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.