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Appendix B
S. 459 (111th): SUPPORT for
Substance Use Disorders Act
S 459 IS
111th CONGRESS
1st Session
S. 459
To improve and enhance substance use disorder programs for members of
the Armed Forces, and for other purposes.
IN THE SENATE OF THE UNITED STATES
February 24, 2009
Mrs. MCCASKILL (for herself and Mr. CORKER) introduced the
following bill; which was read twice and referred to the Committee on
Armed Services
A BILL
To improve and enhance substance use disorder programs for members of
the Armed Forces, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘Supporting Uniformed Personnel by
Providing Oversight and Relevant Treatment for Substance Use
Disorders Act’ or the ‘SUPPORT for Substance Use Disorders Act’.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) The Armed Forces is comprised of more than 1,400,000
members in the regular components and more than 1,080,000
members in the Reserves. More than 1,800,000 members of the
Armed Forces have been deployed in Operation Iraqi Freedom,
283
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284 SUBSTANCE USE DISORDERS IN THE U.S. ARMED FORCES
Operation Enduring Freedom, and the Global War on Terrorism
since 2001.
(2) Substance use disorders are chronic diseases that can be
prevented, treated, and managed effectively. Failure to prevent
or treat these conditions results in severe and widespread
consequences, including increased risk of suicide, exacerbation of
mental and physical health disorders, increased risk of domestic
violence and family discord, and increased risk of unemployment
and homelessness.
(3) According to the 2005 Department of Defense Survey of Health
Related Behaviors Among Active Duty Personnel, 24 percent of
the members of the Armed Forces surveyed reported symptoms of
alcohol dependence and nearly 11 percent of the members surveyed
reported use of an illicit drug. Misuse of controlled prescription
drugs, particularly narcotic painkillers, is a significant and growing
problem among members of the Armed Forces as well.
(4) Substance abuse disorders often co-occur with other health
problems. According to the 2007 Report of the Department of
Defense Task Force on Mental Health, 17 percent of soldiers
from brigade combat teams are at risk of developing clinically
significant symptoms of post-traumatic stress disorder (PTSD),
major depression, or anxiety after deployment, and an even higher
percentage of such soldiers, 28 percent, would experience symptoms
based upon broader screening criteria. The prevalence of post-
traumatic stress disorder within a year of combat deployment was
estimated to range from 10 to 25 percent.
(5) According to the 2007 Report of the Department of Defense
Task Force on Mental Health, symptoms of disorders such as
post-traumatic stress disorder often include complex disinhibitory
behaviors such as self-medicating with alcohol, other medications,
or illicit drugs in an attempt to return to ‘normalcy’.
(6) According to the 2007 Report of the Department of Defense
Task Force on Mental Health, of the 686,306 veterans separated
from active duty between 2002 and December 2006 who were
eligible for care from the Department of Veterans Affairs, 229,015
(or 33 percent) accessed care at a Department facility. Of those
veterans who accessed such care since 2002, 83,889 (or 37 percent)
were diagnosed with or were evaluated for a mental disorder,
including post-traumatic stress disorder (39,243 or 17 percent),
nondependent abuse of drugs (33,099 or 14 percent), and depressive
disorder (27,023 or 12 percent).
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APPENDIX B 285
(7) According to the 2007 Report of the Department of Defense
Task Force on Mental Health, 20 percent of married soldiers
planned to separate or divorce.
(8) According to the 2007 Report of the Department of Defense
Task Force on Mental Health, relationship problems are the top
risk factor for suicide. Mental disorders, alcohol and substance use
disorders, and significant stress are other significant risk factors
for suicide. The National Violent Death Reporting System of the
Centers for Disease Control and Prevention determined that, of a
group of former or current military personnel who died by suicide
in 2005, 17.2 percent had an alcohol problem and 7.7 percent had
a problem with other substances. The suicide prevention action
network (SPAN) reports a 20 percent increase in suicide among
members of the Armed Forces on active duty, 89 suicides in 2007
with 32 deaths under investigation, and a rise of attempted suicides
by soldiers by 6 times higher than it was at the start of Operation
Iraqi Freedom.
(9) While some commands and facilities in the Armed Forces
provide outstanding services for members of the Armed Forces
for substance use disorders, the prevention, diagnosis, mitigation,
treatment, and management of, and research on, substance use
disorders in members of the Armed Forces is inconsistent in
availability, structure, and success among the various Armed Forces.
SEC. 3. COMPREHENSIVE PLAN ON PREVENTION, DIAGNOSIS,
MITIGATION, TREATMENT, AND MANAGEMENT OF
SUBSTANCE USE DISORDERS IN MEMBERS OF THE ARMED
FORCES.
