Individuals identified with high-risk alcohol and other drug use who do not meet the requirements for an SUD diagnosis are targeted for secondary prevention and educational activities—Alcohol Brief Counseling (ABC) (see Appendix D) and education on Air Force and DoD policies related to alcohol use, plus educational modules covering anger management, assertive communication, changing self-talk, sleep enhancement, and other areas. The ABC counseling sessions last 45 minutes and are usually offered one to four times per week, depending on the individual’s needs and risk level. ADAPT counselors use motivational interviewing techniques to provide individual feedback based on what was found during the SUAT initial assessment.
Overall, AFI 44-121 is comprehensive. Encouragement of self-identification is a plus, particularly the recognition that commanders should support self-disclosure; that self-disclosure should not be used against service members in personnel actions; and that when self-disclosure occurs, Command should contact ADAPT for an assessment. On the other hand, encouraging medical personnel to communicate with commanders and ADAPT personnel if alcohol and other drug problems are suspected may be necessary for commanders to assess fitness and readiness for military duty, but it also removes confidentiality from the identification and treatment process and may ultimately inhibit self-disclosure. Moreover, targeted prevention education and brief counseling for those suspected of high-risk alcohol and other drug use is appropriate, but “high-risk” is not defined. Further, the policy requires that treatment or prevention counseling for all clients be based on a thorough assessment (e.g., the SUAT, a clinical interview, and the collection of collateral data as appropriate) and determination of risk and be tailored to the individual; however, it fails to identify specific procedures for conducting a standardized initial assessment and making a subsequent diagnosis.
Clinical services are required for service members medically diagnosed with substance abuse or dependence. The level and intensity of care are determined by the ADAPT program manager using the American Society of Addiction Medicine (ASAM) Patient Placement Criteria. The Air Force’s philosophy is to place personnel with substance abuse problems in the least intensive or restrictive treatment environment that is appropriate to their therapeutic needs. Depending on the service member’s needs, variable lengths of stay or durations of treatment are provided within an array of treatment settings. For example, individuals may be placed in short-term outpatient or intensive outpatient programs at their local base, referred to a partial hospitalization program, or entered into an inpatient residential treatment program with a variable length of stay. Regardless of the level or intensity of care, programs are tailored to meet the specific needs of the individual.