The San Diego SARP is the Navy’s largest and most intensive SARP, providing both residential and outpatient services.2 Eleven interdisciplinary teams (substance abuse counselors, senior addiction counselors, licensed providers) can access medical support, a psychiatrist, and specialized mental health providers. A family counselor, recreation therapists, a creative art therapist, case managers, and chaplain support also are available. The residential staff includes 13.5 licensed providers (2 active duty), 2.5 recreation therapists, 36 alcohol and drug counselors (13 active duty), 14 administrative staff, and 14 medical staff. The outpatient staff includes 4 licensed providers (1 active duty), 16 alcohol and drug counselors (8 active duty), and 3 administrative staff. During a site visit, the committee learned that the San Diego SARP was evolving its services to fully address comorbid mental health disorders. The program now meets criteria for a dual-diagnosis enhanced program and has trained its providers in the treatment of comorbid disorders accordingly.
The Marine Corps operates 15 Substance Abuse Counseling Centers (SACCs), 14 of which have the capability to provide outpatient services. SACCs that do not provide outpatient group therapy are located at smaller installations and generally provide one-on-one counseling or refer to an outside agency. The Marine Corps transitioned to a civilian workforce for its SACCs to improve service delivery and allow for uniformity and stability while returning Marines to their primary military occupational specialty. The SACCs include both treatment and prevention staff. Counselors, directors, and medical officers implement and coordinate screening, assessment, and treatment services. Alcohol abuse prevention specialists and drug demand reduction coordinators have lead responsibility for prevention activities. Substance abuse control officers (SACOs), discussed further below, work closely with SACCs to facilitate Command referrals for screening and to supervise and implement annual drug screening. Alcohol abuse prevention specialists must complete certification as a prevention specialist within 180 days of assignment. They conduct annual assessments of alcohol abuse prevention needs, including a risk assessment, and develop annual alcohol abuse prevention plans. They also provide a monthly train-the-trainers course—Building Alcohol Skills Intervention Curriculum (BASIC)—to support alcohol abuse prevention (see Appendix D for further review of BASIC). Drug demand reduction coordinators assess needs for drug abuse prevention (which includes performing a risk assessment)
2 Personal communication, CAPT Mary K. Rusher, M.D., Substance Abuse Rehabilitation Program Department Head, Naval Medical Center San Diego, March 1, 2012.