Research Article
No access
Published Online: 1 April 2017

Traumatic Brain Injury and Post-Deployment Binge Drinking among Male and Female Army Active Duty Service Members Returning from Operation Enduring Freedom/Operation Iraqi Freedom

Publication: Journal of Neurotrauma
Volume 34, Issue Number 7


This study examines whether the relationship between traumatic brain injury (TBI) and post-deployment binge drinking is independent of screening positive for mental health problems among male and female service members. Data are from the Substance Use and Psychological Injury Combat Study of Army members returning from deployment to Afghanistan or Iraq in fiscal years 2008–2011. The sample consists of 240,694 male and 26,406 female active duty members who completed initial and follow-up questionnaires. The initial questionnaire, completed at the end of deployment, included screens for TBI and mental health problems (post-traumatic stress disorder, depression, harmful thoughts). The dependent variable, frequent binge drinking (six or more drinks on one occasion, at least monthly), was assessed on the follow-up questionnaire on average 3–9 months post-deployment. More than 21% of males and 7% of females reported frequent binge drinking. Male members were more likely to screen positive for TBI, compared with females (7.5% vs. 4.4%). Females with both TBI and mental health positive screens had more than double the risk of frequent binge drinking, compared with those without either problem (15.8% vs. 6.6%), and males with both problems had almost double the risk, compared with males with neither problem (33.6% vs. 19.7%). In multivariable logistic regression models, having a TBI and a comorbid positive mental health screen was associated with increased odds of frequent binge drinking among both males and females (adjusted odds ratio [AOR] = 1.59, CI: 1.50-1.69, and AOR = 2.11, CI: 1.57-2.83, respectively), compared with those with neither condition. More research is needed on the interaction of gender and binge drinking, especially when TBI and mental health problems co-exist.

Get full access to this article

View all available purchase options and get full access to this article.


