Preventing Psychological Disorders in Service Members and Their Families An Assessment of Programs (2014) / Chapter Skim
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Appendix G: PROGRAM REVIEWS FROM *SUBSTANCE USE DISORDERS IN THE U.S. ARMED FORCES*
Appendix G: PROGRAM REVIEWS FROM *SUBSTANCE USE DISORDERS IN THE U.S. ARMED FORCES*
Pages 223-274
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From page 223... ...
Armed Forces (Washington, DC: The National Academies Press, 2012)
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From page 224... ...
Based on the information presented in the Comprehensive Plan, the committee noted that when evidence-based practices (EBPs) are identified for a program, it is in many cases unclear to what extent they are being used or how specifically they are implemented.
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From page 225... ...
Consequently, it has the capacity to reach service members and their families at all stages of military involvement except deployment outside of the United States. Within DoD, the targets are active duty service members (ADSMs)
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From page 226... ...
a The table on this program in the Navy section of Appendix C of the Comprehensive Plan lists the following under "Program Evaluation/Outcomes": "Total number of visits per month to website per Service, Average number of minutes per visit spent on website per Service, To tal number of public service announcements per Service, and Number of promotional items distributed." b The table on this program in the Navy section identifies Reserves as an additional target population. c The table on this program in the Navy section lists "CSAP [Center for Substance Abuse Prevention]
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From page 227... ...
Health Assessments Periodic Health Assessment (PHA) Screening Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • ersonnel are screened P • Screening • ercent P • ctive A • creening S annually for substance of ADSM Duty typically by use related issues during who AUDIT-C, the annual preventive complete • Reserve but health assessment.
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From page 228... ...
NOTE: ADSM = active duty service member; AUDICT-C = Alcohol Use Disorders Identifica tion Test-Consumption; DoD = Department of Defense; EBP = evidence-based practice; N/A = not applicable; PHA = periodic health assessment.
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From page 229... ...
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 pri mary focus is on screening. DoD's pre- and postdeployment health assessments have three stages.
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From page 230... ...
However, studies have found that while positive screening rates for alcohol misuse can be as high as 27 percent among Army soldiers in postdeployment health assessments (Santiago et al., 2010) , only a small proportion of those who screen positive ever receive treatment.
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From page 231... ...
, depression, generalized anxiety disorder, alcohol use, and bipolar disorder. After completing a self assessment, individuals receive referral information including services provided by TRICARE, Military OneSource, and Vet Centers.
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From page 232... ...
The Real Warriors Campaign is an initiative launched by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE)
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EBP = evidence-based practice. The Military and Civilian Drug Testing Program is identified in the Comprehensive Plan as both a prevention and screening program.
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ASAC was initially listed as a Science Applications International Cor poration contract with the Army, but now also includes Air Force (where ASAC is listed under "DoD/Service Branch" programs) , Navy, and Marine Corps dependents.
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From page 235... ...
Additional Programs and Initiatives Military OneSource is an online source of information on many topics, including 800 telephone numbers of "consultants," the National Suicide Prevention Lifeline, and the Safe Helpline for Sexual Assault Support. DoD describes Military OneSource as a free service provided by the Department of Defense to service members and their families to help with a broad range of concerns including money management, spouse employment and education, parenting and child care, relocation, deployment, reunion, and the particular concerns of families with special-needs members.
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AIR FORCE Alcohol and Drug Abuse Prevention and Treatment (ADAPT) Program Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • he ADAPT T • Prevention • ccess time A • Active Duty • ubstance S Program provides to substance Abuse substance related • Diagnosis assessment • Reserve Counselors assessment, and clinical are preventative • Treatment treatment • ational N trained in education, clinical Guard motivational treatment and • roportion of P interviewing referral services participants • Dependents and for Airmen, completing cognitive civilian employees, treatment behavioral and family program interventions members.
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From page 237... ...
treatment to individuals who experience problems attributed to substance abuse; and to return identified substance abusers to unrestricted duty status or assist them in their transition to civilian life. NOTE: ADAPT = Alcohol and Drug Abuse Prevention and Treatment; EBP = evidence-based practice.
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From page 238... ...
The targeted prevention program, Alcohol Brief Counseling (described below) , is correctly directed at individuals who are at high risk because of heavy alcohol use but who do not qualify for a full diagnosis of abuse or dependence.
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From page 239... ...
Finally, ADAPT works closely with the Behavioral Health Optimization Program (BHOP) (described further below)
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From page 240... ...
to track progress on a person alized change plan. NOTE: ABC = Alcohol Brief Counseling; ADAPT = Alcohol and Drug Abuse Prevention and Treatment; AUDIT = Alcohol Use Disorders Identification Test; CEOA = Comprehensive Effects of Alcohol; EBP = evidence-based practice; RTCQ = Readiness to Change Question naire; SIP = Short Index of Problems.
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From page 241... ...
