Substance Use Disorders in the U.S. Armed Forces (2013) / Chapter Skim
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Appendix D: Program Reviews
Appendix D: Program Reviews
Pages 305-356
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From page 305... ...
Based on the information presented in the Comprehensive Plan, the committee noted that when evidence-based practices (EBPs) are identified for a program, it is in many cases unclear to what extent they are being used or how specifically they are implemented.
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From page 306... ...
* Note that the entry on the Red Ribbon campaign in the DoD section of Appendix C of the Comprehensive Plan lists "N/A" in the "EBP" column, while the entry in the Air Force section suggests that the campaign does, in fact, employ EBPs, including "community-based processes, environmental strategies, information dissemination, alternative activities, education and problem recognition and referral." Red Ribbon Week is an annual campaign that is conducted nationwide in the United States every October both at the community level and on military bases.
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From page 307... ...
a The table on this program in the Navy section of Appendix C of the Comprehensive Plan lists the following under "Program Evaluation/Outcomes": "Total number of visits per month to website per Service, Average number of minutes per visit spent on website per Service, Total number of public service announcements per Service, and Number of promotional items distributed." b The table on this program in the Navy section identifies Reserves as an additional target population. c The table on this program in the Navy section lists "CSAP [Center for Substance Abuse Prevention]
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From page 308... ...
Health Assessments Periodic Health Assessment (PHA) Screening Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • Personnel are screened • Screening • Percent • Active • Screening annually for substance of ADSM Duty typically by use related issues during who AUDIT-C, the annual preventive complete • Reserve but health assessment.
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From page 309... ...
NOTE: ADSM = active duty service member; AUDICT-C = Alcohol Use Disorders Identification Test-Consumption; DoD = Department of Defense; EBP = evidence-based practice; N/A = not applicable; PHA = periodic health assessment.
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From page 310... ...
Health assessment could be considered a prevention strategy to the extent that the provider discusses SUD risk factors or the service member raises questions about risk factors or strategies for preventing SUDs, but its primary focus is on screening. DoD's pre- and postdeployment health assessments have three stages.
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From page 311... ...
However, studies have found that while positive screening rates for alcohol misuse can be as high as 27 percent among Army soldiers in postdeployment health assessments (Santiago et al., 2010) , only a small proportion of those who screen positive ever receive treatment.
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From page 312... ...
cites ongoing trials to evaluate the effectiveness of the self-screening and youth program components, but no outcome data have yet been published on the alcohol, PTSD, or mental health screening components. Without such data, the committee cannot comment on the extent to which the program is evidence based or effective at preventing and screening for SUDs.
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From page 313... ...
The Real Warriors Campaign is an initiative launched by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE)
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From page 314... ...
EBP = evidence-based practice. The Military and Civilian Drug Testing Program is identified in the Comprehensive Plan as both a prevention and screening program.
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From page 315... ...
• Total Criteria number of students screened but not enrolled NOTES: The ASAC program is listed as an Air Force program in Appendix C of the Comprehensive Plan, but the committee learned during the course of its research that it is used by other branches as well, and therefore listed it here in the section on DoD programs. ASAC = Adolescent Substance Abuse Counseling; ASAM = American Society of Addiction Medicine; EBP = evidence-based practice; OCONUS = outside of contiguous United States.
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From page 316... ...
guidelines for addressing risk and protective factors in school-based skills training programs. Beyond prevention activities, the ASAC program provides extensive assessments to determine whether individuals need more intensive services.
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From page 317... ...
AIR FORCE Alcohol and Drug Abuse Prevention and Treatment (ADAPT) Program Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • The ADAPT • Prevention • Access time • Active Duty • Substance Program provides to substance Abuse substance related • Diagnosis assessment • Reserve Counselors assessment, and clinical are preventative • Treatment treatment • National trained in education, clinical Guard motivational treatment and • Proportion of interviewing referral services participants • Dependents and for Airmen, completing cognitive civilian employees, treatment behavioral and family program interventions members.
