outpatient services counted may have been associated with and already counted under detoxification, emergency department, and inpatient care.

DoD-Wide Programs

DoD contracts for programs to expand ready access to behavioral health services and encourage help seeking among military personnel and their dependents. Some of these programs, such as Military OneSource and the Yellow Ribbon Campaign, are described in Appendix D. These programs generally provide nonmedical support services and are considered an important pathway to SUD care and other services. Box 7-2 describes these programs. The committee did not receive data on the volume of calls, consultations, or referrals provided. A recent RAND report found that many of these programs do not track outcome data and have largely not been evaluated (Weinick et al., 2011).

Summary of Access in the Direct Care System

The Air Force and Navy reported serving fewer individuals in their SUD programs in FY 2010 than in most prior years. In contrast, the Army and Marine Corps reported increased treatment admissions. No branch had high rates of self-referral to treatment, a finding consistent with the literature reviewed and reports provided to the committee regarding the perceived stigma of receiving treatment. The Army reported the highest proportion of self-referrals, which likely is due to the Confidential Alcohol Treatment and Education Pilot (CATEP) program (described in Appendix D) and contributed to higher than average utilization rates.

The committee identified a number of aspects of the organization of care, policies on and barriers to care, and other differences in how service members gain access to care that appear to contribute to some of this variation. The branches are remarkably diverse in the types of SUD programs they offer and the pathways to care they provide. Despite a far greater number of troops relative to other branches, the Army operates ASAPs at only 38 locations and acknowledges it has been trying to expand its numbers of licensed social workers and psychologists. Many Army installations have no ASAP, and the Army operates only one 20-bed medically monitored inpatient unit for SUD care. In contrast, the Navy operates 38 SARP outpatient programs, including 5 programs in foreign countries and 3 SARP inpatient/outpatient hospital units. SARPs actually provide services to more Marine Corps than Navy patients even though the number of Navy service members far exceeds the number of Marines. The Navy’s SARP integrates care for comorbid mental health issues and is managed by Medical Command. The Marine SACCs are at 15 installations, and nearly



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