Combat is correlated in some to depression and substance abuse - post-traumatic stress disorder is part of the lexicon today, real and claimed by clerks who never heard a gunshot while in the military and then a general malaise for people who had any kind of stress.
But soldiers who endure the highest stress - those who kill in the heat of combat - are least likely to self-medicate, according to analysis of data by researchers with the Walter Reed Army Institute of Research and American University.
In "Changes in Alcohol Use after Traumatic Experiences: The Impact of Combat on Army National Guardsmen" in the journal Drug and Alcohol Dependence, they contradict common sociological wisdom.
"We were very surprised by the findings. Most previous research supported the prediction that more traumatic experiences would lead to more negative health outcomes, such as alcohol abuse," said Cristel Russell, an associate professor of marketing with American University's Kogod School of Business. "We found the opposite —that the most traumatic experiences of killing in combat actually led to a decrease in alcohol abuse post-deployment."
Why would killing in combat, thought to be one of the most difficult stressors, cause soldiers to become less likely to abuse alcohol?
Russell and her colleagues believe that killing experiences may cause soldiers to have an increased sense of mortality and vulnerability that triggers a focus on self-preservation, which manifests itself in reduced high-risk alcohol consumption.
"We reason that a possible explanation may be that soldiers who experience killing during combat become more aware of their own vulnerability to death. Mortality salience is known to have effects on decisions that people make including, in our case, the decision to not take risks and abuse alcohol, presumably to live longer," said Russell. "This is a post hoc explanation and our future research is going to try and explore this intriguing explanation further."
Comparing Pre-and-Post Deployment Data
The study is also one of the first to compare pre-and post- deployment data. Russell and her colleagues used this approach to better identify the associations between different types of combat experiences and changes in alcohol consumption.
For the study, Russell and her fellow researchers surveyed 1,397 members of an Army National Guard Infantry Brigade Combat Team three months before and three months after their deployment to Iraq in 2005. Members of the unit completed anonymous surveys regarding behavioral health and alcohol use and, in the post-survey, the combat experiences they had during deployment.
Aside from the stunning revelation that soldiers who kill in combat are less likely to abuse alcohol post-deployment, survey results revealed that the prevalence of alcohol use increased from 70.8% pre-deployment to 80.5% post-deployment and that alcohol misuse more than doubled, increasing from 8.51% before deployment to 19.15% after deployment.
This study acknowledges that future research is needed on this complex topic. Russell and her colleagues plan to explore the influence mortality salience has on soldiers who have killed while in combat in further detail.
"It is important for healthcare providers and researchers to better understand and account for the fact that traumatic events do not necessarily result in a negative outcome and that positive outcomes can in fact be born from traumatic events," said Russell. "Building on these findings, future research should take into account the degree to which individuals are equipped to deal with stressful situations and assess how coping strategies may affect their behavioral response to potentially traumatic events. There may be ways to promote coping pre- or post-traumatic experiences."