Bray R.M., Pemberton M. R., Lane M. E., Hourani L. L., Mattiko M. J., and Babeu L. A. (2010). Substance use and mental health trends among U.S. military active duty personnel: key findings from the 2008 DoD health behavior survey. Mil. Med. 175, 390–399.
Larson M.J., Wooten N. R., Adams R.S., and Merrick E. L. (2012). Military combat deployments and substance use: review and future directions. J. Soc. Work Pract. Addict. 12, 6–27.
Barlas F.M., Higgins W. B., Pflieger J. C., and Diecker K. (2013). 2011 Department of Defense Health Related Behaviors Survey of Active Duty Military Personnel. Available at: Accessed October 21, 2016.
O'Brien C.P., Oster M., and Morden E., (eds); Committee on Prevention, Diagnosis, Treatment and Management of Substance Use Disorders in the U.S. Armed Forces; Board on the Health of Select Populations; Institute of Medicine. (2013). Substance Use Disorders in the U.S. Armed Forces. Available at: Accessed October 21, 2016.
Bray R.M., Brown J. M., and Williams J. (2013). Trends in binge and heavy drinking, alcohol-related problems, and combat exposure in the U.S. military. Subst. Use Misuse 48, 799–810.
Spera C., Thomas R., Barlas F., Szoc R., and Cambridge M. (2010). Relationship of military deployment recency, frequency, duration, and combat exposure to alcohol use in the Air Force. J. Stud. Alcohol. Drugs 72, 5–14.
Larson M.J., Mohr B. A., Adams R. S., Wooten N. R., and Williams T. V. (2014). Missed opportunity for alcohol problem prevention among army active duty service members postdeployment. Am. J. Public Health 104, 1402–1412.
Adams R.S., Larson M.J., Corrigan J.D., Ritter G.A., Horgan C.M., Bray R.M., and Williams T.V. (2016). Combat-acquired traumatic brain injury, posttraumatic stress disorder, and their relative associations with postdeployment binge drinking. J. Head Trauma Rehabil. 31, 13–22.
Adams R.S., Larson M.J., Corrigan J.D., Ritter G.A., and Williams T.V. (2013). Traumatic brain injury among US active duty military personnel and negative drinking-related consequences. Subst. Use Misuse 48, 821–836.
Mattiko M.J., Olmsted K. L. R., Brown J. M., and Bray R. M. (2011). Alcohol use and negative consequences among active duty military personnel. Addict. Behav. 36, 608–614.
Santiago P.N., Wilk J. E., Milliken C. S., Castro C. A., Engel C. C., and Hoge C. W. (2010). Screening for alcohol misuse and alcohol-related behaviors among combat veterans. Psychiatr. Serv. 61, 575–581.
Stahre M.A., Brewer R. D., Fonseca V. P., and Naimi T. S. (2009). Binge drinking Among US active-duty military personnel. Am. J. Prev. Med. 36, 208–217.
Larson M.J., Adams R. S., Mohr B. A., Harris A. H. S., Merrick E. L., Funk W., Hoffman K., Wooten N. R., Jeffery D. D., and Williams T. V. (2013). Rationale and methods of the substance use and psychological injury combat study (SUPIC): A longitudinal study of Army service members returning from deployment in FY2008–2011. Subst. Use Misuse 48, 863–879.
Bray R.M., Pemberton M. R., Hourani L. L., Witt M., Olmsted K. L. R., Brown J. M., Weimer B., Lane M. E., Marsden M. E., Scheffler S., Vandermaas-Peeler R., Aspinwall K. R., Anderson E., Spagnola K., Close K., Gratton J. L., Calvin S., and Bradshaw M. (2009). Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel. (last accessed July 11, 2016).
Adams R.S., Larson M.J., Corrigan J.D., Horgan C.M., and Williams T.V. (2012). Frequent binge drinking after combat-acquired traumatic brain injury among active duty military personnel with a past year combat deployment. J. Head. Trauma. Rehabil. 27, 349–360.
Rona R.J., Jones M., Fear N. T., Hull L., Murphy D., Machell L., Coker B., Iversen A. C., Jones N., David A. S., Greenberg N., Hotopf M., and Wessely S. (2012). Mild traumatic brain injury in UK military personnel returning from Afghanistan and Iraq: cohort and cross-sectional analyses. J. Head Trauma Rehabil. 27, 33–44.
Bigler E.D., and Maxwell W. L. (2012). Neuropathology of mild traumatic brain injury: relationship to neuroimaging findings. Brain Imaging Behav. 6, 108–136.
Casement M.D., Shaw D. S., Sitnick S. L., Musselman S. C., and Forbes E. E. (2015). Life stress in adolescence predicts early adult reward-related brain function and alcohol dependence. Soc. Cogn. Affect. Neurosci. 10, 416–423.
Forbes E.E., Rodriguez E. E., Musselman S., and Narendran R. (2014). Prefrontal response and frontostriatal functional connectivity to monetary reward in abstinent alcohol-dependent young adults. PLoS One 9, e94640.
Sellitto M., Ciaramelli E., and di Pellegrino G. (2010). Myopic discounting of future rewards after medial orbitofrontal damage in humans. J. Neurosci. 30, 16429–16436.
Weil Z.M., Corrigan J. D., and Karelina K. (2016). Alcohol abuse after traumatic brain injury: experimental and clinical evidence. Neurosci. Biobehav. Rev. 62, 89–99.
Chase S., Ratcliff G., Vernich L., Al-Sukhni E., Yasseen B., and Colantonio A. (2012). Preventive health practices and behavioral risk factors in women surviving traumatic brain injury. Health Care Women Int. 33, 631–645.
Preiss-Farzanegan S.J., Chapman B., Wong T. M., Wu J., and Bazarian J. J. (2009). The relationship between gender and postconcussion symptoms after sport-related mild traumatic brain injury. PM R 1, 245–253.
Wunderle K., Hoeger K. M., Wasserman E., and Bazarian J. J. (2014). Menstrual phase as predictor of outcome after mild traumatic brain injury in women. J. Head Trauma Rehabil. 29, E1–E8.
Slewa-Younan S., van den Berg S., Baguley I. J., Nott M., and Cameron I. D. (2008). Towards an understanding of sex differences in functional outcome following moderate to severe traumatic brain injury: a systematic review. J. Neurol. Neurosurg. Psychiatry 79, 1197–201.
Niemeier J.P., Marwitz J. H., Lesher K., Walker W. C., and Bushnik T. (2007). Gender differences in executive functions following traumatic brain injury. Neuropsychol. Rehabil. 17, 293–313.
US Department of Defense. US Department of Defense and Joint Chiefs of Staff policy memorandum. (2013). Elimination of the 1994 direct ground combat definition and assignment rule. Available at: Accessed October 21, 2016,
Conard P.L., and Sauls D. J. (2014). Deployment and PTSD in the female combat veteran: a systematic review. Nurs. Forum 49, 1–10.