(a) Review and Assessment of Current Capabilities-
(1) IN GENERAL- Not later than 180 days after the date of the
enactment of this Act, the Secretary of Defense shall, in consultation
with the Secretaries of the military departments and the Secretary of
Veterans Affairs, conduct a comprehensive review of the programs
and activities of the Department of Defense for the prevention,
diagnosis, mitigation, treatment, and management of, and research
on, substance use disorders in members of the Armed Forces.
(2) ELEMENTS- The review conducted under paragraph (1)
shall include, but not be limited to, an assessment of each of the
following:
(A) The current state and effectiveness of the programs of the
Department of Defense and the military departments relating to
the prevention, diagnosis, mitigation, treatment, and management
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286 SUBSTANCE USE DISORDERS IN THE U.S. ARMED FORCES
of, and research on, substance use disorders in members of the
Armed Forces.
(B) The adequacy of the availability of and access to care for
substance use disorders in military medical treatment facilities
and under the TRICARE program.
(C) The adequacy of oversight by the Department of programs
relating to the prevention, diagnosis, mitigation, treatment, and
management of substance use disorders in members of the Armed
Forces.
(D) The adequacy and appropriateness of current credentials and
other requirements for healthcare professionals treating members
of the Armed Forces with substance use disorders, including an
assessment of the advisability of adopting uniform credentials
and requirements for such treatment for healthcare professionals
who are members of organizations such as the Association
for Addiction Professionals (NAADAC), the American Society
of Addiction Medicine (ASAM), the American Psychiatric
Association (APA), and the National Board for Certified
Counselors (NBCC).
(E) The advisable ratio of physician and non-physician care
providers for substance use disorders to members of the Armed
Forces with such disorders.
(F) The adequacy and appropriateness of protocols for the
diagnosis, treatment, and management of substance use disorders
in members of the Armed Forces.
(G) The adequacy of the availability of and access to care for
substance use disorders for members of the reserve components
of the Armed Forces when compared with the availability of
and access to care for substance use disorders for members
of the regular components of the Armed Forces, including an
identification of any obstacles that are unique to the prevention,
diagnosis, mitigation, treatment, and management of substance
use disorders in members of the reserve components of the
Armed Forces.
(H) The adequacy of the prevention, diagnosis, mitigation,
treatment, and management of substance use disorders and
related distress in dependent family members of members of the
Armed Forces, whether such family members suffer from their
own substance use disorder or because of the substance use
disorder of a member of the Armed Forces.
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APPENDIX B 287
(I) Any gaps in the current capabilities of the Department of
Defense for the prevention, diagnosis, mitigation, treatment,
and management of, and research on, substance use disorders in
members of the Armed Forces.
(3) REPORT- Not later than 180 days after the date of the
enactment of this Act, the Secretary of Defense shall submit to the
congressional defense committees a report setting forth the findings
and recommendations of the Secretary as a result of the review
conducted under paragraph (1). The report shall--
(A) set forth the findings and recommendations of the Secretary
regarding each element of the review set forth in paragraph (2);
(B) set forth relevant statistics on the frequency of substance
use disorders in members of the regular components of the
Armed Forces, members of the reserve component of the Armed
Forces, and dependents of such members (including spouses and
children); and
(C) include such other findings and recommendations on
improvements to the current capabilities of the Department of
Defense for the prevention, diagnosis, mitigation, treatment,
and management of, and research on, substance use disorders
in members of the Armed Forces as the Secretary considers
appropriate.
(b) Plan for Improvement and Enhancement of Programs-
(1) PLAN REQUIRED- Not later than 180 days after the date
of the enactment of this Act, the Secretary of Defense shall, in
consultation with the Secretaries of the military departments and
the Secretary of the Department of Veterans Affairs, submit to the
congressional defense committees a comprehensive plan for the
improvement and enhancement of the programs and activities of the
Department of Defense for the prevention, diagnosis, mitigation,
treatment, and management of, and research on, substance use
disorders in members of the Armed Forces and their dependent
family members.
(2) BASIS- The comprehensive plan required by paragraph (1) shall
take into account the following:
(A) The results of the review and assessment conducted under
subsection (a).
(B) Any preliminary results of the study required by section 4.
(C) Similar initiatives of the Secretary of Veterans Affairs to
expand and improve care for substance use disorders among
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288 SUBSTANCE USE DISORDERS IN THE U.S. ARMED FORCES
veterans, including the programs and activities conducted
under title I of the Veterans’ Mental Health and Other Care
Improvements Act of 2008 (Public Law 110-387; 112 Stat.
