Binge Drinking Among U.S. Active-Duty
Military Personnel
Mandy A. Stahre, MPH, Robert D. Brewer, MD, MSPH, Vincent P. Fonseca, MD, MPH,
Timothy S. Naimi, MD, MPH
Background: Binge drinking (drinking on a single occasion ⱖ5 drinks for men or ⱖ4 drinks for women)
is a common risk behavior among U.S. adults that is associated with many adverse health
and social consequences. However, little is known about binge drinking among active-duty
military personnel (ADMP). The objectives of this study were to quantify episodes of binge
drinking, to characterize ADMP who binge-drink, and to examine the relationship between
binge drinking and related harms.
Methods:
The prevalence of binge drinking and related harms was assessed from responses to the
2005 Department of Defense Survey of Health Related Behaviors Among Military Personnel (n⫽16,037), an anonymous, self-administered survey. The data were analyzed in 2007
after the release of the public-use data.
Results:
In 2005, a total of 43.2% of ADMP reported past-month binge drinking, resulting in 29.7
episodes per person per year. In all, 67.1% of binge episodes were reported by personnel
aged 17–25 years (46.7% of ADMP), and 25.1% of these episodes were reported by
underage youth (aged 17–20 years). Heavy drinkers (19.8% of ADMP) were responsible for
71.5% of the binge-drinking episodes and had the highest number of annual per-capita
episodes of binge drinking (112.6 episodes). Compared to nonbinge drinkers, binge
drinkers were more likely to report alcohol-related harms, including job performance
problems (AOR⫽6.5; 95% CI⫽4.65, 9.15); alcohol-impaired driving (AOR⫽4.9; 95%
CI⫽3.68, 6.49); and criminal justice problems (AOR⫽6.2; 95% CI⫽4.00, 9.72).
Conclusions: Binge drinking is common among ADMP and is strongly associated with adverse health and
social consequences. Effective interventions (e.g., the enforcement and retainment of the
minimum legal drinking age) to prevent binge drinking should be implemented across the
military and in conjunction with military communities to discourage binge drinking.
(Am J Prev Med 2009;36(3):208 –217) Published by Elsevier Inc. on behalf of American Journal of
Preventive Medicine
Introduction
E
xcessive alcohol consumption resulted in an average of approximately 79,000 deaths and 2.3 million years of potential life lost (about 30 years of
life lost per death) in the U.S. from 2001 to 2005
(https://apps.nccd.cdc.gov/ardi/Homepage.aspx), making it the third leading preventable cause of death.1
Binge drinking, usually defined as the consumption on
a single occasion of ⱖ5 drinks for men or ⱖ4 drinks
From the Alcohol Team, Emerging Investigations and Analytic Methods Branch, Division of Adult and Community Health, National
Center for Chronic Disease Prevention and Health Promotion, CDC
(Stahre, Brewer, Naimi), Atlanta, Georgia; and the Texas Department of State Health Services (Fonseca), Austin, Texas
At the time the research was completed, Fonseca was at the
Population Health Support Division, Air Force Medical Support
Agency, U.S. Air Force, Brooks City-Base, San Antonio, Texas.
Address correspondence and reprint requests to: Mandy A. Stahre,
MPH, CDC/Alcohol Team, c/o University of Minnesota, School of
Public Health, Division of Epidemiology, 1300 S. Second Street, Suite
300, Minneapolis MN 55454-1015. E-mail: [email protected].
208
for women,2,3 typically leads to acute impairment; it
accounted for more than half of these 79,000 deaths
(https://apps.nccd.cdc.gov/ardi/Homepage.aspx). Binge
drinking is a common risk factor among U.S. adults,
with approximately 1.5 billion episodes of binge drinking reported by U.S. adults in 2001 alone.4 Additionally, binge drinking is associated with many adverse
health and social consequences, including interpersonal violence, motor vehicle crashes, sexually transmitted diseases, unintended pregnancy, fetal alcohol syndrome, lost productivity, and suicidal behavior.5–13
Various studies have reported that excessive drinking and related harms are common among military
personnel14 –16 and that a higher percentage of activeduty military personnel (ADMP) misuse alcohol compared to civilian populations, even after controlling
for age and gender.16 –19 Studies have also shown that
high levels of alcohol use, such as binge drinking, are
associated with a high percentage of noncombatrelated hospitalizations and deaths— usually the result
Am J Prev Med 2009;36(3)
Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine
0749-3797/09/$–see front matter
doi:10.1016/j.amepre.2008.10.017
of unintentional injuries—among military personnel.19 –24 Further, binge drinking by ADMP can adversely affect military readiness, workplace productivity,
safety, and healthcare expenditures, particularly given
the equipment and the dangerous environments commonly encountered by ADMP.9,25,26
Despite these known risks, no study has assessed the
frequency and the per-capita rate of binge-drinking
episodes among ADMP in the U.S., nor has a study
examined the relationship between binge drinking and
other health and social consequences (e.g., problems
with job performance). This research is needed because people who binge-drink often do so frequently,
increasing the likelihood of alcohol-attributable harms.
