which is discussed in the recommendations that follow) could inhibit the development of severe alcohol and other drug use disorders, promote force readiness, and prolong careers. The recommendations presented in this chapter focus on

  • increasing emphasis on efforts to prevent SUDs in service members and their dependents;
  • developing strategies for identifying, adopting, implementing, and disseminating evidence-based programs and best practices for SUD care (including prevention, screening, brief intervention, diagnosis, treatment, and ongoing management);
  • increasing access to care for military service members and their dependents; and
  • strengthening the workforce treating SUDs within the armed services.

In addition, although this issue is not addressed by a specific recommendation in this report, DoD and the branches will need to update policy and program language to reflect the forthcoming changes in SUD diagnostic labels and criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

INCREASING EMPHASIS ON EFFORTS TO PREVENT SUBSTANCE USE DISORDERS

Culture change will require the use of strong prevention programs that use the full range of evidence-based prevention interventions. Institute of Medicine (IOM) reports have differentiated three levels of prevention: (1) universal strategies that target communities to reduce the population risk for specific problems (e.g., enforcement of laws on minimum drinking age that affect everyone under age 21); (2) selective prevention strategies that target groups at elevated risk for specific disorders to reduce the probability of their developing those disorders (e.g., a program to prevent tobacco use among children whose parents smoke); and (3) indicated efforts that target individuals who have early signs of a disorder but do not meet diagnostic criteria (e.g., screening and brief intervention for service members seen in primary care) (IOM, 1994; NRC and IOM, 2009).

Recommendation 1: DoD and the individual branches should implement a comprehensive set of evidence-based prevention programs and policies that include universal, selective, and indicated interventions.



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