Maguen S., Luxton D. D., Skopp N. A., and Madden E. (2012). Gender differences in traumatic experiences and mental health in active duty soldiers redeployed from Iraq and Afghanistan. J. Psychiatr. Res. 46, 311–316.
Pietrzak R.H., Whealin J. M., Stotzer R. L., Goldstein M. B., and Southwick S. M. (2011). An examination of the relation between combat experiences and combat-related posttraumatic stress disorder in a sample of Connecticut OEF-OIF Veterans. J. Psychiatr. Res. 45, 1579–1584.
Bryant R.A. (2008). Disentangling mild traumatic brain injury and stress reactions. N. Engl. J. Med. 358, 525–527.
Hoge C.W., McGurk D., Thomas J. L., Cox A. L., Engel C. C., Castro C. A. (2008). Mild traumatic brain Injury in U.S. soldiers returning from Iraq. N. Engl. J. Med. 358, 453–463.
Institute of Medicine. (2012). Treatment for posttraumatic stress disorder in military and veteran populations: Initial assessment. Available at: Accessed October 21, 2016.
Kennedy J., Jaffee M., Leskin G., Stokes J., Leal F., and Fitzpatrick P. (2007). Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury. J. Rehabil. Res. Dev. 44, 895–920.
Schneiderman A.I., Braver E. R., and Kang H. K. (2008). Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: persistent postconcussive symptoms and posttraumatic stress disorder. Am. J. Epidemiol. 167, 1446–1452.
Polusny M.A., Kehle S. M., Nelson N. W., Erbes C. R., Arbisi P. A., and Thuras P. (2011). Longitudinal effects of mild traumatic brain injury and posttraumatic stress disorder comorbidity on postdeployment outcomes in national guard soldiers deployed to Iraq. Arch. Gen. Psychiatry 68, 79–89.
Stein M.B., Ursano R. J., Campbell-Sills L., Colpe L. J., Fullerton C. S., Heeringa S. G., Nock M. K., Sampson N. A., Schoenbaum M., Sun X., Jain S., and Kessler R. C. (2016). Prognostic indicators of persistent post-concussive symptoms after deployment-related mild traumatic brain injury: a prospective longitudinal study in U.S. Army soldiers. J. Neurotrauma 2016 Apr 8; Epub ahead of print.
Ramchand R., Miles J., Schell T., Jaycox L., Marshall G. N., and Tanielian T. (2011). Prevalence and correlates of drinking behaviors among previously deployed military and matched civilian populations. Mil. Psychol. 23, 6–21.
Jakupcak M., Tull M. T., McDermott M. J., Kaysen D., Hunt S., and Simpson T. (2010). PTSD symptom clusters in relationship to alcohol misuse among Iraq and Afghanistan war veterans seeking post-deployment VA health care. Addict Behav. 35, 840–843.
Bliese P.D., Wright K. M., Adler A. B., Hoge C.W., and Prayner R. (2005). Post-Deployment Psychological Screening: Interpreting and Scoring DD Form 2900, in Using the PDHRA 1 of 14, Research Report #2005-003. Available at: Accessed October 21, 2016.
Bliese P.D., Wright K. M., and Hoge C. W., (2011), Preventive mental health screening in the military, in: Deployment Psychology: Evidence-Based Strategies to Promote Mental Health in the Military. Adler A.B., Bliese P.D., and Castro C.A., (eds). American Psychological Association: Washington, D.C., pp. 175–193.
National Institute on Alcohol Abuse and Alcoholism. (2005). Helping Patients Who Drink Too Much: A Clinician's Guide. Available at: Accessed October 21, 2016.
Kay T., Harrington D. E., Adams R., Anderson T., Berrol S., Cicerone K., Dahlberg C., Gerber D., Goka R., Harley P., Hilt J., Horn L., Lehmkuhl D., and Malec J. (1993). Definition of mild traumatic brain injury. J. Head Trauma Rehabil. 8, 86–87.
Prins A., Ouimette P., Kimerling R., Cameron R.P, Hugelshofer D.S., Shaw-Hegwer J., Thraikill A., Gusman F.D., and Sheikh J.I. (2003). The primary care PTSD screen (PC-PTSD): Development and operating characteristics. Primary Care Psychiatry 9, 151–151.
Bliese P.D., Wright K.M., Adler A.B., Cabrera O., Castro C.A., and Hoge C.W. (2008). Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. J. Consult. Clin. Psychol. 76, 272–281.
Calhoun P.S., McDonald S. D., Guerra V. S., Eggleston A. M., Beckham J. C., and Straits-Troster K. (2010). Clinical utility of the primary care—PTSD screen among U.S. veterans who served since September 11, 2001. Psychiatry Res. 178, 330–335.
Kroenke K., Spitzer R. L., and Williams J. B. W. (2003). The Patient Health Questionnaire-2 - validity of a two-item depression screener. Med. Care 41, 1284–1292.
Tanielian T., and Jaycox L. H. (eds). (2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. RAND Corporation: Santa Monica, CA.
Terrio H., Brenner L. A., Ivins B. J., Cho J. M., Helmick K., Schwab K., Scally K., Bretthauer R., andnWarden D. (2009). Traumatic brain injury screening: preliminary findings in a US Army brigade combat team. J. Head Trauma Rehabil. 24, 14–23.
Wilk J.E., Thomas J. L., McGurk D. M., Riviere L. A., Castro C. A., and Hoge C. W. (2010). Mild traumatic brain injury (concussion) during combat: lack of association of blast mechanism with persistent postconcussive symptoms. J. Head Trauma Rehabil. 25, 9–14.
Brown J.M., Bray R.M., and Hartzell M.C. (2010). A comparison of alcohol use and related problems among women and men in the military. Mil. Med. 175, 101–107.
Corrigan J.D., Boger J., and Holloman C. (2012). Lifetime history of traumatic brain injury among persons with substance use disorders. Brain Inj. 26, 139–150.
Kennedy C.H., Porter Evans J., Chee S., Moore J. L., Barth J. T., and Stuessi K. A. (2012). Return to combat duty after concussive blast injury. Arch. Clin. Neuropsychol. 27, 817–827.
McKinlay A., Grace R. C., Horwood L. J., Fergusson D. M., and MacFarlane M. R. (2010). Long-term behavioural outcomes of pre-school mild traumatic brain injury. Child Care Health Dev. 36, 22–30.
Corrigan J.D., Bogner J., Mellick D., Bushnik T., Dams-O'Connor K., Hammond F. M., Hart T., and Kolakowsky-Hayner S. (2013). Prior history of traumatic brain injury among persons in the Traumatic Brain Injury Model Systems National Database. Arch. Phys. Med. Rehabil. 94, 1940–1950.
Golub A., and Bennett A. S. (2014). Substance use over the military–veteran life course: An analysis of a sample of OEF/OIF veterans returning to low-income predominately minority communities. Addict. Behav. 39, 449–454.