Data were used from a worldwide, cross-sectional survey
of ADMP to assess the frequency and rate of bingedrinking episodes and the potential relationship between binge drinking and various health and social
consequences in this population.
Methods
The Department of Defense Survey of Health Related
Behaviors Among Military Personnel is an anonymous, selfadministered survey of health outcomes and health risk
behaviors among current ADMP stationed in the U.S., overseas, and onboard ships. The survey is conducted by the
Research Triangle Institute (RTI) staff every 2–3 years and is
the only population-based health survey involving all
branches of the military. Military personnel are randomly
selected, using a multilevel sampling frame to be representative of the entire active-duty military population. Survey
participants from a particular base may be asked to complete
the survey as a group at a specific base location, or may
complete the survey on their own, and then return it to RTI,
depending on the nature of their assignment (e.g., overseas).
Those who are ineligible to participate include recruits;
service academy cadets; personnel who are transferring to
another base during data collection; those who have left the
military; those who are absent without leave (AWOL); or
those who have an unknown status. Data collection for the
present survey occurred from April 2005 to August 2005, the
most recent year for which survey data were available. Because
of nonresponse, poststratification adjustments were made by
branch of service, age, and race/ethnicity to maintain the
representativeness of the sample. Details of the nested sampling, purpose, method, and analysis have been published
elsewhere.27–29
Based on questions related to alcohol use in the past 30
days, respondents were characterized as either abstainers (no
alcohol use in the past 30 days) or current drinkers. Average
daily alcohol consumption was calculated, using responses to
questions about the frequency of alcohol consumption and
the usual quantity consumed in the last 30 days for beer, wine,
and liquor. Heavy drinkers were defined as those consuming
an average of ⬎2 drinks per day for men or an average of ⬎1
drink per day for women. Nonheavy drinking was an average
daily alcohol consumption level less than that used to define
heavy drinking.
March 2009
Binge drinking was assessed using the following question:
During the past 30 days, on how many days did you have 5 or more
drinks of beer, wine, or liquor on the same occasion (4 or more if you
are a woman)? Binge drinkers were defined as those who
reported at least one ⱖ5/ⱖ4 drinking episode in the last 30
days. Responses to this question were reported categorically
as once, 2–3 days, 4 –10 days, 11–19 days, 20 –27 days, and
28 –30 days. The midpoint of each response range was used to
calculate total binge-drinking episodes, a technique commonly
used when calculating alcohol consumption with frequencyrange data.30 Binge-drinking patterns were assumed to be
fairly stable in this population, so the number of monthly
episodes was multiplied by 12 to estimate total annual episodes. The use of this constant also helped to smooth out
the slight month-to-month variation in alcohol consumption
that occurred during the 5-month sampling period (April–
August). Per-capita episodes of binge drinking (episodes per
person per year) were calculated by dividing the total number
of binge episodes per year for a given stratum by the total
weighted number of people in that stratum.
To further characterize the public health impact of binge
drinking, the prevalence of various health and social consequences (e.g., productivity problems, alcohol-impaired driving, and criminal-justice problems) was assessed among respondents during the 12 months preceding the survey. For
example, respondents were asked How many times in the past 12
months did you not get promoted because of your drinking? The
prevalence of these consequences was compared between
binge drinkers and current drinkers who did not report binge
drinking in the past 30 days.
The overall response rate for the 2005 survey was 51.8%, a
rate based on the number of completed, usable interviews of
personnel who were eligible to participate in the survey.
Nonrespondents were people who either did not show up for
the survey session during their scheduled time or did not
return a completed survey. Fewer than 1% of respondents
were removed from the final study population because of
missing information on binge drinking, resulting in a final
sample size of 16,037.
To examine the relationship between drinking pattern
(binge versus nonbinge) and health and social consequences,
summary Mantel–Haenszel ORs were computed, adjusting for
potential confounders (i.e., age group and gender). All
analyses occurred from May 2007 to August 2007 after the
release of the public-use data files; they were run using SAS
version 9.1 and SAS-callable SUDAAN version 9.0.1 software
to take into account the complex weighting structure of the
survey.