4112).
(3) COMPREHENSIVE STATEMENT OF POLICY- The
comprehensive plan required by paragraph (1) shall include a
comprehensive statement of the policy of the Department of
Defense regarding the prevention, diagnosis, mitigation, treatment,
and management of, and research on, substance use disorders in
members of the Armed Forces and their dependent family members.
(4) AVAILABILITY OF SERVICES AND TREATMENT- The
comprehensive plan required by paragraph (1) shall include
mechanisms to ensure the availability to members of the Armed
Forces and their dependent family members of services and
treatment for substance use disorders, including, but not limited to,
services and treatment as follows:
(A) Screening for substance use disorder in all settings, including
primary care settings.
(B) Short-term motivational counseling services.
(C) Marital and family counseling.
(D) Inpatient, intensive outpatient, or other residential care
services.
(E) Private medical, psychiatric, and professional counseling
services.
(F) Relapse prevention services.
(G) Ongoing aftercare and outpatient counseling services.
(H) Pharmacological treatments aimed at treating substance use
disorders, including treating cravings for drugs and alcohol.
(I) Detoxification and stabilization services.
(J) Coordination with groups providing peer-to-peer counseling.
(K) Such other services as the Secretary considers appropriate.
(5) PREVENTION AND REDUCTION OF DISORDERS- The
comprehensive plan required by paragraph (1) shall include
mechanisms to facilitate the prevention and reduction of substance
use disorders in members of the Armed Forces through science-
based initiatives, including education programs, for members of the
Armed Forces and their families.
(6) SPECIFIC INSTRUCTIONS- The comprehensive plan required
by paragraph (1) shall include each of the following
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APPENDIX B 289
(A) SUBSTANCES OF ABUSE- Instructions on the prevention,
diagnosis, mitigation, treatment, and management of substance
use disorders in members of the Armed Forces, including the
abuse of alcohol, illicit drugs, and nonmedical use and abuse
of prescription drugs (including addiction to prescription drugs
that is an unintended consequence of otherwise required and
medically appropriate pain treatment).
(B) HEALTHCARE PROFESSIONALS- Instructions on--
(i) appropriate training of healthcare professionals in the
prevention, screening, diagnosis, mitigation, treatment, and
management of substance use disorders in members of the
Armed Forces;
(ii) appropriate staffing levels for healthcare professionals
at military medical treatment facilities for the prevention,
screening, diagnosis, mitigation, treatment, and management
of substance use disorders in members of the Armed Forces;
and
(iii) such uniform training and credentialing requirements for
physician and non-physician healthcare professionals in the
prevention, screening, diagnosis, mitigation, treatment, and
management of substance use disorders in members of the
Armed Forces as the Secretary considers appropriate.
(C) SERVICES FOR DEPENDENTS- Instructions on the
availability of services for substance use disorders to military
dependents (including services for dependents suffering from their
own substance use disorder and dependents suffering because of
the substance use disorder of a member of the Armed Forces),
including instructions on making such services available to such
dependents to the maximum extent practicable.
(D) PREVENTION MATERIALS- Instructions on the
dissemination of materials regarding substance abuse prevention,
including, at a minimum, materials on the following:
(i) The dangers of alcohol abuse.
(ii) The risks of self-medication, and the potential
co-occurrence of drug use or abuse with illnesses such as Post
Traumatic Stress Disorder (PTSD).
(iii) The risks associated with abuse of prescription
medications and the signs of inadvertent addiction to
prescription medications that may occur as a consequence of
otherwise prescribed treatment plans, as well as the need to
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290 SUBSTANCE USE DISORDERS IN THE U.S. ARMED FORCES
properly secure and dispose of such substances to safeguard
such substances from third parties such as children.
(iv) The risks of substance abuse faced by military dependents
due to the stresses of having a spouse or parent deployed,
as well as other factors relating to substance abuse that are
unique to military families.
(v) Strategies for prevention of drug and alcohol abuse among
children of military families, and suggestions for military
parents on how to intervene and find help for a child with a
substance use disorder.
(E) DIFFERENTIATION OF DISCIPLINARY ACTION AND
TREATMENT- Instructions on the separation of disciplinary
actions from prevention and treatment of substance use disorders
in members of the Armed Forces.
(F) CONFIDENTIALITY- Instructions on confidentiality for
members of the Armed Forces in seeking or receiving services or
treatment for substance use disorders.
