Alcohol Use and Operational Readiness in the U.S. Active-duty Military: A Review of Burden, Culture, and Barriers to Care

PURPOSE OF REVIEW: This review examines alcohol use among U.S. military personnel, including patterns of use across the full spectrum of consumption, including behaviors not meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for alcohol use disorder. It examines the prevalence and aspects of military life, culture, and context that may serve as important contributors to and risk factors for developing unhealthy, excessive, or disordered alcohol use. This review discusses efforts towards prevention, interventions, and policies pertaining to alcohol use in the military and identifies areas that would benefit from future research. Alcohol use remains a critical determinant of military health, operational readiness, and force lethality. While the Department of War (DoW) has invested in developing a modern framework for harm reduction, rates of binge and heavy drinking in the military continue to exceed that of civilians. Unique challenges of military life, including operational and institutional stressors, stigma and barriers to care, and factors of military social culture and context, coalesce to normalize and sustain unhealthy alcohol consumption within the force. Future efforts must focus on evaluating current interventions and tailoring evidence-based programs to address the needs of a diverse military population.