Results
Overall Active-Duty Military
In 2005, a total of 43.2% of ADMP reported at least one
episode of binge drinking in the past 30 days. Of these
respondents, 12.1% reported at least one episode of
binge drinking in the previous month, and 31.1%
reported two or more. Extrapolation to 1 year produced an estimate of 30 million episodes of binge
drinking, or 29.7 episodes of binge drinking per activeduty person per year (Table 1). The highest numbers of
Am J Prev Med 2009;36(3)
209
Table 1. Prevalence, total number, and per-capita episodes of binge drinkinga among all U.S. active-duty personnel by
selected characteristics, 2005
All respondentsb
Service
Army
Navy
Marine Corps
Air Force
Gender
Male
Female
Age (years)
17–20
21–25
26–34
ⱖ35
Race/ethnicity
White
Black
Hispanic
Otherc
Education
ⱕHigh school
Some college
College graduate
Pay grade/rankd
Junior enlisted
NCO
Senior NCO
Warrant officer
Junior officer
Senior officer
Marital status
Married
Not married
Dependents
Children present
Children not present
No children
Region
U.S. location
Overseas location
Onboard ship
Type of housing
Singlee
Military family
Rent/lease/own
Otherf
Alcohol intakeg
None
Nonheavy
Heavy
Number of
respondents
Weighted proportion
of military population
(nⴝ1,004,879)
Binge-drinking
prevalence, past
30 days (%)
Total (estimated)
weighted number
of binge episodes
per year
Estimated per-capita
binge-drinking
episodes (episodes/
person/year)
16,037
100.0
43.2
29,844,000
29.7
3,629
4,595
3,350
4,463
31.9
26.8
12.8
28.5
51.8
40.1
51.4
32.9
12,196,000
7,791,000
4,904,000
4,954,000
38.0
28.9
38.3
17.3
12,048
3,989
85.3
14.8
46.6
24.1
28,021,000
1,823,000
32.7
12.3
1,290
4,277
4,283
6,187
14.1
32.6
30.2
23.1
44.4
59.5
38.9
25.2
5,038,000
14,990,000
6,521,000
3,296,000
35.5
45.7
21.5
14.2
9,800
2,604
1,993
1,640
64.4
17.6
8.9
9.2
46.5
32.0
46.7
38.8
20,599,000
3,742,000
3,037,000
2,466,000
31.8
21.2
34.1
26.8
4,279
6,975
4,783
34.0
44.0
22.0
53.6
42.1
29.5
14,736,000
11,941,000
3,167,000
43.1
27.0
14.4
2,582
6,322
3,191
399
1,437
2,106
24.0
49.5
9.7
1.0
9.4
6.3
50.5
46.6
29.9
26.1
38.3
19.2
9,522,000
16,260,000
1,697,000
183,698
1,629,000
551,776
39.4
32.7
17.4
17.7
17.2
8.7
9,936
6,101
54.5
45.5
35.2
52.9
11,501,000
18,343,000
21.0
40.1
7,174
4,331
3,538
39.8
30.5
29.7
30.0
49.6
51.2
6,311,000
10,375,000
10,075,000
17.0
36.6
36.4
9,878
4,946
1,213
68.2
22.4
9.4
39.8
51.1
49.4
17,290,000
8,397,000
4,157,000
25.2
37.3
44.0
2,927
3,273
8,595
213
25.4
19.4
53.9
1.4
57.4
34.2
38.3
38.2
11,239,000
3,441,000
11,523,000
461,080
47.8
19.2
23.1
34.4
3,735
8,853
2,724
24.1
56.2
19.8
—
44.1
94.6
—
7,172,000
21,333,000
—
13.3
112.6
Note: Columns will not add to 100%, based on weighted prevalence.
a
Binge drinking is defined as consuming on a single occasion ⱖ5 drinks for men or ⱖ4 drinks for women.
b
Sample sizes are weighted to the entire active-duty military population.
c
Other includes Asian, Pacific Islander, and Native American.
d
Ranks are as follows: junior enlisted, E1–E3; NCO, E4 –E6; senior NCO, E7–E9; warrant officer, W1–W5; junior officer, O1–O3; senior officer,
O4 –O10.
e
Single housing includes military barracks, dormitories, and bachelor quarters.
f
Other housing includes living onboard ships, embassy, and quarters in theater.
g
Nonheavy alcohol intake is defined as consuming an average of ⱕ2 drinks per day for men and ⱕ1 per day for women. Heavy alcohol intake
is defined as consuming ⬎2 drinks per day for men and ⬎1 drink per day for women.
NCO, noncommissioned officer
210
American Journal of Preventive Medicine, Volume 36, Number 3
www.ajpm-online.net
per-capita episodes of binge drinking were estimated
for personnel in the Marine Corps (38.3 per person per
year) and Army (38.0 per person per year), and the
lowest were estimated for the Air Force (17.3 per
person per year).
