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. 2024 Feb;119(2):248-258.
doi: 10.1111/add.16343. Epub 2023 Sep 27.

Community exposure to armed conflict and subsequent onset of alcohol use disorder

Ronny Bruffaerts  1 , William G Axinn  2 , Dirgha J Ghimire  2 , Corina Benjet  3 , Stephanie Chardoul  2 , Kate M Scott  4 , Ronald C Kessler  5 , Paul Schulz  2 , Jordan W Smoller  6
Affiliations

Community exposure to armed conflict and subsequent onset of alcohol use disorder

Ronny Bruffaerts et al. Addiction. 2024 Feb.

Abstract

Aims: To measure the independent consequences of community-level armed conflict beatings on alcohol use disorders (AUD) among males in Nepal during and after the 2000-2006 conflict.

Design: A population-representative panel study from Nepal, with precise measures of community-level violent events and subsequent individual-level AUD in males. Females were not included because of low AUD prevalence.

Setting: Chitwan, Nepal.

Participants: Four thousand eight hundred seventy-six males from 151 neighborhoods, systematically selected and representative of Western Chitwan. All residents aged 15-59 were eligible (response rate 93%).

Measurements: Measures of beatings in the community during the conflict (2000-2006), including the date and distance away, were gathered through neighborhood reports, geo-location and official resources, then linked to respondents' life histories of AUD (collected in 2016-2018) using the Nepal-specific Composite International Diagnostic Interview with life history calendar. Beatings nearby predict the subsequent onset of AUD during and after the armed conflict. Data were analyzed in 2021-2022.

Findings: Cohort-specific, discrete-time models revealed that within the youngest cohort (born 1992-2001), those living in neighborhoods where armed conflict beatings occurred were more likely to develop AUD compared with those in other neighborhoods (odds ratio = 1.66; 95% confidence interval = 1.02-2.71). In this cohort, a multilevel matching analysis designed to simulate a randomized trial showed the post-conflict incidence of AUD for those living in neighborhoods with any armed conflict beatings was 9.5% compared with 5.3% in the matched sample with no beatings.

Conclusions: Among male children living in Chitwan, Nepal during the 2000-2006 armed conflict, living in a neighborhood where armed conflict beatings occurred is associated with increased odds of developing subsequent alcohol use disorder. This association was independent of personal exposure to beatings and other mental disorders.

Keywords: Nepal; alcohol use; alcohol use disorder (AUD); armed conflict; community context; low-income setting.

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Conflict of interest statement

Declaration of Interests: JWS is a member of the Leon Levy Foundation Neuroscience Advisory Board, the Scientific Advisory Board of Sensorium Therapeutics (with equity), and has received grant support from Biogen, Inc. He is PI of a collaborative study of the genetics of depression and bipolar disorder sponsored by 23andMe for which 23andMe provides analysis time as in-kind support but no payments. DJG is also the Director of the Institute for Social and Environmental Research in Nepal (ISER-N) that collected the data for the research reported here. His conflict of interest management plan is approved and monitored by the Regents of the University of Michigan.

Figures

Figure 1.
Figure 1.
Estimated Time-Varying Probability of the Transition to the Onset of AUD 2006–2016 among those born 1992–2001 (ages 4–13 in 2006)
See this image and copyright information in PMC

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References

    1. Ertl V, Saile R, Neuner F, Catani C. Drinking to ease the burden: a cross-sectional study on trauma, alcohol abuse and psychopathology in a post-conflict context. BMC Psychiatry. 2016. Dec;16(1):202. - PMC - PubMed
    1. Degenhardt L, Bharat C, Glantz MD, Bromet EJ, Alonso J, Bruffaerts R, et al. The associations between traumatic experiences and subsequent onset of a substance use disorder: Findings from the World Health Organization World Mental Health surveys. Drug Alcohol Depend. 2022. Nov 1;240:109574. - PubMed
    1. Beardslee J, Schulenberg J, Simonton S. The Long-Term Associations Between Direct and Threatened Physical Violence in Adolescence and Symptoms of Substance Use Disorders During the Mid-30s. J Stud Alcohol Drugs. 2020. Mar;81(2):125–34. - PMC - PubMed
    1. Kilpatrick DG, Ruggiero KJ, Acierno R, Saunders BE, Resnick HS, Best CL. Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: results from the National Survey of Adolescents. J Consult Clin Psychol. 2003. Aug;71(4):692–700. - PubMed
    1. Axinn WG, Ghimire DJ, Williams NE. Collecting survey data during armed conflict. J Off Stat. 2012. Jun;28(2):153–71. - PMC - PubMed

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