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AN02 ALCOHOL HABITUATION
Advisory from Disability Compensation Branch
This is an advisory note only. Disability Compensation Branch and Legal Services Group have agreed this policy view. It is not a Repatriation Commission Guideline or a Departmental Instruction. The advice is not intended to conflict with the proper application of the Veterans' Entitlements Act 1986 or the judgements of the Courts. It may be subject to change as a result of further interpretation by the Courts of the legislation. Nevertheless it represents a considered view that should be taken into account by all delegates.
The Repatriation Commission requested the Repatriation Medical Authority (RMA) to consider whether “alcohol habituation” could be categorised as “a particular injury, disease or death” under the Veterans' Entitlements Act 1986 (VEA).
The Repatriation Commission also requested that, if this were the case, the RMA conduct an investigation, under section 196E of the VEA, into “alcohol habituation”.
Habits are normal behaviours
The area of specific interest for the Repatriation Commission was whether a 'habit' of alcohol drinking continues from the service environment into the community after discharge from service.
The members of the RMA considered this matter. The advice is that “habituation” to alcohol, or indeed any other habit, which falls within the spectrum of normal human activity, is not a disease under the VEA. Habits should be considered under the psychology of normal human behaviours.
The relationship between the normal human behaviours (such as habits), social environments (for example military service) and individual biological and genetic vulnerability to disease is complex. This relationship can influence differently the exposure of each individual and thus the development of disease.
Links to service
The link to service for the consumption of low doses of alcohol not defined as alcohol dependence or alcohol abuse must be considered on an individual case by case basis.
Is habituation a disease?
The answer is simply, no. There is and will not be any SoP on alcohol habituation. Therefore a claim cannot be based on an investigation of the cause of habituation and the non-SoP rule applied. Each case would need to be examined to see if there is a connection between service and the consumption of alcohol. What those connections might be will depend on the claim submitted.
Alcohol abuse and alcohol dependence are two of the possible connections to service but are separately recognised diseases according to the International Classification of Diseases and have SoPs issued. Alcohol abuse/and/or dependence are not the inevitable end result of a 'habit'.
The following is a summary provided by the RMA on its investigation.
- The RMA searched for sound medical scientific evidence bearing on "habituation" to drinking alcohol as distinct from alcohol dependence or alcohol abuse as defined in DSM IV.
- The Literature searches: Medline (Silverplatter and NLM Pubmed), PsychLIT, CINAHL, Social Sciences Index, and Sociological Abstracts database searches were undertaken using broad search subjects 'alcohol' and 'habit' and 'alcohol' and 'habituation' and 'alcohol' and 'military' and 'military' and 'lifestyle'. The searches and abstracts remain on file with the RMA.
- The evidence re-affirmed the basis on which alcohol dependence or alcohol abuse may be linked through stressors to military service. These are covered by existing SoPs.
- The search revealed only one epidemiological study that bears on the 'habituation' issue, that is, whether a “habit” of alcohol drinking continues from the service environment into the community after discharge from service. In fact that paper suggested that not only was there no association with military service there is some evidence that military service produces the opposite effect.
- The Repatriation Medical Authority operates within the legislative framework specified in the Veterans' Entitlements Act 1986. Having regard to sound medical scientific evidence and the provisions of the Act, the RMA decided that 'habituation to alcohol' is not a disease.
Dealing with claims
Claims Assessors must treat each application on merit, according to the law, the interpretations of the Courts and the content of SoPs.
John R Douglas
Policy, Eligibility and Research
Disability Compensation Branch
7 April 2000