Overall, youth and young adults aged 17–25 years
accounted for 46.7% of all ADMP and 67.1% of all
binge-drinking episodes (approximately 20 million; Table 1). Correspondingly, yearly per-capita episodes of
binge drinking were highest in the younger age groups
and declined with increasing age. Young adults aged
21–25 years had the highest number of per-capita
episodes (45.7 per person per year), followed by those
aged 17–20 years (35.5 per person per year). However,
the number of per-capita episodes of binge drinking
remained high for personnel aged 26 –34 years (21.5
per person per year) and for those aged ⱖ35 years
(14.2 per person per year).
During the study period, men—who accounted for
85.3% of all ADMP—were approximately twice as likely
to engage in binge drinking as women (46.6% vs
24.1%), and they reported 93.9% of all binge-drinking
episodes (Table 1). However, women—most of whom
were of childbearing age (i.e., aged 18 – 44 years)— had
an estimated 12 episodes per person per year. When
evaluated by race/ethnicity, whites accounted for
69.0% of the total binge-drinking episodes, but Hispanics had the highest number of per-capita episodes (34.1
per person per year). Junior enlisted and noncommissioned officers (approximately 74% of all ADMP) had
the highest prevalence of binge drinking (50.5% and
46.6%, respectively), which resulted in more than 86%
of all binge-drinking episodes (approximately 26 million); they had the highest numbers of per-capita
episodes (39.4 episodes and 32.7 episodes per person
per year, respectively) among the various pay grades
and ranks. The prevalence of binge drinking among
personnel in the remaining pay grades and ranks
ranged from 38.3% for junior officers to 19.2% for
senior officers, while the number of per-capita episodes
ranged from 17.2 per year for junior officers to 8.7 per
year for senior officers. When evaluated by duty station,
the highest prevalence of binge drinking was reported
by those who were stationed overseas (51.1%), and the
highest number of per-capita episodes was estimated
for those stationed onboard ships (44 per person per
year). When evaluated by type of housing, personnel
living in single, on-base housing had the highest prevalence of binge drinking (57.4%) and the highest
number of per-capita episodes (47.8 per person per
year).
Of the almost 20% of ADMP who were classified as
heavy drinkers based on average daily alcohol consumption, 94.6% reported one or more binge-drinking
episode in the past 30 days, which extrapolates to
approximately 21 million episodes, or 112.6 episodes
per person per year (approximately two episodes per
March 2009
week; Table 1). Because of their high frequency of
binge drinking, heavy drinkers accounted for 71.5% of
all binge-drinking episodes in this population in 2005.
Compared to nonheavy drinkers, heavy drinkers were
more likely to be in the Army (41%); to be male (78%);
aged 21–25 years (49%); non-Hispanic white (70%); a
noncommissioned officer (53%); stationed in the U.S.
(59%); and with a high school education or less (48%;
data not shown).
Active-Duty Military Who Consumed Alcohol
Among the 76% of ADMP who were current drinkers,
the prevalence of binge drinking was 56.6% (59.4% for
men, 36.7% for women), and the number of per-capita
episodes of binge drinking was estimated at 38.9 per
person per year (41.8 for men and 18.8 for women;
Table 2). The highest prevalence of binge drinking was
among current drinkers living in single housing
(75.4%). More than two thirds of personnel who were
junior enlisted, single, or who had a high school
education or less reported binge drinking in the last 30
days. By age, the highest number of per-capita episodes
of binge drinking was estimated for drinkers aged
17–20 years (59.8 per person per year). The prevalence
of binge drinking among male drinkers ranged from
78.5% for those aged 17–20 years to 35.0% for those
aged ⱖ35 years. Among female drinkers, the prevalence ranged from 47.1% for those aged 17–20 years to
26.0% for those aged 26 –34 years; in fact, the prevalence of binge drinking among active-duty women aged
ⱖ35 years (26.2%) was slightly higher than it was for
those aged 26 –34 years. Although the prevalence and
number of per-capita episodes of binge drinking were
higher for men than for women, the subgroups at
highest risk for binge drinking (e.g., youth and young
adults, Hispanics, and those with a high school education or less) were generally similar for both male and
female drinkers.
