Appendix A

Study Activities

The committee held data-gathering sessions that were open to the public at four of its five meetings. Committee members also visited several military installations, including Camp Pendleton, California; Fort Belvoir, Virginia; Keesler Air Force Base, Mississippi; San Diego Naval Base, California; and Fort Hood, Texas. The agendas for the open sessions of the committee’s meetings and for the site visits are presented below.

MEETING ONE

Committee on Prevention, Diagnosis, Treatment and
Management of Substance Use Disorders in the U.S. Armed Forces
March 30-31, 2011
Hotel Monaco
700 F Street, NW
Washington, DC

10:00 a.m.

Welcome and Introductory Remarks

Charles O’Brien, M.D., Ph.D., Committee Chair, University of Pennsylvania



10:10 a.m.

The Charge to the Committee: A Discussion with the Sponsor

Capt. Robert DeMartino, TRICARE Management Activity

Alfred Ozanian, Ph.D., TRICARE Management Activity



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Appendix A Study Activities The committee held data-gathering sessions that were open to the public at four of its five meetings. Committee members also visited several military installations, including Camp Pendleton, California; Fort Belvoir, Virginia; Keesler Air Force Base, Mississippi; San Diego Naval Base, Cali- fornia; and Fort Hood, Texas. The agendas for the open sessions of the committee’s meetings and for the site visits are presented below. MEETING ONE Committee on Prevention, Diagnosis, Treatment and Management of Substance Use Disorders in the U.S. Armed Forces March 30-31, 2011 Hotel Monaco 700 F Street, NW Washington, DC 10:00 a.m. Welcome and Introductory Remarks Charles O’Brien, M.D., Ph.D., Committee Chair, University of Pennsylvania 10:10 a.m. The Charge to the Committee: A Discussion with the Sponsor Capt. Robert DeMartino, TRICARE Manage- ment Activity Alfred Ozanian, Ph.D., TRICARE Management Activity 271

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272 SUBSTANCE USE DISORDERS IN THE U.S. ARMED FORCES 12:00 p.m. Lunch 1:00 p.m. Introduction to SUD Prevention, Diagnosis, Treatment, and Management in the Armed Forces: What Is the Status Quo? Alfred Ozanian, Ph.D., TRICARE Management Activity Les McFarling, Ph.D., Army Center for Sub- stance Abuse Programs Charles Gould, U.S. Navy Bureau of Medicine and Surgery Lt. Col. Mark S. Oordt, Ph.D., Air Force Medi- cal Operations Agency 3:30 p.m. Break 3:45 p.m. Responding to Substance Use Disorders in Mili- tary Personnel and Their Dependents Keith Humphreys, Ph.D., Stanford University 5:00 p.m. Public Comment Period 5:30 p.m. Meeting Close MEETING TWO Committee on Prevention, Diagnosis, Treatment and Management of Substance Use Disorders in the U.S. Armed Forces May 3, 2011 DoubleTree Hotel 1515 Rhode Island Avenue, NW Washington, DC 8:50 a.m.-9:00 a.m. Welcome and Introduction Charles O’Brien, M.D., Committee Chair, Uni- versity of Pennsylvania 9:00 a.m.-9:30 a.m. Q&A on MHS and TRICARE Don Jansen, Congressional Research Service 9:30 a.m.-10:00 a.m. The Reserve Components and Access to Care Brig. Gen. Margaret Wilmoth, Ph.D., Office of the Assistant Secretary of Defense for Health Affairs

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APPENDIX A 273 SUD Prevention, Diagnosis, Treatment, and Management in the Armed Forces: The Medical Perspective 10:00 a.m.-10:50 a.m. Barbara Marin, Ph.D., Walter Reed Army Medi- cal Center Col. John J. Stasinos, M.D., Dept. of the Army, Office of the Surgeon General 10:50 a.m.-11:20 a.m. Capt. Mary Rusher, M.D., Naval Medical Center San Diego 11:20 a.m.-11:40 a.m. Lt. Col. Mark S. Oordt, Air Force Medical Operations Agency 11:40 a.m.-12:00 p.m. Q&A 12:00 p.m.-1:00 p.m. Lunch 1:00 p.m.-1:45 p.m. SUDs in the Military: Medical vs. Personnel Vladimir Nacev, Ph.D., Defense Centers of Excellence 1:45 p.m.-2:30 p.m. Prescription Drug Misuse Among Active Duty Service Members Diana D. Jeffery, Ph.D., TRICARE Management Activity 2:30 p.m.-2:45 p.m. Break 2:45 p.m.-3:45 p.m. Access to SUD Care: Confidentiality and Stigma Col. Charles Milliken, M.D., Walter Reed Army Institute of Research 3:45 p.m.-4:30 p.m. Substance Use Disorders in the Military: The NIDA Perspective Wilson Compton, M.D., National Institute on Drug Abuse Eve Reider, Ph.D., National Institute on Drug Abuse 4:30 p.m.-5:00 p.m. Public Comment Period 5:00 p.m. Meeting Close

