The committee finds that the structure of SUD services in the armed forces also inhibits access to care. For example, DoD’s Comprehensive Plan acknowledges that “gender-specific programs to treat SUDs in women are not available at MTFs [military treatment facilities]” (DoD, 2011b, p. 26). With increased enrollment of women in the military and their greater exposure to combat deployments, the need for gender-specific services is apparent. Additionally, the availability of SUD treatment at the time it is sought is an important principle in the commercial sector. On-base substance abuse programs typically offer care during duty hours, so participation in treatment programs often necessitates notifying Command to arrange adjustments to one’s work schedule. If SUD services were available at times that did not conflict with work duties (perhaps through increased use of telemental health technologies, which could provide care outside of duty hours delivered remotely by a provider in another time zone), ADSMs would have greater opportunities to enter care before the severity of an SUD required leave from their duty assignment. While this conflict with work duties is one rationale for commander involvement on the treatment team, it also is a perceived barrier to seeking care, particularly for career-minded service members who see daytime therapy appointments as often conflicting with job demands (Kim et al., 2011).

Similarly, while waiting to enter treatment or in the middle of treatment, a service member may leave on deployment. Upon return, he or she may receive a different permanent station, which again disrupts continuity of care. The DoD Task Force on Mental Health reached similar findings and recommended that DoD support a full continuum of services for service members and their families, and develop policies that would ensure continuity of care during deployment transitions and transitions between civilian and military providers (DoD, 2007). The task force encouraged DoD to develop strategies for recruiting and retaining mental health professionals, including social workers. The task force’s findings raised concern about access to mental health services within TRICARE and led to recommendations for policy revisions to require access to care within 7 days, competitive reimbursement rates, the use of intensive outpatient services and other new approaches to care, and the use of qualified professionals not affiliated with hospitals to provide outpatient services (DoD, 2007).

Finding 7-5: Members of the National Guard and Reserves have no or limited access to SUD care within the Military Health System.

The large numbers of National Guard and Reserve personnel who have been activated and deployed to Iraq and Afghanistan raise concern about specific barriers to SUD care that they confront. Reserve component personnel often are dispersed within the civilian community and often live



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