, and psychosocial dysfunction.Conclusions: Compared to the community, alcohol consumption was higher in the Army, which may be due to the unique military subculture and the role model effect. While younger age, being single, and exposure to childhood abuse were risk factors, probable depression, fatigue, lack of cohesion, smoking, and cannabis use were either risk factors or outcomes of HRD, BD, or both in the Army. Further, psychosocial dysfunction was observed as an outcome.