The nature of the need and demand for SUD treatment may differ for reserve and active duty component service members, although their role in the recent conflicts has been equally prominent. Reserve component citizen soldiers may transition repeatedly throughout their military career from active duty to civilian status. The Guard and Reserve forces are recognized as indispensable and integral parts of the nation’s defense. In the Army, in particular, the total size of the reserve component was approximately equal to that of the active duty component in FY 2010-2011, and in recent history, its size exceeded that of the active duty component (see Chapter 2).

A GAO (2011b) analysis examined mental health services in the VHA system and utilization of the services among OEF/OIF veterans. GAO estimated that there are 2.6 million living veterans from the OEF/OIF era (12 percent of all living veterans). OIF/OEF veterans accounted for 12 percent (n = 139,167) of veterans who received mental health services in FY 2010 and 10 percent (n = 36,797) of veterans treated for an SUD.14 Thus, among VA recipients of SUD services, OIF/OEF veterans’ use of mental health services is high; OEF/OIF veterans receive mental health care at a higher rate (38 percent) than all other veterans (28 percent) (GAO, 2011b).

The VHA provided the utilization data presented in Table 7-7. VA SUD services are offered in both specialty and primary care settings. The patient numbers shown in Table 7-7 are for veterans, including members of the National Guard and Reserves who have been demobilized from active duty but not released from service; in other words, they may be called to another deployment and return to active duty status. The percent change in diagnosed individuals over the last four quarters shows a clear increase in incidence. Table 7-8 presents data on VA SUD services provided to OEF/OIF/Operation New Dawn (OND) veterans, separating out care provided to those who were ADSMs and those who were members of the National Guard and Reserves in FY 2006-2010. The 4.6-fold increase in numbers treated for SUDs during the 5-year reporting period suggests that the VA has become an important source of SUD treatment services for the armed forces.

CARE AVAILABILITY, ACCESS, AND UTILIZATION IN THE PURCHASED CARE SYSTEM

Under the TRICARE insurance plans, network and non-network providers deliver services for SUD care in civilian-operated settings (purchased

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14 A veteran was counted as having a mental health condition if, at any point in the fiscal year, his or her medical record indicated at least two outpatient encounters with any mental health diagnosis (with at least one encounter having a primary mental health diagnosis) or an inpatient stay in which the veteran had any mental health diagnosis.



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