The committee recognizes the challenge of managing one of the nation’s largest health systems, but notes that the different branches tend to operate their SUD services with minimal direction from and accountability to DoD. Consequently, DoD needs to acknowledge that the current levels of substance use and misuse among military personnel (e.g., reported binge drinking among 47 percent of active duty service members in 2008 [Bray et al., 2009]) and their dependents constitute a public health crisis; require consistent implementation of prevention, screening, and treatment services; and assume the leadership necessary to achieve this goal. This complex task will undoubtedly require changes to military culture, which is perceived by many as inhibiting case finding and discouraging self-referral for alcohol and other drug use problems. Based on the demographics of the U.S. armed forces (i.e., the majority of men and women under age 30), the results of self-report surveys on drug and alcohol use (Bray et al., 2009), and the ready access to relatively inexpensive alcohol on military bases, the committee recognizes that the need for prevention and treatment efforts and services is higher than the utilization data reported in Chapter 7 suggest. The committee believes that the foundation for SUD policy and program formulation and resource allocation should be an understanding that the levels of alcohol and other drug use constitute a public health crisis in the military. The highest leadership levels throughout the military should recognize that alcohol and other drug use problems

  • are currently at unacceptably high levels and detrimental to readiness and total force fitness;
  • should be addressed with an arsenal of public health strategies (e.g., universal, selective and indicated prevention programs and policies) applied to population groups, particularly those at high risk;
  • require medical and behavioral interventions for individuals with emergent problems;
  • can be prevented and treated when detected early and addressed with confidential interventions; and
  • demand the attention of unit leaders and commanders.

The committee recognizes the need for disciplinary action when criminal behavior occurs, supports a strong surveillance program to detect the use of substances that impair performance, and applauds current efforts to enhance the quality and effectiveness of SUD prevention and treatment services. Increased routine screening for unhealthy alcohol use and mechanisms to support brief interventions and confidential treatment (each of

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