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From page 318... ...
treatment to individuals who experience problems attributed to substance abuse; and to return identified substance abusers to unrestricted duty status or assist them in their transition to civilian life. NOTE: ADAPT = Alcohol and Drug Abuse Prevention and Treatment; EBP = evidence-based practice.
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From page 319... ...
The targeted prevention program, Alcohol Brief Counseling (described below) , is correctly directed at individuals who are at high risk because of heavy alcohol use but who do not qualify for a full diagnosis of abuse or dependence.
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From page 320... ...
, which provides brief intervention in a primary care setting to respond to behavioral health needs. Clients are referred by primary care physicians and are seen for three to four sessions.
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From page 321... ...
to track progress on a person alized change plan. NOTE: ABC = Alcohol Brief Counseling; ADAPT = Alcohol and Drug Abuse Prevention and Treatment; AUDIT = Alcohol Use Disorders Identification Test; CEOA = Comprehensive E ffects of Alcohol; EBP = evidence-based practice; RTCQ = Readiness to Change Questionnaire; SIP = Short Index of Problems.
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From page 322... ...
NOTE: ADAPT = Alcohol and Drug Abuse Prevention and Treatment; AUDIT = Alcohol Use Disorders Identification Test; AUDIT-C = AUDIT-Consumption; BHOP = Behavioral Health Optimization Program; DoD = Department of Defense; EBP = evidence-based practice; VA = Department of Veterans Affairs. BHOP providers are psychologists who work in integrated in primary care clinics, consulting on cases that involve either behavioral health (e.g., PTSD)
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From page 323... ...
Culture of Responsible Choices (CoRC) Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • CoRC is a commander's • Prevention • Alcohol- • Active Duty • Use EBPs program consisting of Related (e.g., a four-tiered approach • Screening Misconduct • Dependents screening with emphasis on (ARM)
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From page 324... ...
Toolkit 4 is a training and resource guide aimed at Command, ADAPT staff, and Drug Demand Reduction staff, with the purpose of building community collaborations for prevention. This toolkit includes training in prevention concepts, screening, social norms, consulting to the community, and prevention program management.
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From page 325... ...
. The program curriculum provides youth with a variety of topics including substance abuse prevention and other vital life skills including conflict resolution, self-management skills, study skills, leadership, and community service.
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From page 326... ...
Enforcing Underage Drinking Laws (EUDL) Program Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • EUDL is a pilot • Prevention • DWIs/DUIs • Active Duty • Development prevention program of EUDL was being conducted in • Traffic • Dependents predicated conjunction with accidents on the use the Department of EBPs such of Justice (DOJ)
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From page 327... ...
Air Force Reserve Component Substance Abuse Prevention Specialist Training (SAPST) Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • The SAPST program aims • Prevention • None • Reserve • EBPs are to increase knowledge and identified utilized improve skills of Drug Demand Reduction Program technicians and program managers in substance abuse prevention, facilitate full-scale adaptation and implementation of the SAPST model, and provide preliminary direction to the identification of related training and technical assistance needs.
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From page 328... ...
Prevention, Education, and Training Program Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • The program • Prevention • Screening • Active Duty • DAPT A provides soldiers Enrollment curriculum with substance Report by • Reserve utilizes abuse prevention Installation EBPs and awareness and Command • Dependents training to include at a minimum: Army • Education/ Substance Abuse Training Program (ASAP) Report by Unit policies and services, consequences • UPL of alcohol and Certification other drug abuse, Database by incompatibility of Individual alcohol and other Command drug abuse with physical and mental • Resource and fitness, combat Performance readiness, Army Report by Values, and the Installation Warrior Ethos.
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From page 329... ...
. The most noteworthy Army prevention programs are Prime for Life (PFL)
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From page 330... ...
, traffic at Unit violations, accidents and Level with injuries, and financial Upper Level problems. RRP focuses Comparisons, on effective use of Installation, installation resources Region, and and a coordinated effort Command between commanders and installation agencies to • Reintegration implement intervention URI Survey and prevention programs.