(G) PARTICIPATION OF CHAIN OF COMMAND- Instructions
on appropriate consultation, reference to, and involvement of the
chain of command of members of the Armed Forces in matters
relating to the diagnosis, treatment, and management substance
use disorders in such members.
(H) CONSIDERATION OF GENDER- Instructions on gender
specific requirements in the prevention, diagnosis, mitigation,
treatment, and management of substance use disorders in
members of the Armed Forces, including gender specific care and
treatment requirements.
(I) COORDINATION WITH OTHER HEALTHCARE
INITIATIVES- Instructions on the integration of efforts on the
prevention, diagnosis, mitigation, treatment, and management
of substance use disorders in members of the Armed Forces with
efforts to address co-occurring health care disorders (such as
post-traumatic stress disorder (PTSD) and depression) and suicide
prevention.
(7) OTHER ELEMENTS- In addition to the matters specified in
paragraph (3), the comprehensive plan required by paragraph (1)
shall include the following:
(A) LEAD AGENT- The designation by the Assistant Secretary
of Defense for Health Affairs of a lead agent to coordinate
implementation of the plan.
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APPENDIX B 291
(B) MILESTONES AND SCHEDULES- Milestones and schedules
for the achievement of the goals of the plan, including goals
relating to the following:
(i) Enhanced education of members of the Armed Forces
regarding substance use disorders.
(ii) Enhanced and improved identification and diagnosis of
substance use disorders in members of the Armed Forces.
(iii) Enhanced and improved access of members of the Armed
Forces to services and treatment for and management of
substance use disorders.
(iv) Appropriate staffing of military medical treatment facilities
and other facilities for the treatment of substance use disorders
in members of the Armed Forces.
(C) BEST PRACTICES- The incorporation of evidence-based best
practices utilized in current military and civilian approaches to
the prevention, diagnosis, mitigation, treatment, and management
of substance use disorders.
(D) AVAILABLE RESEARCH- The incorporation of applicable
results of available studies, research, and academic reviews on the
prevention, diagnosis, mitigation, treatment, and management of
substance use disorders.
(8) UPDATE IN LIGHT OF INDEPENDENT STUDY- Upon the
completion of the study required by section 4, the Secretary of
Defense shall--
(A) in consultation with the Secretaries of the military
departments and the Secretary of the Department of Veterans
Affairs, make such modifications and improvements to the
comprehensive plan required by paragraph (1) as the Secretary
of Defense considers appropriate in light of the findings and
recommendations of the study; and
(B) submit to the congressional defense committees a report
setting forth the comprehensive plan as modified and improved
under subparagraph (A).
SEC. 4. INDEPENDENT REPORT ON SUBSTANCE USE DISORDERS
IN MEMBERS OF THE ARMED FORCES.
(a) Study Required- The Secretary of Defense shall provide for a study
on substance use disorders in members of the Armed Forces to be
conducted by the Institute of Medicine of the National Academies of
Sciences or such other independent entity as the Secretary shall select
for purposes of the study.
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292 SUBSTANCE USE DISORDERS IN THE U.S. ARMED FORCES
(b) Elements- The study required by subsection (a) shall include a
review and assessment of the following:
(1) The current state and effectiveness of the programs of the
Department of Defense and the military departments relating to the
prevention, diagnosis, mitigation, treatment, and management of,
and research on, substance use disorders in members of the Armed
Forces.
(2) The adequacy of the availability of and access to care for
substance use disorders in military medical treatment facilities and
under the TRICARE program.
(3) The adequacy of the oversight by the Department of Defense of
programs related to the prevention, diagnosis, mitigation, treatment,
and management of substance use disorders in members of the
Armed Forces.
(4) The adequacy and appropriateness of current credentials and
other requirements for physician and non-physician healthcare
professionals treating members of the Armed Forces with substance
use disorders.
(5) The advisable ratio of physician and non-physician care
providers for substance use disorders to members of the Armed
Forces with such disorders.
(6) The adequacy and appropriateness of protocols for the
diagnosis, treatment, and management of substance use disorders in
members of the Armed Forces.
(7) The adequacy of the availability of and access to care for
substance use disorders for members of the reserve components
of the Armed Forces when compared with the availability of and
access to care for substance use disorders for members of the
regular components of the Armed Forces.
(8) The adequacy of the prevention, diagnosis, mitigation,
treatment, and management of substance use disorders in dependent
family members of members of the Armed Forces, whether such
family members suffer from their own substance use disorder or
because of the substance use disorder of a member of the Armed
Forces.
