FRAMEWORK FOR ACCESS TO CARE

The armed forces focus on maintaining warrior fitness and promoting resilience among service members and military families. Active duty personnel experience frequent mobilizations, difficult transitions, combat situations, and an operational tempo with long and multiple periods away from their families and supports. The physical and emotional stressors experienced by many military women and men may contribute to an increase in their use of alcohol and other drugs. Access to substance use services—from prevention to a wide spectrum of interventions for substance misuse and abuse—can help military personnel and their families maintain psychological resilience and fitness. Access to routine screening, confidential brief education, brief counseling, brief interventions for those with emerging substance use problems, and more intensive treatment for those with SUDs promotes good health and may reduce the current high rates of alcohol and prescription drug misuse. If these services are delivered without sanctions or stigma, they promote an effective response to emerging alcohol and other drug use problems, and foster a system in which individuals seek help rather than hide problems.

The committee’s framework for assessing access to SUD care is based on its view that alcohol and other drug use behaviors exist on a continuum, and that certain patterns of alcohol and other drug use place some individuals at high risk of developing medical and social problems and possibly abuse or dependence. The discussion here focuses on the use of legal substances (i.e., alcohol, controlled substances prescribed by a clinician) since the use of illicit substances (when detected) prompts separation proceedings.

Addressing access to brief intervention and treatment for alcohol and other drug use is a complex undertaking. Access includes both the availability of services and the use of appropriate modalities and types of services at the appropriate times. As described in Chapter 5, contemporary substance use treatment systems include frequent screening, brief counseling, brief interventions in primary care settings, a focus on client-centered motivational interviewing, multiple entry points to treatment, pharmacotherapies that reduce cravings and maintain functioning, outpatient counseling, intensive outpatient programs, residential treatment when needed, and continuous contact with counseling professionals after an intense period of treatment. Modalities of care utilize evidence-based environmental, psychosocial, and medication interventions. The standard of practice in modern SUD treatment no longer relies on inpatient hospital services, except for the most medically complex patients. Continuity and duration of ambulatory services are more important than the provision of care in residential settings (IOM, 2006).



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