Health and Social Outcomes
Compared with current drinkers who did not bingedrink, binge drinkers were more likely to report not
being promoted, getting into a fight and hitting someone, working below their normal level of performance,
and drinking and driving (Figure 1). These behaviors
and outcomes were increasingly prevalent with morefrequent binge drinking (Figure 1). In terms of adverse
outcomes or high-risk behaviors that were explicitly
attributed to alcohol consumption, 36.4% of currentdrinking ADMP reported at least one outcome or
behavior in the past year (e.g., driving after having had
too much to drink; Table 3). Specifically, 18.4% of
ADMP who drank reported one or more alcoholattributable problems related to their job performance,
28.1% reported injury-related outcomes or risk behaviors, 2.2% reported problems related to interpersonal
Am J Prev Med 2009;36(3)
211
Table 2. Prevalence and per-capita episodes (per person per year) of binge drinkinga among current drinkers in the U.S.
active-duty military, by gender and selected sociodemographic information, 2005
Men (nⴝ9472)b
Characteristics
All respondents
Service
Army
Navy
Marine Corps
Air Force
Age (years)
17–20
21–25
26–34
ⱖ35
Race/ethnicity
White
Black
Hispanic
Otherc
Education
ⱕHigh school
Some college
College graduate
Pay grade/rankd
Junior enlisted
NCO
Senior NCO
Warrant officer
Junior officer
Senior officer
Marital status
Married
Not married
Dependents
Children present
Children not present
No children
Region
U.S. location
Overseas location
Onboard ship
Type of housing
Singlee
Military family
Rent/lease/own
Otherf
Alcohol intakeg
Nonheavy
Heavy
Prevalence
(%)
Per-capita
episodes
Women (nⴝ2725)b
Total (nⴝ12,197)b
Prevalence
(%)
Per-capita
episodes
Prevalence
(%)
Per-capita
episodes
59.4
41.8
36.7
18.8
56.6
38.9
68.5
55.0
68.7
47.4
51.1
40.4
51.6
25.8
43.1
32.6
48.0
33.0
24.8
18.2
26.7
13.2
65.5
52.1
67.8
44.9
48.1
37.6
50.4
23.6
78.5
73.8
54.0
35.0
64.2
58.7
30.1
20.0
47.1
46.7
26.0
26.2
26.7
23.9
12.6
12.9
74.9
69.9
50.6
34.0
59.8
53.7
27.9
19.2
60.9
50.7
64.2
57.6
42.8
33.6
48.7
40.2
38.1
31.6
42.5
34.7
17.4
21.3
19.0
21.0
58.4
47.1
61.5
54.3
40.0
31.3
45.0
37.4
72.9
58.6
39.3
59.5
38.8
19.0
47.4
35.9
29.0
29.6
15.8
14.9
70.6
55.4
37.7
56.9
35.5
18.3
74.4
63.3
42.2
32.0
49.1
24.7
59.6
45.5
24.5
20.1
22.2
10.4
47.8
36.1
23.4
37.3
36.4
18.2
25.6
17.5
14.4
44.2
15.8
14.2
71.2
59.8
40.6
32.4
46.9
23.9
55.5
41.9
23.6
22.0
21.1
10.9
48.6
73.1
29.3
57.4
27.1
43.5
13.4
22.6
46.5
68.3
27.8
51.8
42.7
66.3
71.2
24.7
49.5
52.1
23.8
39.3
47.1
9.9
24.3
22.5
40.4
62.9
67.6
22.9
46.4
47.7
55.7
67.7
64.9
36.1
50.5
58.9
33.8
45.5
43.9
16.6
24.2
27.5
52.6
65.4
62.9
33.4
47.8
56.0
77.8
48.6
52.6
53.4
65.9
27.7
32.4
53.7
51.8
26.6
33.2
63.0
32.3
10.1
16.1
25.7
75.4
46.9
49.4
54.9
62.7
26.1
29.7
49.4
47.0
95.9
14.6
117.7
24.8
84.2
5.2
67.6
44.1
94.6
13.3
112.6
Note: Columns will not add to 100%, based on weighted prevalence.
a
Binge drinking is defined as consuming on a single occasion ⱖ5 drinks for men or ⱖ4 drinks for women.
b
Sample sizes are weighted to the entire active-duty military population.
c
Other includes Asian, Pacific Islander, and Native American.
d
Ranks are as follows: junior enlisted, E1–E3; NCO, E4–E6; senior NCO, E7–E9; warrant officer, W1–W5; junior officer, O1–O3; senior officer, O4–O10.
e
Single housing includes military barracks, dormitories, and bachelor quarters.
f
Other housing includes living onboard ships, embassy, and quarters in theater.
g
Nonheavy alcohol intake is defined as consuming an average of ⱕ2 drinks per day for men and ⱕ1 per day for women. Heavy alcohol intake
is defined as consuming ⬎2 drinks per day for men and ⬎1 drink per day for women.
