the risk for addiction or misuse. Further, the military’s reliance on drug testing limits the identification of misuse to those drugs within the laboratory panel, and does not fully address evolving patterns of drug and alcohol use.

Standards of care and best practices in the prevention, diagnosis, treatment, and management of SUDs have changed considerably over the course of the past decade to reflect developments in the evidence base. Health care reform and federal parity legislation have enhanced access to health insurance and mandated that commercial health plans provide similar coverage for general health, mental health, and alcohol and other drug use disorders. Advocates and policy makers also have called for increased integration of addiction treatment and primary care. Greater integration of prevention and treatment services with primary care could reduce the stigma of alcohol and other drug use disorders and encourage individuals to seek care. The continuum of care for substance misuse in the Military Health System (from prevention through intervention and aftercare) has not been modified to accord with current understanding of factors that motivate individuals to seek help, settings in which care or interventions can be delivered most effectively, training/skills required by key staff, and medications that have proven useful in achieving or maintaining abstinence. These developments set the stage for a comprehensive review and critique of existing SUD policies and programs within DoD and of standards for access to care and SUD care providers.

FINDINGS

The committee’s research yielded the findings summarized below regarding the military’s policies and programs pertaining to SUDs, access to care for substance misuse and abuse, and the workforce of SUD care providers.

SUD Policies and Programs in the Military

In assessing the SUD policies and programs in place in DoD and each of the branches, the committee arrived at the following findings. First, while DoD and branch policies emphasize screening as a key strategy in combating SUDs, these policies fall short with respect to identifying all service members who have or are at risk of developing these disorders because of a failure to screen for all substances of interest, as well as a lack of confidentiality protections. The committee’s review made clear that drug testing also is considered an integral component of DoD’s prevention strategy. The committee found very different attitudes toward alcohol and other drugs. These differences are reflected in the screening and drug testing policies, in



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