pathway to obtaining substance use services. First, random drug testing technology is not applicable to alcohol or to designer drugs not yet classified as illicit (e.g., Spice, bath salts). Second, civilian best practice addresses unhealthy substance use as a preventable and treatable health problem with known risk factors and offers screening and interventions as part of primary care services early and confidentially. Military practices, however, focus on abuse and dependence and view alcohol and other drug misuse as violations of the code of conduct and/or as criminal activities (e.g., DUI, drug possession). The emergence of unhealthy use before a negative incident occurs generally goes unnoticed or is ignored by medical programs, and while policy describes the need for prevention programs (see Chapter 6), the vast majority of resources are used for random drug testing.

The lack of distinction between unbecoming conduct and a medical problem creates an environment in which engaging in substance use treatment has counterproductive implications. Receiving treatment, even when treatment causes the desired change in behavior, is perceived as resulting in a negative career trajectory. Consequently, active duty service members (ADSMs) are not highly motivated to enter treatment. This can have the unanticipated effect on public safety of having service members continue to perform critical tasks without having had their problems treated. Indeed, during its information gathering meetings and site visits, the committee heard from military treatment professionals that many service members perceive alcohol treatment as a threat to their military career and consequently avoid it.1 The vignette in Box 7-1 describes an extreme, but not isolated, case in which early intervention with a soldier could have occurred. A random drug test in 2007 identified cocaine use, but 15 subsequent tests were negative. In 2011, the soldier self-enrolled in an Army Substance Abuse Program (ASAP), fully 8 years after a problem was first indicated.

In keeping with the military’s occupational health model, policy DODI 1010.6 requires that a service member’s commander be notified of and involved in treatment for an SUD (DoD, 1985, 5.2.2.2.3) (see also Chapter 6). This policy applies whether the soldier self-refers, is referred by a medical provider, or is referred by the commander, and regardless of whether an alcohol-related incident or positive drug test is involved. Branch policies impose similar requirements. For example, the Army policy for self-referral states:

The ASAP counselor will contact the unit commander and coordinate the Soldier’s formal referral using DA Form 8003, which will be signed by the

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1 Personal communication, Vladimir Nacev, Ph.D., Resilience and Prevention Directorate Defense Centers of Excellence, and Col. John J. Stasinos, M.D., Department of the Army, Office of the Surgeon General, May 4, 2011.



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