The U.S. Military as a Natural Experiment: Changes in Drinking Age, Military Environment, and Later Alcohol Treatment Episodes among Veterans
Level 2 - randomized trial
Natural experiment evaluating policy cohorts over time (by design analogy)
OpenAlex W2792687090 · doi:10.7205/milmed.173.7.619
What was done
The authors used administrative databases from 1992 to 2003 to compare alcohol treatment episode rates between male U.S. military veterans and civilian controls across four age cohorts. The study examined whether institutional policy reforms enacted between 1982 and 1988—raising the base drinking age to 21 and establishing policies to discourage problem drinking—were associated with long-term changes in treatment rates.
What was found
In 1992, alcohol treatment rates were similar between veterans and same-aged civilians, with odds ratios of 1.0 or greater. By 2003, treatment rates among veterans aged 25 to 34 decreased by 60%, compared to a 20% to 25% reduction among civilians. Consequently, odds ratios for veterans relative to civilians declined to between 0.80 and 0.60.
Why it matters
This study indicates that raising the minimum legal drinking age and enforcing stricter environmental alcohol policies within the military had lasting protective associations, substantially lowering later-life alcohol treatment utilization among veterans relative to civilian peers.
Limits
The abstract does not report the total sample size or the specific administrative databases utilized. The sample was restricted to males and measured only formal treatment episodes, omitting untreated alcohol use disorders. Confounding from secular changes in military recruitment, retention, or differential healthcare access between veterans and civilians cannot be excluded.
Cited by
- contradicts In the United States military, service members under the age of 21 are legally permitted to consume alcohol.