Information & Authors


Published In

cover image Journal of Neurotrauma
Journal of Neurotrauma
Volume 34Issue Number 7April 1, 2017
Pages: 1457 - 1465
PubMed: 27762655


Published in print: April 1, 2017
Published online: 1 April 2017
Published ahead of print: 2 December 2016
Published ahead of production: 20 October 2016


Request permissions for this article.




Rachel S. Adams
The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.
John D. Corrigan
Department of Physical Medicine and Rehabilitation, the Ohio State University, Columbus, Ohio.
Beth A. Mohr
The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.
Thomas V. Williams
United States Department of Defense, Falls Church, Virginia.
Mary Jo Larson
The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.


Address correspondence to:Rachel Sayko Adams, PhD, MPHThe Institute for Behavioral HealthThe Heller School for Social Policy and ManagementBrandeis University415 South StreetWaltham, MA 02453E-mail: [email protected]

Author Disclosure Statement

The opinions and assertions herein are those of the authors and do not necessarily reflect the official views of the DoD, NIDA, or the National Institutes of Health. No competing financial interests exist.

Metrics & Citations



Export citation

Select the format you want to export the citations of this publication.

View Options

Get Access

Access content

To read the fulltext, please use one of the options below to sign in or purchase access.

Society Access

If you are a member of a society that has access to this content please log in via your society website and then return to this publication.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

View options


View PDF/ePub

Full Text

View Full Text







Copy the content Link

Share on social media

Back to Top