NCO, noncommissioned officer
relationships, and 7.7% reported criminal-justice problems. The prevalence of these outcomes was even
higher for binge drinkers; more than half (52.2%)
reported one or more adverse outcomes or high-risk
212
behaviors. In fact, even after adjustment for age and
gender, binge drinkers were significantly more likely
than nonbinge drinkers to report 21 of 22 studied
alcohol-related consequences. For example, binge
American Journal of Preventive Medicine, Volume 36, Number 3
www.ajpm-online.net
nonbinge drinkers to report alcohol-related harms,
including job-performance
problems, alcohol-impaired
driving, and alcohol-related
criminal activity.
Studies examining binge
drinking among U.S. adults
estimate the prevalence to be
about 14%,4 while college
students report a higher
prevalence (44%).31 The
similarity of binge-drinking
rates among college students
and the military reflects
some of the similarities between these two groups in
demographic characteristics
(e.g., the predominance of
young, unmarried adults);
living arrangements (e.g.,
dormitories or single residences); and environmental
exposures (e.g., access to alcohol).29 Consistent with
this, and in contrast to studFigure 1. Alcohol-attributable risk behavior or consequences in the last 12 months among
ies of binge drinking in the
current drinkers in the active-duty military, by frequency of binge drinking, 2005
civilian population,4 approximately two thirds (67.1%) of
drinkers were almost six times as likely as nonbinge
the episodes of binge drinking in the military in 2005
drinkers to report leaving work early or arriving late
involved youth and young adults aged ⬍26 years.
(OR⫽5.8; 95% CI⫽3.78, 8.93); nearly five times as
However, even among young adults, the age-specific
likely to report drinking and driving (OR⫽4.9; 95%
prevalence of binge drinking in the military was higher
CI⫽3.68, 6.49); and more than five times as likely to
than that reported among U.S. adults (e.g., 44.4% for
report riding in a car with someone who had been
active-duty members aged 17–20 years vs 26.1% for
drinking (OR⫽5.4; 95% CI⫽4.03, 7.17).
comparably aged civilians).4,32 These findings suggest
that interventions directed toward reducing youth access to alcohol, particularly among those who are
Discussion
underage and living in on-base housing or stationed
This is the first in-depth study of binge-drinking epionboard ships, could have a substantial impact on
sodes and alcohol-related problems among ADMP in all
reducing binge drinking in the military population. At
branches of the military. Almost half of all ADMP
the same time, it is important to recognize that high
reported at least one episode of past-month binge
levels of binge drinking were also reported by officers
drinking—an estimated 30 million episodes of binge
and senior enlisted personnel. Thus, it is important to
drinking, or about 30 episodes of binge drinking per
reduce binge drinking among all ADMP, including
person per year. Especially high numbers of per-capita
those aged ⱖ26 years.
episodes of binge drinking were observed among MaAlthough military men accounted for a higher perrines, male drinkers, youth and young adults, Hispancentage of the total number of binge-drinking epiics, junior enlisted and noncommissioned officers,
sodes, military women, particularly those aged 17–25
those stationed onboard ships, and those living in
years, also had high numbers of per-capita episodes of
on-base housing. Approximately two thirds of bingebinge drinking—in fact, several times higher than those
drinking episodes involved personnel aged 17–25 years,
reported by similarly aged women in the civilian popuand more than 70% were reported by heavy drinkers,
lation.4,33 This is particularly concerning because alwho reported an average of two binge-drinking epimost all female ADMP are of childbearing age (aged
sodes per person per week. Alcohol-related problems
18 – 44 years).34 In addition, other studies have found
were reported by more than half of all binge drinkers,
that, as in the U.S. civilian population, more than half
and binge drinkers were significantly more likely than
of pregnancies in the military are unintended.35,36
March 2009
Am J Prev Med 2009;36(3)
213