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From page 331... ...
Command NOTE: EBP = evidence-based practice; N/A = not applicable. Civilian employers frequently offer EAPs as a human resources benefit to provide assessment and brief intervention services for employees seeking behavioral health assistance.
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From page 332... ...
The ASAP Rehabilitation Program focuses on returning soldiers to full duty quickly by providing outpatient, intensive outpatient, and residential rehabilitation services for SUDs. Enrollment in rehabilitation services requires Command notification, and the commander is included on the treatment team.
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From page 333... ...
Currently, the program is providing ASAM Level II.5 care as a 4-weekday treatment program; therefore, the name of the program will be changing to reflect that it provides care beyond the IOP level. For further discussion of these two pilot programs, see Chapter 6.
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From page 334... ...
NAVY Substance Abuse Rehabilitation Program (SARP) Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • Using the American • Prevention • Number • Active • Motivational Society of Addiction of patients Duty interviewing Medicine patient • Screening retained on placement criteria, Active Duty • Reserve • Twelve-step SARP matches the • Diagnosis after 1 year facilitation appropriate intensity • Dependents of treatment to the • Treatment • Percentage • Living in individual's level of patients Balance of need.
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From page 335... ...
. ADMITS collects, maintains, analyzes, and disseminates data on all incidents and activities related to the Navy's drug and alcohol abuse prevention and control programs.
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From page 336... ...
-- medical services for detoxification and comorbidities coordinated through military treatment facilities. SARP is therefore a comprehensive treatment program that offers several therapeutic interventions with varying levels of intensity depending on ASAM placement criteria (Levels 0.5 to IV)
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From page 337... ...
MORE was developed and is administered by the widely recognized Hazelden treatment program and is oriented toward 12-step recovery. Since August 2010, MORE has supported those in the early stages of aftercare by giving them a recovery coach who is a licensed addiction counselor and is available to provide electronic and telephone support.
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From page 338... ...
Provides policy guidance and • Number of drug ensures compliance positives due to with existing policies illicit drug use and directives of DoD, Department • Number of drug of the Navy, and positives cleared other agencies due to prescribed in development, medication implementation, quality assurance, • Number of drug and evaluation of positives retained substance abuse due to innocent prevention programs. ingestion • Number of drug positives retained due to break in the chain of custody • Number of drug positives cleared due to ADMIN board/Court-Martial acquittal and Board of Inquiry retention NOTE: DoD = Department of Defense; EBP = evidence-based practice; N/A = not applicable.
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From page 339... ...
CSAP = Center for Substance Abuse Prevention; DEFY = Drug Education for Youth; EBP = evidence-based practice.
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From page 340... ...
Therefore, it is unknown whether the program is effective at preventing SUDs for military dependents. The Air Force reported that DEFY administers surveys to youth participants and parents for purposes of evaluating the program.6 Right Spirit Campaign Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • The Right Spirit • Prevention • Number of • ctive A • CSAP Campaign command and Duty prevention enhances fleet self-referrals strategies readiness by the for alcohol • Reserve reduction of screenings alcohol abuse and related incidents, • Number of and provides a safe participants in and productive local events held working to deglamorize environment while alcohol use deglamorizing alcohol use.
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From page 341... ...
Thus, the committee finds that there appears to be either a breakdown in implementation or some limitations in the materials used for the Navy's alcohol prevention programs. Further, the program relies on information dissemination rather than motivational interviewing messages and skill-building exercises that are part of evidence-based prevention programs.
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From page 342... ...
Clinical Program Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • The NDAAC • Prevention • Quarterly • Active Duty • N/A provides local meetings in area of and regional responsibility • Reserve commanders with written plans of • Number of • Dependents action to combat prevention identified local and programs/events regional drug and monitored alcohol threats. • Number of ARIs at AOR • Number of DUIs/ DWIs at AOR • Number of days without ARI or DUI/DWI NOTE: AOR = Area of Responsibility; ARI = Alcohol Related Incident; DUI = driving under the influence; DWI = driving while intoxicated; EBP = evidence-based practice; N/A = not applicable; NDAAC = Navy Drug and Alcohol Advisory Council.
