Problems stemming from the misuse and abuse of alcohol and other drugs are by no means a new phenomenon, although the face of the issues has changed in recent years. National trends indicate substantial increases in the abuse of prescription medications. These increases are particularly prominent within the military, a population that also continues to experience long-standing issues with alcohol abuse. The problem of substance abuse within the military has come under new scrutiny in the context of the two concurrent wars in which the United States has been engaged during the past decade--in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom and Operation New Dawn). Increasing rates of alcohol and other drug misuse adversely affect military readiness, family readiness, and safety, thereby posing a significant public health problem for the Department of Defense (DoD).
To better understand this problem, DoD requested that the Institute of Medicine (IOM) assess the adequacy of current protocols in place across DoD and the different branches of the military pertaining to the prevention, screening, diagnosis, and treatment of substance use disorders (SUDs). Substance Use Disorders in the U.S. Armed Forces reviews the IOM's task of assessing access to SUD care for service members, members of the National Guard and Reserves, and military dependents, as well as the education and credentialing of SUD care providers, and offers specific recommendations to DoD on where and how improvements in these areas could be made.
Table of Contents
|2 Understanding Substance Use Disorders in the Military||25-68|
|3 The Military Health System||69-84|
|4 Changing Standards of Care for Substance Use Disorders||85-96|
|5 Best Practices in Prevention, Screening, Diagnosis, and Treatment of Substance Use Disorders||97-136|
|6 Policies and Programs on Substance Use Disorders||137-184|
|7 Access to Care for Substance Use Disorders||185-226|
|8 Substance Use Disorder Workforce||227-246|
|9 Conclusions and Recommendations||247-270|
|Appendix A: Study Activities||271-282|
|Appendix B: S. 459 (111th): SUPPORT for Substance Use Disorders Act||283-296|
|Appendix C: Sec. 596 of Public Law 111-84, October 28, 2009||297-304|
|Appendix D: Program Reviews||305-356|
|Appendix E: Features of TRICARE and Related Purchased Care Plans||357-360|
|Appendix F: Workforce Standards for Substance Use Disorder (SUD) Care||361-368|
|Appendix G: Access Standards for TRICARE Prime Enrollees||369-370|
|Appendix H: Levels of Care||371-372|
|Appendix I: Summary of Policy-Relevant Strategies for the Prevention of Alcohol-Related Problems||373-380|
|Appendix J: Biosketches of Committee Members and Staff||381-390|
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