News features

Exploring alcohol misuse in ex-Service personnel: Current evidence and ongoing research.

Alcohol Awareness Week ran from July 3rd to July 7th 2023 in the UK, offering an opportunity to think and talk openly about alcohol harm across different communities. During this week, we shared key evidence on alcohol misuse in the UK ex-Service personnel community through our Twitter platform. Expanding on this, in the following article we further explore harmful alcohol consumption among UK ex-Service personnel and their families, drawing attention to current research projects in the UK.

Alcohol misuse is an ongoing public health concern in the UK. Alcohol Change, a leading UK alcohol charity, reports that harmful drinking is currently the fifth-highest cause of death and disability across the general population and is an established causal factor in over 60 medical conditions [1]. Additionally, advice from the NHS suggests that harmful alcohol consumption can negatively affect interpersonal relationships, academic or professional behaviour, and the general well-being of the individual affected [2].

Harmful consumption of alcohol is of particular concern among some members of the UK ex-Service personnel community. Evidence from the King’s Centre for Military Health Research (KCMHR) found a higher incidence of harmful alcohol use in UK male ex-Service personnel population versus their civilian counterparts (11% v. 6%) [3]. There is an established and long-standing drinking culture across the UK Armed Forces that doesn't dissipate once a Serving individual leaves. Researchers from the University of Liverpool and KCMHR explored motivations for drinking in Serving and ex-Service personnel [4]. They found that social pressure to drink and drinking as a coping mechanism may be key motivators driving Serving and ex-Service personnel to potentially harmful alcohol consumption. The Northern Hub for Veterans and Military Families' Research at Northumbria University also observed the normalisation of higher alcohol consumption within the UK military context [5]. Specifically, they found that some ex-Service personnel may fail to establish a connection between this behaviour and other personal issues they may be experiencing. Therefore, this may delay them accessing or engaging with help.

Increased risk of excessive drinking in UK ex-Service personnel has been linked to mental health difficulties. A report in 2023 from KCMHR and Combat Stress indicated that from a sample of 428 ex-Service personnel referred to Combat Stress for mental health assistance, 81.6% reported experiencing issues with alcohol [6]. It is suggested that some individuals will employ excessive consumption of alcohol as a coping mechanism when struggling with their mental health. A survey undertaken by PTSD Resolution in 2020, completed by UK ex-Service personnel living with a diagnosis of post-traumatic stress disorder, indicated that 46% of the 500 respondents turned to alcohol or drugs to cope with symptoms of prior trauma [7]. A review published in 2023 by Queens University Belfast reflects this trend. Their work found that some UK ex-Service personnel may attempt to manage mental health disorder symptoms through harmful consumption of alcohol, specifically to avoid reaching a crisis point. Conversely, increasing alcohol use to harmful levels may be responsible for worsening issues with their mental health [8].

The negative impact of harmful drinking is further reaching than the individual who is misusing alcohol and can significantly affect their partners and family. Research from the University of York indicates that an individual from the UK ex-Service community misusing alcohol can have a resulting negative impact on their partner or Family.  Family members trying to cope with their loved one's substance misuse expressed feelings of isolation and hopelessness and were unlikely to seek or be offered active assistance [9]. Furthermore, evidence from KCMHR indicates military partners themselves are at increased risk of harmful alcohol consumption in comparison with the UK public. Military partners are more likely to report engaging in binge drinking weekly, almost daily, or daily [10]. Increased harmful alcohol use in this population indicates a critical need for exploration into the drivers impacting this group’s relationship with alcohol and how to develop effective support for families and partners affected by alcohol misuse.

Recently, the UK government took action to address harmful alcohol consumption in the ex-Service community from a policy and funding perspective. In 2021 the UK Health Secretary granted £2.7 million worth of funding to Op COURAGE, the NHS Veterans Mental Health Service [11], matched with £2.7 million from the NHS. Op COURAGE is a critical service with a far-reaching positive impact on the ex-Service personnel community. Receiving this funding facilitates and ensures the longevity of their specialist support services for ex-Service personnel and their families if they are struggling with mental health, alcohol misuse, and substance abuse issues.

The UK government is funding research to develop available interventions for alcohol misuse in the ex-Service personnel community. Earlier in 2023, the Office for Veterans Affairs launched the Veterans Health Innovation Fund for innovative projects to improve ex-Service physical and mental health [12]. One grant recipient was KCMHR for the next phase of the Drinks:Ration app development [13]. The app uses personalised messaging and behavioural adaption in a bespoke intervention for reducing harmful drinking in ex-Service personnel and has been shown to have clinical efficacy in reducing alcohol consumption. The team are now seeking to adapt the app to specifically address the needs and motivations of ex-Servicewomen [14]. To tailor the app’s support resources and personalised messaging, they will include the input of stakeholders and focus groups made up of ex-Servicewomen. The adapted app will be tested for its efficacy and effectiveness using a randomised controlled trial. The new iteration of the Drinks:Ration project has the potential to positively impact an often-overlooked minority in the ex-Service personnel population and further strengthen the application and reach of the app.

In the North of England,  Dr Patricia Irizar (University of Manchester) and Dr Laura Goodwin (University of Lancaster) are exploring the efficacy of currently available interventions for ex-Service personnel experiencing co-occurring common mental disorders (CMD) and alcohol use disorders (AUD) with funding from Forces in Mind Trust (FiMT) [15].  This study aims to determine the efficacy of current treatment models, and factors impacting this. From the evidence generated, they will develop service recommendations for improving current treatment approaches and health promotion materials for the UK ex-Service personnel community. Thus, directly translating evidence into practice and service improvement to produce a positive impact for UK ex-Service personnel seeking treatment for CMD and AUD and those who care for them.

