A new review published in Current Psychiatry Reports by researchers at the Uniformed Services University has found that alcohol use remains one of the most consequential and least addressed behavioral health challenges facing the active-duty force, with rates of binge and heavy drinking that continue to exceed civilian levels despite years of Pentagon investment in prevention.
The review, led by Kathleen Huber and colleagues, draws on the Department of War’s Health Related Behaviors Survey and finds that 34% of active component service members reported binge drinking, compared to 26.5% of civilian adults, and that 9.8% met the threshold for heavy drinking, defined as bingeing at least once a week over the previous month. The Marine Corps has the highest rates of binge and heavy drinking among the services, while the Air Force has the lowest. Between 2019 and 2023, alcohol related disorders accounted for more than 70,000 incident diagnoses, or 7.3% of all mental health diagnoses in the active force, with the highest incidence among men aged 20 to 24 and those in combat occupations like infantry and artillery.
The authors link heavy drinking in the military to a mix of individual, cultural, and structural forces. Widespread belief that military culture supports drinking correlates strongly with negative outcomes, including risky driving and lost productivity, and troops consistently overestimate how much their peers drank, a normative misperception that itself predicts heavier consumption over time.
That culture is reinforced by tax free, discounted alcohol sold in on-base stores and by inconsistent enforcement of existing policies. Some structural fixes have been slow to arrive. A ban on late night alcohol sales at exchange stores took effect for the Navy and Marine Corps in 2013 but was not extended to the Army and Air Force until 2024, following recommendations from the Pentagon’s Suicide Prevention and Response Independent Review Committee.
Deployment itself is not a reliable predictor of drinking, the review notes, but specific features of the deployment experience are. Combat trauma, PTSD symptoms, and exposure to life-threatening situations or atrocities all raise the risk of heavy drinking and alcohol use disorder, consistent with what researchers call the self-medication hypothesis, in which troops drink to manage trauma-related distress. Unit cohesion only complicates the picture further.
Strong bonds among service members are tied to lower rates of PTSD and suicidal ideation after deployment, but among Marines, cohesion also predicts higher alcohol use even as it predicts fewer disciplinary violations, suggesting the same social ties that protect mental health can normalize heavy drinking.
The costs extend beyond individual health. Alcohol related emergency department visits and hospitalizations occurred at a rate of 75.3 per 10,000 person years between 2009 and 2018, with more than 17% involving co-occurring injuries. A 2006 cost analysis estimated that alcohol use among TRICARE Prime beneficiaries cost the department $1.2 billion annually, with roughly two-thirds of that tied to lost readiness and misconduct among the active-duty force. Researchers have estimated that interventions like brief counseling programs or a 20% price increase on base alcohol sales could each save $75 million to $129 million a year, and one Air Force prevention program returned $4 to $6 for every dollar spent.
Despite this evidence, the review concludes that treatment access remains a persistent gap. No routine biochemical screening exists for alcohol use, unlike the random urinalysis testing required for illicit drugs, leaving identification dependent on self-report or command referral, both of which are vulnerable to stigma.
Nearly 44% of service members said they worry leadership will treat them differently if they seek mental health care, and only 16% of those with moderate to severe alcohol use disorder received medication in 2017, though that figure had risen from 9% in 2010. A 2023 policy change allowed some service members to seek behavioral health care, including alcohol treatment, without notifying their command, and the Brandon Act similarly guarantees confidential referrals for anyone requesting a mental health evaluation, though the review notes little systematic study of either policy’s impact.
The authors call for more research into two underserved populations: women, who reported lower rates of binge drinking than men but showed comparable or higher rates of dependence symptoms at lower levels of consumption, and military aviators, for whom an alcohol-related diagnosis can trigger immediate suspension from flying duty and whose drinking may go undetected because standard screening tools perform poorly in that population. The reviewers conclude that closing the gap would require treating alcohol use not as an isolated behavioral problem but as one shaped by military culture, deployment stress, and institutional barriers to care, all of which carry direct consequences for force readiness and lethality.