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274 SUBSTANCE USE DISORDERS IN THE U.S. ARMED FORCES SITE VISIT: MARINE CORPS BASE CAMP PENDLETON, CALIFORNIA Committee on Prevention, Diagnosis, Treatment and Management of Substance Use Disorders in the U.S. Armed Forces July 18, 2011 Marine Corps Consolidated Substance Abuse Counseling Center (CSACC) & The Navy Substance Abuse and Rehabilitation Program 7:45 a.m.-8:00 a.m. Check-In at Camp Pendleton Main Gate 8:00 a.m.-8:30 a.m. Meet with CSACC Director John Veneziano 8:30 a.m.-9:30 a.m. Meet with CSACC Staff 9:30 a.m.-10:00 a.m. Break 10:00 a.m.-12:00 p.m. Meet with Drug Demand Reduction Coordinators 12:00 p.m.-1:00 p.m. Lunch 1:00 p.m.-2:00 p.m. Meet with Staff from Navy Drug and Alcohol Counselor School 2:00 p.m.-3:00 p.m. Meet with Marines Assigned for Temporary Duty at CSACC 3:00 p.m.-4:00 p.m. Debrief with John Veneziano MEETING THREE Committee on Prevention, Diagnosis, Treatment and Management of Substance Use Disorders in the U.S. Armed Forces July 19, 2011 Beckman Center of the National Academies 100 Academy Way Irvine, California 9:10 a.m.-9:30 a.m. Welcome and Introduction Charles O’Brien, M.D., Committee Chair, Uni- versity of Pennsylvania

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APPENDIX A 275 9:30 a.m.-10:15 a.m. Purchased Care for Service Members and Their Families: The TRICARE SUD Benefit John Sparks, TRICARE Regional Office-West Frank Maguire, M.D., TriWest Andrea Brooks Tucker, TRICARE Regional Office-South Debbie Del Rosario and Gary Proctor, M.D., ValueOptions Marie Mentor, TRICARE Regional Office-North Ian Schaffer, M.D., and John Wagoner, M.D., Healthnet Federal Services 10:15 a.m.-10:30 a.m. Break 10:30 a.m.-11:15 a.m. Panel: Prevention for Members of the Armed Forces and Their Families John M. Morrow, Ph.D., Substance Abuse and Mental Health Services Administration Abigail Gewirtz, Ph.D., University of Minnesota Ron Astor, Ph.D., University of Southern California 11:15 a.m.-11:45 a.m. Substance Abuse and Military Families Barbara Cohoon, Ph.D., National Military Fam- ily Association 11:45 a.m.-12:15 p.m. Seeking Safety: Therapy for Comorbid PTSD and SUD Lisa Najavits, Ph.D., Harvard University 12:15 p.m.-1:15 p.m. Lunch 1:15 p.m.-1:45 p.m. Workforce Training Anthony Hassan, Ph.D., University of Southern California 1:45 p.m.-2:15 p.m. Prescription Drug Monitoring in the Military Eugene Moore, PharmD, TRICARE Pharmacy Operations Cdr. Joseph B. Lawrence, PharmD, M.B.A., TRICARE Pharmacy Operations

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276 SUBSTANCE USE DISORDERS IN THE U.S. ARMED FORCES Josh Devine, PharmD, TRICARE Pharmacy Operations Libby Hearin, PharmD, TRICARE Pharmacy Operations 2:15 p.m.-2:45 p.m. Alcohol Abuse in the Military: Findings from the Millennium Cohort Study Isabel Jacobson, M.P.H., Naval Health Research Center 2:45 p.m.-3:00 p.m. Break 3:00 p.m.-3:45 p.m. A General’s Story Lt. Gen. David Fridovich, Dept. of the Army 3:45 p.m.-4:45 p.m. Advancements in the Treatment of Pain: Efforts to Prevent Opioid Dependence Lt. Col. Kevin Galloway, Army Pain Manage- ment Task Force Col. Chester Buckenmaier, M.D., Walter Reed Army Medical Center Col. John J. Stasinos, M.D., Dept. of the Army, Office of the Surgeon General 4:45 p.m.-5:00 p.m. Public Comment Period 5:00 p.m. Meeting Close SITE VISIT: FORT BELVOIR, VIRGINIA, ADDICTION PROGRAMS Committee on Prevention, Diagnosis, Treatment and Management of Substance Use Disorders in the U.S. Armed Forces November 15, 2011 8:00 a.m. Arrive at Fort Belvoir Tulley Gate 8:30 a.m.-9:00 a.m. Tour of the Fort Belvoir Community Hospital Anthony H. Dekker, D.O., Chief, Addiction ­ M ­ edicine at Fort Belvoir Community Hospital

