drinking). Blood alcohol tests should be conducted as soon as possible after an instance of problematic behavior to determine alcohol involvement. Commanders are required to contact ADAPT for assessment of SUDs within 7 days of a potential alcohol- or other drug-related incident. In the case of driving-under-the-influence/driving-while-intoxicated offenses, commanders are required to contact ADAPT within 24 hours, but no later than the next duty day. Members who return from deployment because of problematic behavior must be assessed at the nearest ADAPT program. Air Force policy requires commanders or first sergeants to “actively participate” on the treatment team “by providing input to treatment decisions” (U.S. Air Force, 2011). Health care providers can also identify substance abuse. They are required to notify unit commanders and the ADAPT program manager when a service member is observed, identified, or suspected to be under the influence of alcohol or other drugs; receives treatment for an injury or illness that may be the result of substance use; is suspected of abusing substances; or is admitted as a patient for alcohol or other drug detoxification.
In the committee’s review of Air Force programming, the Behavioral Health Optimization Program (BHOP) stood out as a useful model for integrating behavioral health with primary care services. The Air Force recognizes that the primary care work setting differs substantially from specialty behavioral health care and requires a different practice pattern and pace. The BHOP training is designed to prepare behavioral health consultants to work effectively in the primary care setting. A study on the initial implementation of BHOP showed high levels of satisfaction among patients and primary care providers at pilot sites with integrated behavioral health care (Runyan et al., 2003). BHOP is an important step toward fully integrated care, particularly as it evolves from identification and referral to specialty care to include the provision of early and brief intervention for SUDs by primary care providers. BHOP may be a model for expanding integrated care in all military treatment facilities.
Individuals referred to ADAPT complete a detailed computerized assessment with the Substance Use Assessment Tool (SUAT). The use of this tool is standardized across all Air Force ADAPT sites, and contains validated screening tools to assess for SUD. The committee heard during its site visit to Keesler Air Force Base that use of the SUAT allows service members to complete a detailed assessment without having to spend hours being interviewed by a licensed clinician. Once the SUAT has been completed, a licensed clinician reviews the results and meets with the service member to ask follow-up questions and determine an appropriate diagnosis (the SUAT even provides a diagnostic impression as part of its results). After reviewing the content of the SUAT, the committee found it to be comprehensive and based on the use of validated screening instruments (see Appendix D for further review of the SUAT).