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Alcohol Problems, Aggression, and Other Externalizing Behaviors After Return From Deployment: Understanding the Role of Combat Exposure, Internalizing Symptoms, and Social Environment


  • This research was funded by the Military Operational Medicine Research Area Directorate, U.S. Army Medical Research and Materiel Command, Fort Detrick, MD. The views expressed in this article are those of the authors and do not necessarily represent the official policy or position of the U.S. Army Medical Command or the Department of Defense.

  • We thank Angela Salvi, Steven Terry, and SSG Victor Martinez for their research assistance and Thomas Britt for his review of the manuscript.

Please address correspondence to: Kathleen Wright, U.S. Army Medical Research Unit, APO AE 09042; email:



The study examined whether elevated rates of externalizing behaviors following deployment could be explained by internalizing symptoms (depression, anxiety, and PTSD symptoms), and health of the social environment (unit leadership, organizational support, and stigma/barriers to care).


A model of combat exposure, social environment, internalizing symptoms, and externalizing behaviors was tested in a military unit following a fifteen-month deployment to Iraq. The sample included 1,397 soldiers assessed four month post-deployment; 589 of these soldiers were assessed again nine months post-deployment.


Externalizing behaviors were highly stable over the five-month post-deployment period. Both social environment and internalizing symptoms were significantly associated with level of externalizing behaviors at four months and nine months post-deployment, but combat exposure alone significantly predicted change in externalizing behaviors over the follow-up period.


Results suggest the need to broaden the scope of interventions targeted to combat veterans and have implications for care providers and military leaders. © 2012 Wiley Periodicals, Inc. J. Clin. Psychol. 68:782-800, 2012