Table 3. Alcohol-attributable risk behavior or consequences in the last 12 months among current drinkers in the active-duty
military, by binge-drinkinga status, 2005
Category of alcohol-attributable risk
behavior or consequence
Current drinkersb
% (nⴝ12,197)
Binge drinkersb
% (nⴝ6,030)
Nonbinge drinkersb
% (nⴝ6,167)
AORc (95% CI)
for binge drinkers
Any alcohol-attributable risk behavior
or consequence
Alcohol-attributable job-performance
problem
Any job-performance problems
Worked below normal level of
performance
Late for work or left work early
Did not come to work at all
Did not get promoted
Got a lower score on efficiency
report or performance rating
Drunk while working
Called up during off-duty hours
and reported to work drunk
Drank while working, during lunch
break, or during work breakd
Alcohol-attributable injury-related
outcome or risk behavior
Any injury outcome or risk
behavior
Caused an accident where
someone else was hurt or
property damaged
Hurt in accident
Drove after having had too much
to drink
Rode with someone who had too
much to drink
Drove or rode in a boat after
having had too much to drink
Operated machinery after having
too much to drink
Diagnosed with an STDe
Alcohol-attributable interpersonal
problems
Any interpersonal problems
Spouse of live-in partner
threatened to leave me or left me
Was asked to leave or did leave my
spouse or live-in partner
Alcohol-attributable criminal-justice
problems
Any criminal justice problems
Got into a fight and hit
someone (not family member)
Received UCMJ punishment
Arrested for DUI
Arrested for drinking incident
Spent time in jail, stockade, or brig
36.4
52.2
15.7
4.9 (4.12, 5.75)
18.4
11.4
28.9
18.0
4.6
2.8
6.5 (4.65, 9.15)
6.3 (4.46, 8.98)
7.1
2.0
1.9
1.9
11.3
3.3
3.1
3.1
1.6
0.4
0.4
0.3
5.8 (3.78, 8.93)
6.5 (3.27, 12.85)
4.1 (2.45, 6.95)
4.3 (2.04, 9.13)
4.3
3.6
7.2
6.1
0.6
0.4
7.43 (3.01, 18.3)
12.6 (5.75, 27.54)
5.2
7.2
2.6
2.3 (1.52, 3.39)
28.1
40.0
12.5
4.0 (3.36, 4.68)
1.3
2.0
0.4
3.7 (1.94, 7.00)
1.6
16.7
2.5
25.3
0.3
5.5
5.4 (1.72, 17.00)
4.9 (3.68, 6.49)
18.0
27.7
5.5
5.4 (4.03, 7.17)
4.4
6.9
1.1
5.0 (3.34, 7.53)
3.9
6.3
0.8
5.7 (3.27, 10.03)
3.7
4.1
3.3
1.0 (0.77, 1.39)
2.2
2.0
3.5
3.1
0.4
0.4
5.4 (3.07, 9.64)
5.1 (2.86, 8.90)
1.2
1.9
0.2
8.9 (3.32, 24.02)
7.7
5.2
12.5
8.8
1.4
0.6
6.2 (4.00, 9.72)
10.2 (5.68, 18.30)
2.7
1.8
1.6
1.7
4.3
2.7
2.7
2.6
0.5
0.5
0.3
0.4
4.9 (2.81, 8.63)
3.6 (1.47, 8.81)
5.8 (2.38, 14.34)
4.2 (2.10, 8.50)
Binge drinking is defined as consuming on a single occasion ⱖ5 drinks for men or ⱖ4 drinks for women.
Sample sizes are weighted to the entire active duty military population.
c
Adjusted for age and gender
d
Incident occurred in the last 30 days.
e
Question was not asked in relation to their alcohol use.
DUI, driving under the influence; STD, sexually transmitted disease; UCMJ, Uniform Code of Military Justice
a
b
Unintended pregnancy is, in turn, associated with
delayed pregnancy recognition, which increases the
risk that a woman might unintentionally expose a
developing fetus to high levels of alcohol if she binge214
drinks during her pregnancy, thus increasing the risk of
fetal alcohol spectrum disorder and fetal alcohol syndrome.12,37 Therefore, in addition to reducing youth
drinking, special consideration should be given to
American Journal of Preventive Medicine, Volume 36, Number 3
www.ajpm-online.net
preventing binge drinking among female ADMP of
childbearing age.38
Personnel stationed onboard ships also reported a high
prevalence of binge drinking (49%) and a high percapita number of episodes of binge drinking (37 per person per year). In addition, high numbers of per-capita
episodes of binge drinking and total binge drinking
episodes were reported by ADMP living in single housing,
which is frequently occupied by underage personnel (e.g.,
military barracks, dormitories, and bachelor quarters).
This suggests that important reductions in binge drinking
among military personnel could be achieved by enforcing
the laws restricting the access of youth to alcohol and
enforcing blood alcohol– concentration policies related
to drinking and driving on military property.
The finding that more than 70% of all binge-drinking
episodes involved ADMP who were heavy drinkers
means that approximately one in five ADMP reported
binge drinking an average of more than twice per week.
