The role of combat exposure on drinking behavior and subjective well-being: A Rubin Causal Model approach.

Abstract

Objective: Investigating the role of combat exposure on behavioral outcomes has been limited due to ethical and logistical constraints. Method: Using a large data set from UK BioBank of U.K. citizens (n = 157,161), we created hypothetical randomized experiments, with treatment conditions for combat exposure or no combat exposure matched for relevant covariates and compared differences in combat exposure groups on a broad range of alcohol-related and subjective well-being outcomes. Additionally, using a randomizationbased approach, we calculated 95% Fisherian intervals for constant treatment effects consistent with the matched data and the hypothetical combat exposure intervention. Results: Results suggest that combat exposure plays a role in several negative outcomes related to alcohol behavior and subjective well-being, such as increased typical daily alcohol consumption (estimated average causal effect [ACE] = 0.0545, Fisher pvalue = .0119) and less general health happiness (estimated ACE = −0.1077, Fisher p-value , 1/ 100,000). Conclusions: This study expands our current understanding of the role of combat exposure on many alcohol and subjective well-being-related measures. We also show that the Rubin Causal Model provides a rigorous and valid approach to better understand myriad other issues in psychological science. Clinical Impact StatementFindings support the need for screening and evidence-based treatment for war-related trauma, in an inclusive manner for civilians, military personnel, and veterans. Most affected persons in less affluent countries do not receive treatment, or receive treatment that is not evidence-based. Empirically supported treatments for trauma exist but are not widely available in less affluent countries and areas. This is a problem with dissemination and delivery of effective treatment. Evidence-based treatment should emphasize alcohol consumption, subjective well-being, and sleep health, as areas of potential need, as well as fruitful outcome measures for assessing progress and recovery.