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Pages 1-14

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From page 1...
... . Increasing rates of alcohol and other drug misuse adversely affect military readiness, family readiness, and safety, thereby posing a significant public health problem for the Department of Defense (DoD)
From page 2...
... To address these issues, DoD and the individual branches developed a series of policy directives starting in the early 1970s, largely as an outgrowth of concern about substance use during the Vietnam era. Substance abuse has wellknown negative health consequences and detrimental effects on military readiness, levels of performance, and discipline.
From page 3...
... Standards of care and best practices in the prevention, diagnosis, treatment, and management of SUDs have changed considerably over the course of the past decade to reflect developments in the evidence base. Health care reform and federal parity legislation have enhanced access to health insurance and mandated that commercial health plans provide similar coverage for general health, mental health, and alcohol and other drug use disorders.
From page 4...
... Further, branch-specific policies that divide program responsibility among the military human resources, legal, installation management, and medical domains create challenges for delivering SUD services. In addition, neither DoD nor the individual branches evaluate their respective programs or initiatives consistently or systematically.
From page 5...
... Access is even more problematic in TRICARE's purchased care system, which is utilized by active duty service members and their dependents. The restriction of services to certified Substance Use Disorder Rehabilitation Facilities leads to an expensive reliance on geographically distant hospital-based treatment services, a lack of access to community-based outpatient and intensive outpatient services, and poor transition between inpatient and outpatient services.
From page 6...
... The increased prevalence of comorbid behavioral health diagnoses necessitates access to providers with advanced levels of training rather than certified counselors or peer support by individuals in recovery. The results of the committee's review on this topic revealed, first, that credentialing and training vary considerably across the different branches.
From page 7...
... While DoD and the individual branches advocate for the adoption and implementation of evidence-based practices throughout their policies and program literature, there is scant detail on the specific practices to be used; consequently, adoption and implementation are highly variable both across and within branches. The lack of standardization, monitoring, and evaluation of SUD policies and programs by DoD and the individual branches contributes to a variety of strategic and quality control problems.
From page 8...
... Primary care is the single greatest missed opportunity in the military for early and confidential identification of and brief education on the misuse of alcohol, and provider credentialing restrictions within the Army also limit service provision of treatment for those with comorbid disorders. Therefore, the committee recommends improvements in integration that will ultimately increase the reach and improve the quality of SUD care: Recommendation 5: DoD and the individual branches should better integrate care for SUDs with care for other mental health conditions and ongoing medical care.
From page 9...
... The individual branches are well positioned to provide these levels of care. Thus the committee makes the following recommendation: Recommendation 6: The Military Health System should reduce its reliance on residential and inpatient care for SUDs in its direct care system and build capacity for outpatient and intensive outpatient SUD treatment using a chronic care model that permits patients to remain connected to counselors and recovery coaches for as long as needed.
From page 10...
... collaborating with the VHA to contract with community providers or existing programs (e.g., Military OneSource) to perform active outreach telephone contacts and facilitated linkage for particularly high-risk or difficult-tocontact reserve component members who are demobilized or discharged, and (6)
From page 11...
... Changing SUD Workforce Requirements Since the 1970s, the SUD patient population has become considerably more complex: poly-substance use has become common, the rates and severity of psychiatric and medical comorbidities have increased, and SUD services have increasingly become integrated with behavioral health and primary care services. The committee found high levels of comorbid mental health disorders among active duty service members, reserve component members, and their dependents who seek care for alcohol and other drug use disorders.
From page 12...
... Furthermore, certified alcohol and drug counselors and individuals in recovery may provide support and continuing care services under the direction of licensed independent practitioners, but they do not have sufficient training to provide SUD treatment independently. Individuals in recovery no longer dominate the workforce; counselors with graduate degrees are prevalent, and health care reforms are likely to demand counselors who are licensed independent practitioners.
From page 13...
... However, PHRAMS underestimates the need for SUD treatment practitioners because the Military Health System Data Repository (MDR) database used by PHRAMS excludes many SUD encounters and appears to exclude encounters in specialty SUD treatment programs.


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