The Air Force, Navy, and Marine Corps rely on certified alcohol and drug counselors, while the Army requires individuals to have graduate training and professional licenses as psychologists, social workers, or counselors. The committee finds that few licensed professionals (physicians, psychiatrists, psychologists, social workers, licensed professional counselors, marriage and family counselors) are available to individuals seeking treatment for SUDs in the U.S. armed forces. Currently, each branch sets requirements for the staffing of its SUD programs; DoD has set forth no overarching guidelines. The result is considerable variability from branch to branch in the size and makeup of the SUD counseling workforce.

The certified counselor specialty emerged in the 1980s because licensed professionals were not trained and had little interest in treating alcohol and other drug use disorders. In 1979, fewer than one in four counselors (22 percent) held a graduate degree (Camp and Kurtz, 1982). Counselor certification is a useful tool for setting minimum standards. Certification standards, however, have not evolved to keep pace with scientific developments and the emergence of evidence-based pharmacological and behavioral therapies for SUDs. Women and men seeking treatment for SUDs are increasingly burdened with comorbid mental health and physical health disorders. In the U.S. military, comorbid posttraumatic stress disorder (PTSD) diagnoses are common. Treatment for comorbid mental health diagnoses is outside the scope of practice for most certified alcohol and drug counselors.

The nation’s SUD workforce is evolving in response to the changing needs of the patient population. A 2007 workforce analysis found that 42 percent of counselors and 58 percent of counselor supervisors working within treatment centers participating in the National Drug Abuse Treatment Clinical Trials Network held a master’s or doctoral degree; in outpatient treatment settings, moreover, 53 percent of counselors held graduate degrees (McCarty et al., 2007). Nationally, health care reforms are likely to limit the use of unlicensed credentialed counselors. Payers will require independent licensure for counselors providing care for SUDs (McCarty et al., 2009).

Instead of continuing to use a 20th-century workforce to treat SUDs, DoD is challenged to structure and staff treatment services for alcohol and other drug use disorders for the 21st century. As discussed in Appendix F, the emerging model of SUD care uses multidisciplinary treatment teams to create a varied workforce with carefully articulated roles and training. Individuals in recovery provide peer support instead of serving as primary counselors. Certified counselors work under the supervision of licensed practitioners. Treatment plans include evidence-based pharmacological and behavioral therapies, as well as long-term continuing care with peer support. To increase caseloads and enhance productivity, services emphasize outpatient and intensive outpatient modalities, rely on relatively brief intensive

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