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APPENDIX A 277 9:00 a.m.-9:30 a.m. Tour of the Residential Treatment Center, Fort Belvoir Community Hospital (4 South) Anthony H. Dekker, D.O., Chief, Addiction ­ M ­ edicine at Fort Belvoir Community Hospital 9:30 a.m.-10:00 a.m. Tour of the Inpatient Residential Treatment Program, Fort Belvoir Community Hospital (4 North) Maj. Brunt, M.D., Staff Psychiatrist 10:00 a.m.-11:00 a.m. The Pain Clinic at Fort Belvoir Ben Krepps, M.D., Director of the Pain Clinic at Fort Belvoir Community Hospital 11:00 a.m.-11:30 a.m. Inpatient Residential Treatment Program, Fort Belvoir Community Hospital (4 North) Jennifer Weaver, M.D., Program Director 11:30 a.m.-12:15 p.m. Lunch 12:30 p.m.-12:45 p.m. Shuttle to the Dewitt Army Hospital Warrior Zone 12:45 p.m.-1:30 p.m. Co-Occurring Program, Dewitt Army Hospital, Warrior Transition Brigade Chideha Ohuoha, M.D., M.P.H., Program Director 1:30 p.m.-2:00 p.m. Army Substance Abuse Program, Dewitt Army Hospital Doryan Dixon, Program Manager for ASAP Dr. Jorge Grandella, ASAP Clinical Supervisor 2:00 p.m.-3:45 p.m. Army Substance Abuse Program, Dewitt Army Hospital Ms. Susan Jessup, LCSW, LCAS, Clinical Pro- gram Manager 3:45 p.m. Return to the Fort Belvoir Community Hospital River Garage

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278 SUBSTANCE USE DISORDERS IN THE U.S. ARMED FORCES MEETING FOUR Committee on Prevention, Diagnosis, Treatment and Management of Substance Use Disorders in the U.S. Armed Forces November 16, 2011 Keck Center of the National Academies 500 Fifth Street, NW Washington, DC 9:00 a.m.-9:15 a.m. Welcome and Introduction Charles O’Brien, M.D., Committee Chair, Uni- versity of Pennsylvania 9:15 a.m.-9:45 a.m. NIAAA Update on Treatment for Alcohol Prob- lems Among Active Duty Military Personnel and Veterans Bob Huebner, Ph.D., National Institute on Alco- hol Abuse and Alcoholism 9:45 a.m.-10:30 a.m. Improving Population Care of Substance Use Disorders in the Military: The Primary Care Imperative Col. Charles Engel, M.P.H., M.D., Department of Defense Deployment Health Clinical Center 10:30 a.m.-10:45 a.m. Break 10:45 a.m.-11:30 a.m. A Systems Perspective of Substance Use and Abuse in the Military Harold Holder, Ph.D., Prevention Research Center of the Pacific Institute for Research & Evaluation 11:30 a.m.-12:15 p.m. Implementing Evidence-Based Practices for Identification and Management of Substance Use Conditions in the Veterans Health Administration Daniel Kivlahan, Ph.D., Office of Mental Health Services, Veterans Health Administration 12:15 p.m.-12:30 p.m. Public Comment Period 12:30 p.m. Meeting Close

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APPENDIX A 279 SITE VISIT: KEESLER AIR FORCE BASE, MISSISSIPPI Committee on Prevention, Diagnosis, Treatment and Management of Substance Use Disorders in the U.S. Armed Forces January 27, 2012 7:30 a.m. Arrive at White Avenue Gate Meet 1Lt. Julianna Petrone at Visitors Center 7:45 a.m.-8:15 a.m. Tour of Mental Health Flight Clinics 8:30 a.m.-9:15 a.m. ADAPT Drunk Busters Presentation at the Triangle 1Lt. Julianna Petrone, LISW, ADAPT Program Manager SSgt. Cecilia Cardenas, ADC in Training, ADAPT NCOIC Prevention Activity at Keesler AFB 9:30 a.m.-10:15 a.m. Alcohol and Drug Abuse Prevention and Treat- ment (ADAPT) 1Lt. Petrone, LISW, ADAPT Program Manager Paul Ahlberg, ADC, ADAPT Counselor SrA. Stephanie Tipton, ADC in training, ADAPT Counselor SSgt. Cecilia Cardenas, ADC in Training, ADAPT NCOIC 10:15 a.m.-10:45 a.m. Families OverComing Under Stress (FOCUS) Kim Perez, LPC, Family Resiliency Trainer Eva Shinka, LSCW-C, Assistant Site Director 10:45 a.m.-11:00 a.m. Behavioral Health Optimization Program (BHOP) Maj. David Cordry, Clinical Neuropsychologist, Mental Health Flight Commander Dr. Myron Horn, Clinical Psychologist, BHOP Consultant 11:00 a.m.-11:45 a.m. Question and Answer Session

