Sept. 17, 2012 -- WASHINGTON -- The U.S. Defense Department needs more providers trained in treating substance abuse in the armed forces, according to an Institute of Medicine report.
The prevalence of comorbid behavioral conditions "necessitates access to providers with advanced levels of training rather than certified counselors or peer support by individuals in recovery," the report, released Monday, read.
The Department of Defense (DOD) asked the IOM to assess the way it handles the prevention, screening, diagnosis, and treatment of substance use disorders (SUDs) for service members, National Guard troops, members of the Reserves, and military dependents.
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IOM researchers held public information gathering meetings, conducted five site visits to military bases to meet with primary care and behavioral health providers, and received information and data on services from the military.
Failure to address issues identified will result in detrimental effects on the military's readiness and have significant public health consequences on the public health of the DOD, the IOM said. A survey of military personnel found 20 percent engage in heavy drinking and 47 percent in binge drinking, the report said.
Specifically, the IOM found:
Shortages of SUDs counselors across all branches
Wide variation in training and credentialing requirements for counselors across the branches
Outdated training manuals for Air Force and Navy substance abuse counselors
A noticeable shortage of a workforce trained in SUD prevention including physicians trained in addiction medicine or psychiatry
To address this finding, the military needs to restructure its counseling workforce and use physicians and other licensed independent practitioners to lead and supervise treatment teams. These teams need to address both mental health and physical health.
The DOD relies heavily on certified alcohol and drug counselors but needs clinical psychologists, clinical social workers, and professional counselors.
The IOM acknowledged that hiring these practitioners would be difficult, so they suggest "increased use of Internet technology to promote access to appropriately trained and licensed counselors."
The IOM found several other areas lacking besides the workforce including outdated policies and limited access to care.
The report found wide variability in policies and programs across the branches and noted neither the DOD nor its branches evaluate their programs consistently or evenly.
"Finally, the committee observed a lack of integration of SUDs care with other behavioral health and medical care within the Army and Marine Corps," the 352-page report said.
The IOM also found the number of patients treated was below expectations signaling barriers to treatment. Some of those barriers include service members having to notify commanding officers of treatment, stigma of seeking help, and the military's reliance on residential care rather than outpatient treatment.
"Finally, the committee found that members of the National Guard and Reserves, in particular, have limited access to SUDs care within the Military Health System when not on active duty," the report found.
The IOM called for the DOD and its branches to adopt evidence-based practices and programs. The military should also conduct routine screening for unhealthy alcohol use with brief alcohol education sessions.
The DOD should also reduce its reliance on inpatient care for SUDs and build its outpatient treatment model using counselors. It should also better integrate SUDs care with other mental health conditions and medical care.