The need for mental health services, and substance use treatment in particular, among deployed military personnel is well known and can hardly be debated [1-4]. However, the need of the children in families with deployed parents is relatively poorly understood and remains a critically important and largely unaddressed public health issue in the United States [5-7]. This is why the manuscript by Acion and colleagues  is both timely and important, as it examines the increased risk of alcohol and drug use among children from deployed families. The findings, while descriptive in nature, clearly demonstrate higher levels of current alcohol use, heavy alcohol use, current marijuana use, current illegal drug use and current prescription drug misuse among children in deployed families versus children in other families. This issue is particularly troubling given that the United States has had a substantial increase in deployed military personnel in recent years and a corresponding increase in the number of children who have had their parents deployed.
An emerging literature outlines a range of psychosocial issues among children in military-connected families [5, 8]. The issue of increased substance use among the children in military families appears to be troubling, in particular because substance use may exacerbate many of the other issues these children and youth are facing . It has been well documented that alcohol and substance misuse is a pervasive problem among military personnel and veterans that extends to their families [3, 4, 8, 9]. Recent findings indicate that half the substance abuse treatment admissions among veterans aged 21–39 years involve alcohol as the primary substance of abuse . Additionally, research concerning army soldiers examined shortly after returning from deployment show that 27% met criteria for alcohol abuse . As such, it is not surprising that alcohol misuse is a critically important problem not only for those serving in the military, but also for their family members. However, data on substance use among family members, particularly the children, are lacking [5-7].
While most attention has been given to the deployed family member, less attention has been given to the children of the deployed family members. These children may be vulnerable to a host of issues that also include mobility and disruption of care and social networks . Several new strategies have been proposed , and recent initiatives have been launched to understand more clearly and address the broader issues of family functioning in this population [12, 13]. For example, in 2010 the National Institute of Drug Abuse and the Department of Veteran Affairs launched a program to support research on substance abuse among US military personnel, veterans and their families . However, it is not yet clear how these initiatives will address the growing needs of at-risk children in military families specifically and what the outcomes may be pertaining to prevention and intervention initiatives, including screening and treatment services.
The paper by Acion and colleagues  suggest that schools and health-care providers conduct screening for early substance use and facilitate access to services among youth at heightened risk for substance use. Similarly, the American Academy of Pediatrics recommends that pediatricians screen and evaluate youth routinely for substance use and provide office interventions and referrals for patients who are using alcohol or other substances . While this policy does not address military-connected families specifically, if the policy were implemented fully, with particular attention to youth whose parents are deployed, substance use issues in this population could be addressed more promptly and thoroughly, and then evaluated in future research. Additionally, the National Institute of Alcohol Abuse and Alcoholism has disseminated the recently developed Alcohol Screening and Brief Intervention for Youth: A Practitioner's Guide , which will greatly streamline interaction with youth and provide guidance to practitioners on this important topic.
In addition to these new tools and initiatives, it will be important to establish future research priorities regarding substance use among the children in military-connected families . It is particularly important to identify strategies to reduce and delay alcohol use in this population and seek to prevent the consequences of early alcohol and substance use [16, 17]. Additionally, providing reassurance to the impacted communities will also be important by implementing additional protection to these youth to offset the hardship their families have faced.
To conclude, military-connected youth have substantially higher levels of substance use than other youth for a number of reasons and, as such, it should be considered an important health disparity. This issue, as do other disparities, merits commensurate increased attention and provision of resources to these affected children and youth. Unfortunately, lack of action to address this issue more deliberately raises important questions about our capacity, commitment and willingness to provide the support services that many of these children need and deserve.
Declarations of interest