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Workplace intervention programmes for decreasing alcohol use in military personnel: a systematic review
  1. Jason R Watterson1,2,
  2. B Gabbe1,
  3. J V Rosenfeld3,4,
  4. H Ball5,
  5. L Romero6 and
  6. P Dietze1,7
  1. 1Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  2. 2Department of Intensive Care and Hyperbaric Medicine, Alfred Health, Melbourne, Victoria, Australia
  3. 3Department of Neurosurgery, Alfred Health, Melbourne, Victoria, Australia
  4. 4Department of Surgery, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
  5. 5National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia
  6. 6Library Services, Alfred Health, Melbourne, Victoria, Australia
  7. 7Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia
  1. Correspondence to Jason R Watterson, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3181, Australia; jason.watterson{at}monash.edu

Abstract

Introduction Harmful or risky-single occasion drinking (RSOD) alcohol use in the military is a significant problem. However, most studies of interventions have focused on veterans, representing a missed opportunity for intervention with active military personnel. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework, the aim of this systematic review was to analyse and synthesise the evidence related to workplace-based interventions for reducing alcohol use in active-duty military personnel.

Methods Four electronic databases and reference lists of relevant articles were searched from database inception until 20 January 2020. This review focused on experimental and quasi-experimental studies of active-duty military personnel. Data extraction and methodological quality assessment were independently performed by two reviewers using a standardised checklist. A third reviewer was used to arbitrate the disputed studies for final selection.

Results The search yielded seven studies from an initial 1582 records identified. A range of interventions were used in these studies (four randomised controlled trials, two non-randomised trials and one before and after cohort study), including web-based approaches, telephone-delivered interventions and individual and group-based face-to-face interventions. Seven studies found decreased drinking, measured using a range of outcomes, following the intervention. However, this was not sustained in the longer term in any of the studies.

Conclusions The low methodological rigour of most studies limited the capacity to demonstrate the efficacy of the interventions studied. Given the importance of reducing harmful or RSOD use of alcohol in the military, future studies would benefit from improved methodological rigour including ensuring adequate study power, randomisation, selection of validated outcome measures, including measures other than consumption (eg, attitudinal measures), and longer-term follow-up. There is also a need to develop methods that ensure participant loss to follow-up is minimised.

  • public health
  • epidemiology
  • substance misuse

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Footnotes

  • Twitter @jasonwatto

  • Contributors JRW, BG, JVR and PD planned the study and developed the protocol. JRW, BG, JVR, HB, LR and PD all reviewed and approved the final protocol. JRW and LR developed the search strategy and conducted the search. JRW, HB and BG undertook the review process. JRW wrote the first draft of the manuscript. JRW, BG, JVR, HB, LR and PD reviewed the first and all subsequent drafts and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. N/A.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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