(9) The need for and appropriate provision of confidentiality for
members of the Armed Forces who seek services or treatment for a
substance use disorder.
(10) Such other matters as the Secretary considers appropriate for
purposes of the study.
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APPENDIX B 293
(c) Report- Not later than one year after the date of the enactment of
this Act, the entity conducting the study required by subsection (a)
shall submit to the Secretary of Defense and the congressional defense
committees a report on the results of the study. The report shall set
forth the findings and recommendations of the entity as a result of the
study.
SEC. 5. CENTER OF EXCELLENCE IN THE PREVENTION,
DIAGNOSIS, MITIGATION, TREATMENT, AND MANAGEMENT
OF SUBSTANCE USE DISORDERS.
(a) In General- The Secretary of Defense shall establish within the
Department of Defense a Center of Excellence in the Prevention,
Diagnosis, Mitigation, Treatment, and Management of Substance Use
Disorders.
(b) Partnerships- The Secretary of Defense shall ensure that the Center
collaborates to the maximum extent practicable with the Department
of Veterans Affairs, institutions of higher education, and other
appropriate public and private entities (including international entities)
to carry out the responsibilities specified in subsection (c).
(c) Responsibilities- The Center shall have responsibilities as follows:
(1) To implement the comprehensive plan of the Department of
Defense for the prevention, diagnosis, mitigation, treatment, and
management of substance use disorders under section 3, including
the performance of research on gender and ethnic group-specific
health needs related to substance use disorders.
(2) To provide for the development, testing, and dissemination
within the Department of evidence-based best practices for the
prevention, diagnosis, mitigation, treatment, and management of
substance use disorders.
(3) To provide guidance for healthcare professionals and support
service staff of the health system of the Department in providing
quality health care for members of the Armed Forces with substance
use disorders, and their dependents, when possible, who are
suffering from the effects of substance use disorders.
(4) To provide guidance for healthcare professionals and support
service staff to make members of the Armed Forces receiving
prescription pain medications aware of the potential for abuse
of or addiction to such substances, and to provide such members
education on ways of properly securing such substances and
disposing of such substances when no longer needed.
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294 SUBSTANCE USE DISORDERS IN THE U.S. ARMED FORCES
(5) To recommend uniform credentials and other requirements for
healthcare professionals and support service staff who provide care
and support for members of the Armed Forces and their dependents
who suffer from substance use disorders.
(6) To establish, implement, and oversee a uniform and
comprehensive program to train physician and non-physician
healthcare professionals and support staff in the Department in the
screening, intervention, treatment, and management of substance
use disorders.
(7) To coordinate research, data collection, and data dissemination
on the prevention, diagnosis, mitigation, treatment, and
management of substance use disorders, and to maintain a database
of information for that purpose.
(8) To facilitate advancements in the study of the short-term and
long-term physical and psychological effects of substance use
disorders.
(9) To disseminate evidence-based best practices within the military
medical treatment facilities for training healthcare professionals and
support staff with respect to substance use disorders.
(10) To conduct basic science and translational research on
substance use disorders in members of the Armed Forces for the
purposes of understanding the etiology of substance use disorders
and developing preventive interventions and new treatments.
(11) To develop programs and outreach strategies for families of
members of the Armed Forces with substance use disorders to
address and to mitigate the impact of substance use disorders on
such family members and to support the recovery of such members
from substance use disorders.
(12) To conduct research on the health needs of families of members
of the Armed Forces with substance use disorders and develop
protocols to address any needs identified through such research.
(13) To disseminate information to families of members of the
Armed Forces regarding ways to help prevent alcohol and drug
abuse among their children, as well as educational materials to
address how situations unique to military families, such as having
a parent deployed, can increase stress levels and put a child at
increased risk of abusing drugs or alcohol.
(14) To develop and oversee a long-term plan to increase the
number of healthcare professionals and support personnel within
the Department in order to facilitate the meeting by the Department
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APPENDIX B 295
of the needs of members of the Armed Forces with substance use
disorders while they remain on active duty and until their transition
to care and treatment from the Department of Veterans Affairs.
(15) To develop and deploy an education and awareness training
initiative designed to reduce the negative stigma associated with
substance use disorders and treatment.
(16) Such other responsibilities as the Secretary shall specify.
SEC. 6. CONGRESSIONAL DEFENSE COMMITTEES DEFINED.
In this Act, the term ‘congressional defense committees’ means--
(1) the Committee on Armed Services and the Committee on
Appropriations of the Senate; and
(2) the Committee on Armed Services and the Committee on
Appropriations of the House of Representatives.
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