This concentration of binge-drinking episodes among
heavy drinkers contrasts with studies of binge-drinking
episodes in the civilian population, where total episodes were fairly evenly divided between heavy and
nonheavy drinkers.4 These findings suggest that there
is a substantial minority (20%) of ADMP who bingedrink frequently and thus put themselves and others at
substantially increased risk for a wide range of health
and social problems.31,39,40 These findings further underscore the need to combine policy and environmental approaches for reducing binge drinking with clinical interventions that are designed to screen ADMP for
alcohol misuse (i.e., binge drinking) and to provide
those who screen positive with brief counseling, referral
to specialized treatment, or both, depending on the
severity of their alcohol problems.41
This study also highlights the potential impact of
binge drinking by ADMP on job performance and force
readiness. ADMP who reported binge drinking were
consistently more likely than nonbinge drinkers to
report a wide range of alcohol-attributable problems,
including problems with job performance and drinking
and driving, both of which were reported by more than
one quarter of all binge drinkers. Binge drinkers were
also substantially more likely than nonbinge drinkers to
report being drunk while working and being called to
work during off-duty hours and reporting to work
drunk. While binge drinking is also known to be
strongly associated with a wide range of health and
social problems in the civilian population (e.g., interpersonal violence and sexually transmitted disease),
this pattern of alcohol consumption poses special risks
in the military setting. For example, the performance of
pilots has been shown to be impaired for up to 14 hours
after drinking at a level sufficient to achieve a blood
alcohol concentration of 0.10 grams per deciliter (g/
dL).42 In addition, serious criminal behavior resulting
from binge drinking among military personnel can
March 2009
bring widespread media attention that damages the
effectiveness and credibility of the U.S. military as a
whole.43,44 Finally, the high levels of binge drinking
among ADMP, particularly among those aged ⱕ25
years, increase the likelihood of alcohol-related harms
and alcohol-use disorders (e.g., alcoholism) following
military service.45– 47 The impact of binge drinking in
the military on the future drinking behavior of veterans
and their families is important, because 13.3% of U.S.
adults report current or past military service (CDC
Behavioral Risk Factor Surveillance System, unpublished
raw data, 2005 ). Thus, reducing binge drinking among
ADMP could have both short- and long-term benefits
for both the military and the general population.
Several strengths mark this study, including the large
sample size and the ability to assess both alcohol
consumption and alcohol-related outcomes among
ADMP. Another strength is the use of standardized
questions on alcohol use, which are comparable to
those used in other large surveys of risk factors. This
study also has several imitations. First, binge drinking
and related consequences are underreported on surveys; thus, the estimates of the prevalence and frequency of binge drinking, and of the prevalence of
alcohol-related problems, were likely conservative.48,49
Second, although the response rate for this survey
(51.8%) is similar to that of other large, populationbased surveys,50 respondents to this survey may differ
from nonrespondents. However, based on the characteristics that were used to weight the survey population (e.g.,
branch of service, race/ethnicity), respondents were representative of ADMP (R. Bray, RTI, personal communication, April 2008). Third, while this study examined several
different types of alcohol-related consequences among
military personnel, the survey did not ask about a number
of important secondhand effects of alcohol use (e.g.,
being a victim of vandalism, sexual assault).51,52
While this study provides new insights into the problem of binge drinking in the military, the problem itself
is not new, and has, in fact, been documented in
previous surveys of the active-duty population going
back more than 20 years.53 Although previous analyses
of the current survey have not assessed the frequency or
per-capita episodes of binge drinking, the prevalence of
binge drinking is similar to that found in 2005 and only
slightly increased (43.2% vs 41.8%) compared to 2002.
However, this does not mean that binge drinking is so
much a fixture of military life that it is impossible to
change. For example, the military has been quite
successful in reducing smoking rates among ADMP
using a comprehensive public health approach that has
included smoking-cessation programs and smoking
bans.54,55 These interventions were successfully implemented even though smoking was historically quite
common among ADMP. In contrast, most alcohol
programs in the military have tended to focus exclusively on screening for and treating alcoholism, even
Am J Prev Med 2009;36(3)
215
though other studies suggest that only a small minority
of ADMP meet the diagnostic criteria for alcoholism.56 –59 Nonetheless, small, base-specific, and community programs to reduce underage and binge drinking
on military bases have been implemented and appear
to be showing promising results.60,61
In addition to these programs, potentially effective
community-based interventions include increasing the
price of alcoholic beverages, particularly on military bases;
enforcing and retaining laws prohibiting the sale to or
acquisition of alcoholic beverages for underage youth,
particularly at alcohol outlets adjacent to military bases;
working with communities to limit the density of alcohol
outlets; and discouraging drink specials that promote
binge drinking (www.thecommunityguide.org).62,63 In
addition, bases should offer alcohol-free social events
and increase the availability of recreational activities
that do not involve drinking. Further, because a large
percentage of young service members live on base, it is
important to establish and enforce rules restricting the
use of alcohol in dormitories, in single housing, and
onboard ships. Finally, although the U.S. Preventive
Services Task Force has noted that routine screening
for binge drinking in primary care and other treatment
settings is effective in reducing these types of behaviors64 more research on the effectiveness of these
interventions in the military setting is required.
The findings and conclusion in this report are those of the
authors and do not necessarily represent the official position
of the CDC or the U.S. Department of Defense.
No financial disclosures were reported by the authors of
this paper.
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