The impetus for this study began when criminal cases involving the illegal sale and distribution of prescription pain medications, coupled with rising rates of prescription drug abuse, reported staffing shortages in Army SUD treatment programs, concerns about access to care, and allegations of misconduct at Fort Leonard Wood, led Missouri Senator Claire McCaskill to question whether these issues were indicative of more systemic problems across the military.
The Comprehensive Plan
To answer this question, Senator McCaskill’s office sponsored the Support for Substance Use Disorders Act (S. 459) in February 2009, “a bill to improve and enhance substance use disorder programs for members of the Armed Forces, and for other purposes.”1 The bill would have directed DoD to conduct a comprehensive review of its programs and activities for the prevention, diagnosis, mitigation, treatment, and management of, as well as research on, SUDs among members of the armed forces, and based on this review, to develop a plan for improving these programs and activities for service members and their dependents. This plan was to include recommendations for SUD prevention, training for health care professionals treating SUDs, SUD services for military dependents, and the dissemination of SUD prevention materials. The bill did not become law, but it did lead to a provision within the National Defense Authorization Act for Fiscal Year 2010.2 Section 596 of the act authorized the Comprehensive Plan on Prevention, Diagnosis, and Treatment of Substance Use Disorders and Disposition of Substance Abuse Offenders in the Armed Forces (Comprehensive Plan), which mandates an internal program review on these matters by DoD, as well as an external review conducted by an independent organization such as the IOM. (The full text of S. 459 and Section 596 of Public Law 111-84 can be found in Appendixes B and C, respectively.)
To develop the Comprehensive Plan, the Assistant Secretary of Defense for Health Affairs formed an expert workgroup to review and assess (1) the availability of and access to SUD care, (2) DoD oversight of SUD programs, (3) credentialing requirements for providers of SUD care, (4) the epidemiology of SUDs, and (5) disciplinary actions and separations for substance abuse. The resulting Comprehensive Plan analyzes policies related to prevention, screening and diagnosis, and treatment of SUDs and
1 S. 459: Support for Substance Use Disorders Act, 111th Cong., 1st sess. (February 24, 2009).
2 National Defense Authorization Act for Fiscal Year 2010, Public Law 111-84 (October 28, 2009).