BOX 7-1
A Soldier’s Untreated Substance Abuse

A soldier tested positive for cocaine use in March 2007. He was not required to enroll in an Army Substance Abuse Program (ASAP), and a Department of the Army (DA) Form 4833 was never completed. Despite 15 negative urinalyses from October 2008 to January 2011, the soldier self-enrolled in ASAP during the latter month for cocaine abuse and marijuana and alcohol dependence. He was apprehended in July 2011 for assault consummated by a battery (domestic violence). A review of law enforcement databases revealed that these offenses were not the beginning of the soldier’s high-risk behavior; he had been arrested for criminal trespass, marijuana possession, and evading arrest in 2003—3 years prior to his delayed-entry report date of August 2006. While driving on an interstate highway in November 2011, the soldier collided with another vehicle, killing himself and two others instantly and injuring two others. He had been driving the wrong way on the highway for 2 miles at the time of the accident. While drug and toxicology results are unknown at this time, packets of Spice were found in the soldier’s vehicle.

SOURCE: U.S. Army, 2012a, p. 30.

unit commander and be annotated as a self referral. The commander will be a part of the rehabilitation program and, as a member of the Rehabilitation Team, will be directly involved in the decision of whether rehabilitation is required. (U.S. Army, 2009, p. 49)

These policies are necessary to ensure that service members are medically ready for deployment. Yet in current practice, the lack of confidential treatment even for problems that do not meet symptom criteria for substance abuse or dependence has the perverse effect of leaving many treatable problems undetected and unaddressed. As a consequence, several Army reviews have identified a high proportion of suicides, other deaths, and other negative consequences associated with untreated SUDs (U.S. Army, 2010, 2012a).

Historically, military policy has not addressed unhealthy alcohol use or reliance on prescribed medications that places service members at high risk for SUDs and later disciplinary problems. The military now has programs that provide screening and early intervention for depression and posttraumatic stress disorder (PTSD) within primary care settings to reduce the stigma associated with seeking treatment for these conditions, but it has not

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