Substance Abuse in Uniform: Some Good Outside Advice

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There’s a lot of really good stuff in the Institute of Medicine report released Monday on substance abuse inside the U.S. military. Much of the coverage focused on the problems of substance use after 11 years of war. I’d rather drill down on several of the report’s key recommendations:

“Recommendation 4: Policies of DoD and the individual branches should provide evidence-based diagnostic treatment and treatment processes.

The lack of integration of substance use disorder care, with behavioral health care and medical care, is highlighted in the report.

One of the challenges, at least in the Army, the service I know best, is that substance abuse treatment does not belong to the medical department. It used to belong to personnel and now to Installation Management Command.

This has been a continuous source of tension. For example, the latest advances in treatment of addictions are not part of treatment practice.

Recommendation 8: DoD should encourage each service branch to provide options for confidential treatment of alcohol use disorders.

Another issue is that referrals to substance use treatment are not confidential; referrals are reported to command.

The Army started some options of confidential self-referral in a pilot program a few years ago. The IOM report encourages more of these, a positive move.

Recommendation 11: The individual service branches should restructure their SUD [substance use disorder] counseling workforces…

Bottom line: we need more physicians and other licensed providers in the mix.

When I was on active duty we tried to improve the delivery of SUD care, but were hampered by many organizational and cultural barriers.

Confidentiality was an enormous issue. Commanders wanted to know whether their service members were in treatment for substance abuse. We understood why the commanders wanted to know, but knew that service members shunned treatment if their command would find out. Likewise, service members worried about their security clearances.

We were always trying to hire more substance abuse counselors, but the hiring process in the government is very cumbersome. Anyway there were not enough trained providers, which is why workforce growth is so important.

Let’s hope this independent report from some of the nation’s leaders in substance abuse will help.

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Drug addiction is a chronic, progressive brain disease and should be treated medically. But too many people still don't understand addiction has a biological basis.

That's why education about the disease of addiction is crucial.

For a not-for-profit website that discusses the science of substance use and abuse in accessible English (how alcohol and drugs work in the brain; how addiction develops; why addiction is a chronic, progressive brain disease; what parts of the brain malfunction as a result of substance abuse; how that malfunction skews decision-making and motivation, resulting in addict behaviors; why some get addicted while others don't; how treatment works; how well treatment works; why relapse is common; what family and friends can do; etc.) please click on


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One very important aspect of the current rates of heavy alcohol use in the military -- often endorsed by military leaders as 'tradition' -- is the high potential for death for those combining alcohol with the widely-prescribed powerful opioids and or psych meds (SSRIs, anti-psychotics, sleep meds, and benzodiazepines).

Heavy alcohol use is rampant in combat MOSs and a very serious danger for those diagnosed with neuropsychiatric injuries when they are prescribed (ordered to take) these medications by their military doctors.

The DoD's last published Suicide Event Report (DODSER) released for 2010 indicated hundreds of deaths due to toxic drug overdoses, many of them very likely alcohol related. 

The 2011 DODSER has not yet been published or reported to the public.

It would be interesting to see if the rate of drug toxicity deaths -- always accounted for by DoD statisticians as 'accidental deaths' -- has increased from the figures presented in 2010 DODSER. 

Bob Brewin has done some good reporting on this topic at

According to information contained in one of his reports published April 25, 2012, the Army released a revised policy to address drug toxicity issues, and in part declared ...

"Benzodiazepine use should be considered relatively contraindicated in combat veterans with PTSD because of the high co-morbidity of combat-related PTSD with alcohol misuse and substance use disorders (up to 50 percent co-morbidity) and potential problems with tolerance and dependence."


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