As noted above, harmful alcohol consumption can be experienced by the partners of those who serve, but as noted by KCMHR, this is a highly understudied topic. To address this gap, the LIFE-Q study, funded by Forces in Mind Trust, is currently being conducted by researchers at KCMHR [16]. This study aims to expand on this relatively under-explored area using qualitative diaries and interviews to capture lifestyle behaviours of UK Serving and ex-Service personnel partners with a particular focus on alcohol use. The study will examine social and cultural influences on lifestyle behaviours in this group, including alcohol consumption, and explore the availability of support services or products that could potentially help this population. This study will generate valuable evidence of how alcohol use fits into the lives and experiences of military partners.

There has been a growing body of research evidence in recent years about the impact of alcohol misuse on the ex-Service personnel community, but there is still more to learn to understand risk and protective factors, the socioeconomic impact, and identify effective treatments more fully. Current research in this area will contribute to the growth of evidence needed to inform the development of effective and implementable policies and practices to support UK ex-Service personnel and their families affected by alcohol misuse. You can keep up to date with current research and new publications of evidence about the UK Armed Forces community and alcohol use on our Ongoing Research Page, our Repository, and by signing up for our newsletter at the bottom of our homepage here. 

If you or someone you know is struggling with alcohol and would like to access help, Op COURAGE is available to offer mental health, alcohol misuse and substance abuse help to UK ex-Service personnel and their families. Alternatively, Combat Stress provides an informative self-help guide to help individuals struggling with misusing alcohol. For services that are not specific to ex-Service or Serving personnel, DrinkAware lists resources that include helplines and services specific to minority groups such as members of the LGBTQ+ community. 

 

  1. ‌Alcohol Change UK. Alcohol Statistics [Internet]. Alcohol Change UK; [cited 16 July 2023]. Available from: https://alcoholchange.org.uk/alcohol-facts/fact-sheets/alcohol-statistics
  2. NHS England. Risks of Alcohol Misuse [Internet]. NHS; [cited 16 Jul 2023 ]. Available from: https://www.nhs.uk/conditions/alcohol-misuse/risks/
  3. Rhead R, MacManus D, Jones M, Greenberg N, Fear NT, Goodwin L. Mental health disorders and alcohol misuse among UK military veterans and the general population: a comparison study (2022). Psychol Med.  Jan;52(2):292-302. 
  4. Irizar P, Leightley D, Stevelink S, Rona R, Jones N, Gouni K, et al. (2020) Drinking motivations in UK serving and ex-serving military personnel. Occupational Medicine, 70(4). 259–67. 
  5. Osborne, A. K., McGill, G., Greaves, P. J., & Kiernan, M. D. (2022). Developing an Integrated Model of Care for Veterans with Alcohol Problems. International Journal of Integrated Care, 22(1). 1–13.
  6. Williamson, C., Baumann, J., & Murphy, D. (2023). Exploring the health and well-being of a national sample of U.K. treatment-seeking veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 15(4), 672–680.
  7. PTSD Resolution. Veteran’s Mental Health Journey: Survey Analysis & Insights to date [Internet]. PTSD Resolution; [cited 20 Jul 2023]. Available from: https://ptsdresolution.org/pdf/PTSDR_Veteran
  8. Hitch, C., Toner, P., & Armour, C. (2023). Enablers and barriers to military veterans seeking help for mental health and alcohol difficulties: A systematic review of the quantitative evidence. Journal of Health Services Research & Policy, 28(3), 197–211.
  9. Lloyd C, Templeton L, Stebbings R, Evans V. Fighting Their Own Battle: Families of Veterans with Substance Use Problems. Forces in Mind Trust; 2020 Oct.
  10. Gribble, R., Goodwin, L., & Fear, N. T. (2019). Mental health outcomes and alcohol consumption among UK military spouses/partners: a comparison with women in the general population. European Journal of Psychotraumatology, 10(1). 
  11. UK Government. Veterans’ mental health services to receive £2.7 million boost [Internet]. GOV.UK. 2021[cited 19 Jul 2023] Available from: https://www.gov.uk/government/news/veterans-mental-health-services-to-receive-27-million-boost
  12. £5 million in contracts awarded to fund innovations that enhance veterans’ healthcare [Internet]. https://www.gov.uk. 2023 [cited 20 Jul 2023]. Available from: https://www.gov.uk/government/news/5-million-in-contracts-awarded-to-fund-innovations-that-enhance-veterans-healthcare
  13. Leightley, D., Williamson, C., Rona, R. J., Carr, E., Shearer, J., Davis, J. P., Simms, A., Fear, N. T., Goodwin, L., & Murphy, D. (2022). Evaluating the Efficacy of the Drinks:Ration Mobile App to Reduce Alcohol Consumption in a Help-Seeking Military Veteran Population: Randomized Controlled Trial. JMIR MHealth and UHealth, 10(6)
  14. FiMT Research Centre. DrinksRation for Female Veterans  [Internet]. FiMT Research Centre. 2023 [cited 16 Jul 2023]. Available from: https://www.fimt-rc.org/research/ongoing-research/drinksration-for-female-veterans
  15. FiMT Research Centre. Treating co-occurring alcohol use disorders and common mental disorders in veterans [Internet]. FiMT Research Centre. 2023 [cited 21 Jul 2023]. Available from: https://fimt-rc.org/research/ongoing-research/treating-co-occurring-alcohol-use-disorders-and-common-mental-disorders-in-veterans
  16. FiMT Research Centre. Lifestyles of military and veteran partners: A qualitative study (LIFE-Q) [Internet] FiMT Research Centre. 2023 [cited 20 Jul 2023]. Available from: https://fimt-rc.org/research/ongoing-research/lifestyles-of-military-and-veteran-partners-a-qualitative-study-life-q

Related articles