NOTE: ADAPT = Alcohol and Drug Abuse Prevention and Treatment; AUDIT = Alcohol Use Disorders Identification Test; AUDIT-C = AUDIT-Consumption; BHOP = Behavioral Health Optimization Program; DoD = Department of Defense; EBP = evidence-based practice; VA = Department of Veterans Affairs. BHOP providers are psychologists who work in integrated in primary care clinics, consulting on cases that involve either behavioral health (e.g., PTSD)
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From page 242... ...
instruments) leadership, individual, • Diagnosis incidences recommended base, and community- per 1,000 by the level involvement -- • Treatment SMs National underscoring Institute responsible behaviors • rug D of Alcohol including alcohol positives per Abuse and and drug abuse, the 1,000 SMs Alcoholism prevention of accidents, (NIAAA)
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From page 243... ...
Toolkit 2 is a selected prevention program component that trains Command on the purpose of preventive health assessment and routine care, as well as on procedures for referring ADSMs who have been or are at risk for being involved in alcohol-related incidents to appropriate selective prevention and intervention. Annual screening using AUDIT-C is recommended.
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From page 244... ...
. The program curriculum provides youth with a variety of topics including substance abuse prevention and other vital life skills including conflict resolution, self-management skills, study skills, leadership, and community service.
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From page 245... ...
Enforcing Underage Drinking Laws (EUDL) Program Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • UDL is a pilot E • Prevention • DWIs/DUIs • Active Duty • evelopment D prevention program of EUDL was being conducted in • raffic T • Dependents predicated conjunction with accidents on the use the Department of EBPs such of Justice (DOJ)
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From page 246... ...
Air Force Reserve Component Substance Abuse Prevention Specialist Training (SAPST) Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • he SAPST program aims T • Prevention • one N • Reserve • BPs are E to increase knowledge and identified utilized improve skills of Drug Demand Reduction Program technicians and program managers in substance abuse prevention, facilitate full-scale adaptation and implementation of the SAPST model, and provide preliminary direction to the identification of related training and technical assistance needs.
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From page 247... ...
and Command NOTE: ADAPT = Alcohol and Drug Abuse Prevention and Treatment; EBP = evidence-based practice; UPL = unit prevention leader. The Army employs designated personnel called unit prevention leaders (UPLs)
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. The most noteworthy Army prevention programs are Prime for Life (PFL)
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From page 249... ...
. During its site visit to Fort Hood, the committee learned that the Risk Reduction Program had helped lead to the decision to close on-base liquor
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Command NOTE: EBP = evidence-based practice; N/A = not applicable. Civilian employers frequently offer EAPs as a human resources benefit to provide assessment and brief intervention services for employees seek ing behavioral health assistance.
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From page 251... ...
to a Summary rehabilitation facility in the vicinity where they • ehabilitation R reside after discharge Caseload from the Army; help resolve alcohol and other • AMIS D drug abuse problems dynamic ad in the family, with the hoc query ultimate goal of enabling capability the soldier to perform more effectively; and for civilian employees to restore them to effective duty performance. NOTE: DAMIS = Drug and Alcohol Management Information System; EBP = evidence-based practice; N/A = not applicable.
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From page 252... ...
Currently, the program is pro viding ASAM Level II.5 care as a 4-weekday treatment program; therefore, the name of the program will be changing to reflect that it provides care beyond the IOP level. For further discussion of these two pilot programs, see Chapter 6.
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From page 253... ...
NAVY Substance Abuse Rehabilitation Program (SARP) Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • sing the American U • revention P • umber N • ctive A • otivational M Society of Addiction of patients Duty interviewing Medicine patient • Screening retained on placement criteria, Active Duty • eserve R • welve-step T SARP matches the • Diagnosis after 1 year facilitation appropriate intensity • ependents D of treatment to the • Treatment • ercentage P • iving in L individual's level of patients Balance of need.
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From page 254... ...
. ADMITS collects, maintains, analyzes, and disseminates data on all incidents and activities related to the Navy's drug and alcohol abuse prevention and control programs.
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-- medical services for detoxification and comorbidities coordinated through military treatment facilities. SARP is therefore a comprehensive treatment program that offers sev eral therapeutic interventions with varying levels of intensity depending on ASAM placement criteria (Levels 0.5 to IV)
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MORE was developed and is admin istered by the widely recognized Hazelden treatment program and is ori ented toward 12-step recovery. Since August 2010, MORE has supported those in the early stages of aftercare by giving them a recovery coach who is a licensed addiction counselor and is available to provide electronic and telephone support.
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From page 257... ...
Provides policy guidance and • umber of drug N ensures compliance positives due to with existing policies illicit drug use and directives of DoD, Department • umber of drug N of the Navy, and positives cleared other agencies due to prescribed in development, medication implementation, quality assurance, • umber of drug N and evaluation of positives retained substance abuse due to innocent prevention programs. ingestion • umber of drug N positives retained due to break in the chain of custody • umber of drug N positives cleared due to ADMIN board/Court-Martial acquittal and Board of Inquiry retention NOTE: DoD = Department of Defense; EBP = evidence-based practice; N/A = not applicable.