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From page 343... ...
local command fully passing in selecting level. the certification prevention examination programs for and becoming their local certified community • Prevention specialists • Number of prevention programs implemented at the command level Navy Drug and Alcohol Counselor School (NDACS)
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From page 344... ...
Course Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • prevention education and • A Prevention • Number of • Active Duty • N/A health promotion course personnel (24-hr course) specifically who attend • Reserve developed to target the annually 18- to 25-year age group.
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From page 345... ...
Alcohol and Drug Abuse Management Seminar (ADAMS) for Leaders Course Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • brief seminar A • Prevention • Number of • Active Duty • N/A designed for personnel Commanding who attend • Reserve Officers, Executive annually Officers, Command Master Chiefs, • 723 (3-year Chiefs of the annual average Boat, and other throughput)
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From page 346... ...
NOTE: CO = commanding officer; CSAP = Center for Substance Abuse Prevention; EBP = e vidence-based practice; N/A = not applicable; SARP = Substance Abuse Rehabilitation Program.
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From page 347... ...
The committee finds that while the content of this course appears to be appropriate, directing prevention specialists to Center for Substance Abuse Prevention (CSAP) strategies and to a registry of evidence-based programs, the implementation of unique prevention programs at each installation is challenging and likely to erode overall quality.
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From page 348... ...
It is believed that this will reduce risk-related behaviors and enhance mission readiness. Like the ADAMS and DAPA Courses, PREVENT has training goals and lesson plans; its facilitator guide was prepared by the Pacific Institute for Research and Evaluation, a group with sophisticated knowledge of prevention programs.
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From page 349... ...
Prevention support services include prevention activities, urine testing, and indicated prevention programs. The Drug Demand Reduction program includes Command-level education and training, compulsory random drug testing with punitive consequences,
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From page 350... ...
Outpatient education and counseling may include early intervention, outpatient care, and intensive outpatient services. Marine Corps Order 5300.17 details the requirements for SACCs: "The Marine Corps is required to identify, counsel, or treat Marines identified as alcohol or drug abusers or alcohol or drug dependent" (USMC, 2011b, p. 3-1)
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From page 351... ...
APPENDIX D 351 Substance Abuse Prevention and Intervention Program Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • The Marine Corps • Prevention • Number • Active • Prevention Substance Abuse of positive Duty tools created Prevention program samples specifically for provides prevention • Reserve the Marine tools such as antidrug • Number Corps based videos and games, of multiple on research substance abuse positives by the Naval prevention tool Health kits, Command • Number of Research Summits, and the prescription Center Battalion Alcohol drug Skill Intervention confirmed Curriculum that positives help commanders prevent problems that detract from unit performance and mission readiness. • assist in the To commander's prevention efforts, a Drug Demand Reduction Coordinator, Substance Abuse Control Officers, and Alcohol Abuse Prevention Specialists are available to provide support in the following areas: llegal drug use I prevention activities Drug testing Implementing prevention programs Coordinating treatment services with the SACC Conducting aftercare NOTE: EBP = evidence-based practice; SACC = Substance Abuse Counseling Center.
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From page 352... ...
The Impact program (described previously in the section on Navy programs) also falls under the umbrella of the Marine Corps Substance Abuse Prevention and Intervention Program.
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From page 353... ...
2011. Comprehensive plan on prevention, diagnosis, and treatment of substance use disorders and disposition of substance use offenders in the armed forces.
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From page 354... ...
2003. Evaluation of an alcohol misuse prevention program in a military popula tion.
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From page 355... ...
2011. Instruction 44-121: Alcohol and Drug Abuse Prevention and Treatment (ADAPT)
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