Health assessments of military members are conducted during active military duty service on a yearly basis, as well as pre- and postdeployment. Health assessment could be considered a prevention strategy to the extent that the provider discusses SUD risk factors or the service member raises questions about risk factors or strategies for preventing SUDs, but its primary focus is on screening.
DoD’s pre- and postdeployment health assessments have three stages. Stage 1 is based on self-report and has the objective of defining high-risk groups. The first three questions of the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) are used to detect risky drinking as part of Stage 1. Stage 2 collects additional information if Stage 1 screening is positive for posttraumatic stress disorder (PTSD) or depression. If Stage 1 screening with AUDIT-C is positive, Stage 3 consists of a provider interview in which brief intervention for risky drinking is administered or a referral is made. The provider training for the deployment health assessments instructs the provider to do the following in the brief intervention: bring attention to the elevated level of drinking; recommend limiting use or abstaining; inform about the effects of alcohol on health; explore and help/support in choosing a drinking goal; and follow up and refer for specialty treatment, if indicated (Vythilingam et al., 2010). Referral is recommended when the service member requires further evaluation of use, has tried and has been unable to change on his/her own, has had prior treatment, has had a recent problem with alcohol that resulted in counseling or referral to treatment, or has an AUDIT-C score equal to or greater than 8. Referral options vary with the service member’s status, and include emergency behavioral health referral and referral to a provider in a military treatment facility, a TRICARE purchased care provider, a Department of Veterans Affairs (VA) medical center, a Veterans (VET) center, or Military OneSource (DoD, 2010; Vythilingam et al., 2010).
The committee finds that the use of AUDIT-C for pre- and postdeployment health assessments is an appropriate means of screening for excessive and hazardous alcohol use; AUDIT-C is well known and has been well validated for use in a variety of settings. Unfortunately, the only service branch to require the use of AUDIT-C in periodic health assessments is the Air Force. The other branches recommend screening by a clinician but do not identify specific screening tools to be used. The committee would prefer to see AUDIT-C used uniformly across all the branches and in all health assessments, independently of whether they are related to deployment.
A second important consideration in evaluating screening in both periodic and deployment-related health assessments is that positive screening should lead to further intervention depending on the severity of the condition being screened for. In the case of alcohol, identification of excessive