group therapy, use computer-assisted cognitive-behavioral techniques, and include long-term support and ongoing recovery monitoring.

The U.S. military needs to begin to reconfigure the workforce providing alcohol and other drug treatment services so that active duty military personnel have the same level of professional care that is afforded to the civilian population (as discussed in Appendix F). The U.S. military also appears to have an increased need for licensed practitioners to support its members with comorbid mental health disorders and SUDs.

Finding 8-2: The SUD counselor training manuals of the Air Force and Navy are dated, do not address the use of evidence-based pharmacologica and behavioral therapies, and do not reference the VA/DoD Clinical Practice Guideline for Management of Substance Use Disorders.

Chapter 10 of the Air Force Alcohol and Drug Counselor Certification Handbook (U.S. Air Force, 2010) outlines knowledge and skill requirements. The listed skills are based on the Model Professional Standards for Counselor Credentialing released in 1984 (Birch and Davis Associates, Inc., 1984). The standards developed under contract for the National Institute on Alcohol Abuse and Alcoholism were crafted to stimulate and support voluntary credentialing efforts (Birch and Davis Associates, Inc., 1984). The standards are obsolete and do not address medication-assisted treatment for alcohol and opioid use disorders, nor do they describe evidence-based behavioral therapies. The Center for Substance Abuse Treatment released an update (Technical Assistance Publication [TAP] 21, Addiction Counseling Competencies) in 2008, but it, too, overlooks important developments in the use of pharmacological and behavioral therapies. The next revision of Chapter 10 of the Air Force Alcohol and Drug Counselor Certification Handbook should be updated to address the use of evidence-based pharmacological and behavioral therapies. Similarly, NDACS bases its curriculum on the Center for Substance Abuse Treatment’s TAP 21, which as noted does not address pharmacological and behavioral therapies for treatment of alcohol and other drug use disorders. An updated curriculum should more fully encompass emerging developments in evidence-based treatments for SUDs. Counselor training in both the Navy and Air Force neglects the VA/DoD Clinical Practice Guideline for Management of Substance Use Disorders (VA and DoD, 2009). The Clinical Practice Guideline, developed in collaboration between the Department of Veterans Affairs (VA) and DoD, should be a core element of counselor training.

Finding 8-3: Physicians who provide care in military treatment facilities and have received training in addiction medicine or addiction psychiatry are a rarity.



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