While the current SUD workforce serving the military falls short of meeting the need for SUD services generally, a particular shortfall is that few physicians have received training in addiction medicine or addiction psychiatry. General medical officers and flight surgeons receive minimal instruction in SUDs, yet often are on the front lines of diagnosis, suggesting that these providers should receive additional training to diagnosis and treat alcohol and other drug-related disorders. Beyond specialty training, one opportunity to increase background SUD training among the larger workforce of primary care physicians who provide care to military personnel is for these physicians to have a continuing medical education requirement in screening, brief intervention, and referral to treatment (SBIRT) and SUD treatment. As an example, the American Society of Addiction Medicine (ASAM) offers highly regarded state-of-the-art courses in this area and the Ruth Fox Course for Physicians (which educates doctors on addiction medicine) at its annual conferences. The committee also reviewed a webinar course on SBIRT created by the Defense Centers of Excellence that was offered in January 2012 to DoD providers. The committee finds this effort to train DoD providers in evidence-based practices such as SBIRT a promising step toward building a more knowledgeable workforce; however, the extent to which this course is widely disseminated and whether providers are implementing the practices learned through the webinar are unclear. The committee also learned of an additional effort by the Defense Centers of Excellence to further educate providers in SUDs and their treatment. A toolkit was developed for this purpose and became available for provider use in early 2012. The committee’s review of this toolkit revealed that the materials are comprehensive and represent an excellent start toward training providers in best practices for treatment of SUDs. Because the toolkit was developed and released recently, however, the extent of its dissemination and of implementation of the practices at the provider level is unknown.

Finding 8-4: The PHRAMS program is a reasonable start toward determining the quantitative relationship between the need for SUD care and staffing levels.

PHRAMS appears to be a useful tool for assessing staffing needs for care for mental health disorders. The Government Accountability Office noted that the Army, Air Force, and Navy are using PHRAMS to estimate mental health staffing requirements for their budget requests (GAO, 2010). The committee finds that PHRAMS provides an underestimate of the staffing required to address alcohol and other drug use disorders. DoD’s Comprehensive Plan on Prevention, Diagnosis, and Treatment of Substance Use Disorders and Disposition of Substance Use Offenders in the Armed Forces

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