The Air Force’s 75 Alcohol and Drug Abuse Prevention and Treatment (ADAPT) programs provide services to prevent and treat SUDs. Located organizationally in the Mental Health Flight, three types of providers staff ADAPT clinics: (1) licensed clinical social workers with master’s or doctoral training; (2) licensed clinical psychologists with doctoral training; and (3) certified Air Force alcohol and drug counselors (Oordt, 2011). The certified alcohol and drug counselors make up the primary staffing for the ADAPT programs. They work under the supervision of an ADAPT program manager (a licensed psychologist or social worker). Licensed mental health counselors (military and civilian) assigned to the behavioral health clinic may also work with ADAPT patients, diagnosing, developing and amending treatment plans, and terminating treatment within the scope of their licenses. The number of privileged providers assigned specifically to each ADAPT clinic depends on the local need for services. The Air Force identified two physicians (one civilian internal medicine provider and one civilian anesthesiologist) certified in addiction medicine. In addition, the Air Force reported 144 active duty psychiatrists and 12 civilian psychiatrists; although none was certified in addiction medicine, it was reported that psychiatrists frequently provide treatment services in the ADAPT clinics. Table 8-1 shows the numbers of ADAPT providers by job title.

Air Force Instruction 44-121, section 3.13, indicates that the primary objective of the treatment team for an individual ADAPT client is “to guide the clinical course of treatment of the client after examining all the facts” (U.S. Air Force, 2011b, p. 21). The treatment team meets within 14 days of the initial assessment. It includes (1) the client’s unit commander or first sergeant, (2) the client’s immediate supervisor, (3) the ADAPT program manager (treatment team leader), (4) alcohol and drug counselors and mental health technicians involved in the case, (5) medical providers if needed, (6) other individuals as needed, and (7) the client (unless deemed clinically inappropriate).

Air Force Instruction 44-121 (U.S. Air Force, 2011b) also establishes guidance for the ADAPT program and implements Air Force Policy Directive 44-172, Medical Operations for Behavioral Health Flight (U.S. Air Force, 2011c). The instruction applies to all active duty Air Force members and to members of the Air Force Reserve Command and Air National Guard. Air Force policy requires health care personnel to complete annual training on substance misuse and abuse. According to information provided to the committee by the Air Force, the training begins with a review of the mandate that all suspected or diagnosed cases of substance abuse be referred to mental health services for assessment. The training reviews standardized screening tools (Alcohol Use Disorders Identification Test

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