well as by branch-specific policies. These policies set forth clear guidelines for zero tolerance of drug and alcohol abuse, as well as the legal and administrative consequences of such abuse (DoD, 1997). The requirement to provide education focused on preventing drug and alcohol abuse, to conduct drug use testing, and to offer rehabilitation for substance use offenders also is laid out in DoD policies and instructions (DoD, 1985, 1994, 1997). Each branch is then responsible for developing its own branch-level policies to guide programs and activities that address SUDs. The branch policies set forth the specifics of how drug prevention, testing, and rehabilitation programs will operate. Some of the branch-level policies are more detailed than others and also address the responsibilities of personnel at different levels, as well as training and credentialing requirements for providers. Chapter 6 of this report provides a thorough review of all DoD and branch-level policies and programs addressing SUDs, while Chapter 8 details the requirements for credentialing and training for providers in these programs. The branches vary widely in how SUD care is delivered in the direct care system. In the Army, for instance, all SUD prevention activities and nearly all SUD treatment are provided under the authority of the Installation Management Command, which is responsible for all personnel issues. In contrast, the Navy houses all of its SUD treatment services under the Navy Bureau of Medicine and Surgery, its Medical Command, while prevention activities and services are delivered under the Personnel Command. This “ownership” by either the Medical or Personnel Command has implications for how care and services are delivered. Chapter 6 details the various types of SUD services and care that are provided within each branch of the military and the authority under which they operate.

SUD Care Provided Through the TRICARE Network

TRICARE is required to provide care for SUDs under the authority of 32 Code of Federal Regulations (CFR) 199.4.5 This care may include detoxification, rehabilitation, and outpatient group and family therapy. TRICARE provides a lifetime limit of three SUD treatment benefit periods (each benefit period is 365 days from the first visit), although this limit can be waived by the managed care support contractor that oversees the TRICARE plans for the region. Emergency and inpatient hospital services for detoxification and stabilization and for treatment of medical complications from an SUD do not start a benefit period for treatment. Emergency and inpatient hospital services are deemed medically necessary when the personnel and facilities of a hospital are required to manage the patient’s

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5 Basic Program Benefits, 32 CFR § 199.4 (2004).



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