practice to the VA/DoD Clinical Practice Guideline for SUD care (VA and DoD, 2009) that has been acknowledged as the military’s standard of care.
The committee’s findings are in line with earlier findings of the DoD Task Force on Mental Health (DoD, 2007). That task force observed that the stigma of mental health disorders inhibits military members and their families from seeking care. The task force recommended that DoD (1) develop public education campaigns to dispel this stigma; (2) embed mental health professionals in primary care to improve access and reduce stigma; (3) train officers, families, and medical professionals to value and promote psychological health and services; and (4) recognize that DoD regulations often inhibit seeking care (DoD, 2007). Recommendation 220.127.116.11 specifically addresses the effects of policy on care for alcohol use disorders and suggests policy changes to promote access to care:
The Department of Defense should promote earlier recognition of alcohol problems to enhance early and appropriate self-referral. If, in the clinician’s judgment, alcohol use does not warrant a diagnosis, mechanisms should exist to ensure that service members receive appropriate and non-prejudicial education and preventive services, without a requirement for command notification. Evaluations resulting in a diagnosis of substance abuse or dependence or entry into a formal outpatient or inpatient treatment program should continue to require command notification, as should reporting of alcohol-related incidents. (DoD, 2007, p. 21)
Lack of confidentiality is a persistent barrier to SUD care and appears as well to influence the lack of preventive and early intervention services that may prevent the development of an SUD. To reduce the stigma associated with seeking help for mental health and substance abuse problems, a recent DoD policy (DODI 6490.08) gives health care providers more latitude in responding to requirements for notifying Command of mental health and substance abuse disorders. The policy clarifies that if a service member voluntarily seeks drug and alcohol abuse education and does not meet diagnostic criteria, brief intervention services can be provided without Command notification (DoD, 2011a). The instruction also creates an opportunity for health care providers in primary care or other medical settings to screen for alcohol and other drug misuse and provide patient education. The committee suggests that policies such as DODI 64990.08 are a step toward creating confidential systems of intervention and may encourage help-seeking behavior. If DoD and branch policies do not provide for early and confidential treatment of alcohol and other drug misuse, the committee believes that stigma will remain a significant barrier to SUD services. While these subclinical behaviors are not detected or treated, they may still have a tremendous impact on force health and readiness.