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280 SUBSTANCE USE DISORDERS IN THE U.S. ARMED FORCES SITE VISIT: SAN DIEGO NAVAL AIR STATION, CALIFORNIA Committee on Prevention, Diagnosis, Treatment and Management of Substance Use Disorders in the U.S. Armed Forces March 1, 2012 8:00 a.m.-8:30 a.m. Welcome/In-Brief Warren Peter Klam, M.D., M.S.(MM), CAPT MC USN (r), Director, Mental Health S ­ ervices, and Chairman, Psychiatry, General, Child, Adolescent and Addiction Psychiatry, Naval Medical Center, San Diego 8:30 a.m.-9:30 a.m. Substance Abuse Rehabilitation Program (SARP) Mary K. Rusher, M.D., CAPT MC USN, Depart- ment Head, Substance Abuse Rehabilitation Program, Naval Medical Center, San Diego Joanne Rigoloso, Social Worker, Clinic Head at SARP Charlie Gould, Director of SARP at Navy Bureau of Medicine (BUMED) 9:30 a.m.-10:15 a.m. Center for Personal and Professional Development Tara Leverett, Chief Yeoman (YNC), Preven- tion and Outreach, Center for Personal and Professional Development West 10:15 a.m.-10:30 a.m. Break 10:30 a.m.-11:15 a.m. DAPA/Command Master Chief NMCSD— CMDCM Duberek Valerie Sudduth, Hospital Corpsman (HM1), Assistant Command Drug and Alcohol Pro- gram Administrator, Naval Medical Center, San Diego Nelson Ferrer, Hospital Corpsman Chief (HMC), Command Drug and Alcohol Program Administrator, Naval Medical Center, San Diego 11:15 a.m.-12:00 p.m. Fleet and Family Services Mr. Richard Arriaga, Director, Fleet and Family Support Center, San Diego

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APPENDIX A 281 12:00 p.m.-1:00 p.m. Lunch 1:00 p.m.-1:45 p.m. Primary Care Steven Sovich, M.D., Primary Care Physician, Naval Medical Center, San Diego 1:45 p.m.-2:30 p.m. Pain Management Specialist Steven Hanling, M.D., CDR MC USN, Pain Management Provider, Naval Medical C ­ enter, San Diego 2:30 p.m.-2:45 p.m. Break 2:45 p.m.-3:30 p.m. Substance Abuse Rehabilitation Program (SARP) Mary K. Rusher, M.D., CAPT MC USN, Depart- ment Head, Substance Abuse Rehabilitation Program San Diego, Naval Medical Center, San Diego 3:30 p.m.-4:00 p.m. Out-Brief Warren Peter Klam, M.D., M.S.(MM), CAPT MC USN (r), Director, Mental Health S ­ ervices, and Chairman, Psychiatry, General, Child, Adolescent and Addiction Psychiatry, Naval Medical Center, San Diego SITE VISIT: CARL R. DARNALL ARMY MEDICAL CENTER, FORT HOOD, TEXAS Committee on Prevention, Diagnosis, Treatment and Management of Substance Use Disorders in the U.S. Armed Forces March 15, 2012 7:00 a.m. Arrive at Fort Hood Main Gate Check into Visitor’s Center 8:00 a.m.-8:30 a.m. Introduction to Department of Behavioral Health LTC Gray, M.D., Chief, Department of Behav- ioral Health Ms. Nicolette Dennis, LCSW, Acting Chief of Intensive Outpatient Program MAJ Agius, M.D., Chief, Hospital & Adminis- trative Psychiatry

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282 SUBSTANCE USE DISORDERS IN THE U.S. ARMED FORCES 8:30 a.m.-10:30 a.m. Intensive Outpatient Program (IOP) Ms. Dennis, LCSW, Acting Chief of IOP program Dr. Shehan, Staff Psychiatrist for IOP program and ASAP Ms. Barnard, Administrator, IOP 10:30 a.m.-11:30 a.m. Primary Care/Respect-Mil Dr. Ingram, Chief of Family Medicine Dr. Borah, Staff Psychiatrist (Respect-Mil repre- sentative, dept BH) Ms. April Arrington, Administrator, DFCM 1:00 p.m.-5:00 p.m. Army Substance Abuse Program (ASAP) Ms. Pickering, LMFT, LCDC, Clinical Program Director Ms. Thompson, Administrator, ASAP