which are used in the Navy and Air Force, respectively (see Appendix D for descriptions of these programs).

Finding 6-5 states that neither DoD nor the branches evaluate their programs and initiatives consistently or systematically. This finding is in line with a recent RAND report examining the psychological health programs available to service members, which also notes a lack of evaluation of program effectiveness (Weinick et al., 2011). To address this gap, the committee advises DoD and each branch to require annual evaluation of the effects of prevention programs. Benchmarks with which to determine whether programs are effective or need to be changed should be established as part of the evaluation design.

As noted in Finding 6-1, DoD and the individual branches use drug testing as an integral component of their prevention strategies; however, the committee notes the limitations of these drug testing programs in preventing SUDs. The committee encourages DoD to sponsor research on the cost-effectiveness of the current urinalysis programs. Considering the complexity of drug use behavior and the continuing problem it poses for the armed forces, this research should identify ways to improve the deterrence effect of these programs and provide insight into how the programs affect service members’ attitudes toward the use of tested and untested illicit drugs. The research should also yield quantitative data on the cost per annual drug user deterred that can be compared with the cost-effectiveness of alternative evidence-based prevention programs, particularly those that may be implemented to deter alcohol misuse, which is far more prevalent than other drug misuse in the military. There appears to be a temporal correlation between the introduction of random urinalysis testing to detect and deter illicit drug use among military personnel and a declining trend in the prevalence of some drug use in the military. However, no other data are available on the effectiveness of drug screening in the armed forces, and this temporal association by itself does not meet the burden of proof for establishing a causal relationship. Further, the panel of tested substances is minimal and historically has not included some opioids and benzodiazepines that are frequently abused. Recently, DoD made changes to its drug testing program to expand the panel of tested substances to include hydrocodone and benzodiazepines, two of the most widely abused prescription medications. DoD should continue to revise the panel of tested substances as feasible to include the detection of emerging drugs of abuse, such as Spice and bath salts. DoD should also undertake evaluations to determine whether decreases in prevalence rates occur for substances recently added to the testing panel. The committee cautions DoD not to take hasty action by reducing funding for its drug testing programs before reviewing the results of cost-effectiveness research regarding whether decreased illicit drug use is causally related to these programs.



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