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From page 258... ...
CSAP = Center for Substance Abuse Prevention; DEFY = Drug Education for Youth; EBP = evidence-based practice.
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From page 259... ...
Therefore, it is unknown whether the program is effective at preventing SUDs for military dependents. The Air Force reported that DEFY admin isters surveys to youth participants and parents for purposes of evaluating the program.6 Right Spirit Campaign Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • he Right Spirit T • Prevention • umber of N • ctive A • SAP C Campaign command and Duty prevention enhances fleet self-referrals strategies readiness by the for alcohol • Reserve reduction of screenings alcohol abuse and related incidents, • umber of N and provides a safe participants in and productive local events held working to deglamorize environment while alcohol use deglamorizing alcohol use.
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From page 260... ...
Thus, the committee finds that there appears to be either a breakdown in implementation or some limitations in the materials used for the Navy's alcohol prevention programs. Further, the program relies on information dissemination rather than motivational interviewing messages and skill-building exercises that are part of evidence-based prevention programs.
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From page 261... ...
The NDAAC is a local and regional mechanism by which commanders can monitor and communicate achievements or lack of success in attain ing prevention goals related to alcohol-related incidents. Thus it is not a prevention program.
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From page 262... ...
local command fully passing in selecting level. the certification prevention examination programs for and becoming their local certified community • Prevention specialists • Number of prevention programs implemented at the command level Navy Drug and Alcohol Counselor School (NDACS)
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From page 263... ...
PREVENT deals with life • 5,798 (3-year 1 choices related to alcohol annual average and drug use; interpersonal throughput) relationships (including sexual responsibility)
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Alcohol and Drug Abuse Management Seminar (ADAMS) for Leaders Course Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • brief seminar A • revention P • umber of N • ctive Duty • /A A N designed for personnel Commanding who attend • eserve R Officers, Executive annually Officers, Command Master Chiefs, • 23 (3-year 7 Chiefs of the annual average Boat, and other throughput)
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NOTE: CO = commanding officer; CSAP = Center for Substance Abuse Prevention; EBP = evidence-based practice; N/A = not applicable; SARP = Substance Abuse Rehabilitation Program.
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From page 266... ...
The committee finds that while the content of this course appears to be appropriate, directing pre vention specialists to Center for Substance Abuse Prevention (CSAP) strate gies and to a registry of evidence-based programs, the implementation of unique prevention programs at each installation is challenging and likely to erode overall quality.
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From page 267... ...
The emphasis is on leadership, deglamorization, intervention, and accountability. The DAPA Course trains advisers who manage and administer the Command's alcohol and drug abuse programs.
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From page 268... ...
NOTE: ASAM = American Society of Addiction Medicine; EBP = evidence-based practice. The Marine Corps Substance Abuse Program operates under the Marine Corps Community Services Command and within the Marine and Family Programs Division "to provide timely, consistent and effective care for active duty military members and other eligible beneficiaries with sub stance abuse and dependency disorders which interfere with mission readi ness and inter-personal functioning" (USMC, 2011a, p.
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From page 269... ...
Outpatient education and counseling may include early intervention, outpatient care, and intensive outpatient services. Marine Corps Order 5300.17 details the requirements for SACCs: "The Marine Corps is required to identify, counsel, or treat Marines identified as alcohol or drug abusers or alcohol or drug dependent" (USMC, 2011b, p.
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From page 270... ...
270 PREVENTING PSYCHOLOGICAL DISORDERS IN SERVICE MEMBERS AND THEIR FAMILIES APPENDIX D 351 Substance Abuse Prevention and Intervention Program Program Clinical Evaluation/ Target Purpose and Goals Focus Outcomes Population EBPs • he Marine Corps T • revention P • umber N • ctive A • revention P Substance Abuse of positive Duty tools created Prevention program samples specifically for provides prevention • eserve R the Marine tools such as antidrug • umber N Corps based videos and games, of multiple on research substance abuse positives by the Naval prevention tool Health kits, Command • umber of N Research Summits, and the prescription Center Battalion Alcohol drug Skill Intervention confirmed Curriculum that positives help commanders prevent problems that detract from unit performance and mission readiness. • o assist in the T commander's prevention efforts, a Drug Demand Reduction Coordinator, Substance Abuse Control Officers, and Alcohol Abuse Prevention Specialists are available to provide support in the following areas: Illegal drug use prevention activities Drug testing Implementing prevention programs Coordinating treatment services with the SACC Conducting aftercare NOTE: EBP = evidence-based practice; SACC = Substance Abuse Counseling Center.
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From page 271... ...
The specific content of the education delivered through these activities varies from site to site. One component of the Marine Corps Substance Abuse Prevention and Intervention Program is the Battalion Alcohol Skills Inter vention Curriculum (BASIC)
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2011. Comprehensive plan on prevention, diagnosis, and treatment of substance use disorders and disposition of substance use offenders in the armed forces.
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From page 274... ...
2011b. Order 5300.17: Marine Corps substance abuse program.
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