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Suggested Citation:"Front Matter." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
×

SUBSTANCE USE DISORDERS

in the U.S. Armed Forces

Committee on Prevention, Diagnosis, Treatment and Management of
Substance Use Disorders in the U.S. Armed Forces

Board on the Health of Select Populations

Charles P. O’Brien, Maryjo Oster, and Emily Morden, Editors

INSTITUTE OF MEDICINE

OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by the U.S. Department of Defense through an interagency agreement with the U.S. Department of Health and Human Services under Contract No. HHSP23337030T. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

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Suggested citation: IOM (Institute of Medicine). 2013. Substance use disorders in the U.S. armed forces. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
×

“Knowing is not enough; we must apply.
Willing is not enough; we must do.”

—Goethe

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INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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COMMITTEE ON PREVENTION, DIAGNOSIS, TREATMENT AND MANAGEMENT OF SUBSTANCE USE DISORDERS IN THE U.S. ARMED FORCES

CHARLES P. O’BRIEN (Chair), Kenneth E. Appel Professor of Psychiatry and Vice-Chair of Psychiatry, and Director, Center for Studies of Addiction, University of Pennsylvania School of Medicine, Philadelphia

HORTENSIA D. AMARO, Associate Vice Provost for Community Research Initiatives and Dean’s Professor of Social Work and Preventive Medicine, University of Southern California, Los Angeles

RHONDA ROBINSON BEALE, Chief Medical Officer, OptumHealth Behavioral Solutions, Glendale, CAL

ROBERT M. BRAY, Senior Research Psychologist and Senior Director of the Substance Abuse Epidemiology and Military Behavioral Health Program, RTI International, Research Triangle Park, NC

RAUL CAETANO, Regional Dean and Professor, Dallas Regional Campus of the University of Texas School of Public Health

MATHEA FALCO, President, Drug Strategies, Inc., Washington, DC

JOYCE M. JOHNSON, Vice President of Health Services, Battelle Memorial Institute, Arlington, VA

THOMAS KOSTEN, J.H. Waggoner Chair and Professor of Psychiatry, Pharmacology and Neuroscience, Baylor College of Medicine, Houston, TX

MARY JO LARSON, Senior Scientist, Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, MA

DAVID C. LEWIS, Professor Emeritus of Community Health and Medicine, and the Donald G. Millar Distinguished Professor of Alcohol and Addiction Studies, Brown University, Providence, RI

DENNIS McCARTY, Professor of Public Health and Preventive Medicine and Division Head, Health Services Research, Oregon Health and Science University, Portland

MARY ANN PENTZ, Professor of Preventive Medicine and Director, Institute for Health Promotion and Disease Prevention Research, University of Southern California, Los Angeles

TRACY STECKER, Assistant Professor of Community and Family Medicine, Dartmouth Medical School, Lebanon, NH

CONSTANCE WEISNER, Professor of Psychiatry, University of California, and Associate Director for Health Services Research, Kaiser Permanente, Oakland

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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IOM Staff

MARYJO M. OSTER, Study Director

EMILY C. MORDEN, Research Associate

JON Q. SANDERS, Program Associate

NANCY LESTER, Uniformed Services University of the Health Sciences Intern (Spring 2012)

ANDREA COHEN, Financial Associate

FREDERICK (RICK) ERDTMANN, Director, Board on the Health of Select Populations

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Thomas F. Babor, University of Connecticut Health Center

Mady Chalk, Treatment Research Institute

Arthur T. Dean, Community Anti-Drug Coalitions of America

Michael Fitzsimons, Massachusetts General Hospital

Deirdre Hiatt, Managed Health Network

Cristine S. Hunter, U.S. Office of Personnel Management

Kimberly C. Kirby, Treatment Research Institute

Daniel Kivlahan, VA Puget Sound Health Care System

James McKay, Treatment Research Institute

Thomas McLellan, Treatment Research Institute

Roland S. Moore, Pacific Institute for Research and Evaluation

Rumi Kato Price, Washington University School of Medicine

Eve E. Reider, National Institute on Drug Abuse

Stephen N. Xenakis, U.S. Army (Ret.)

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Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Richard J. Bonnie, University of Virginia, and Susan J. Curry, The University of Iowa. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
×

Preface

Substance abuse has long been an issue of concern for the U.S. population and for its military in particular. Dating as far back as the Revolutionary War, Dr. Benjamin Rush detailed the effects of alcohol on the troops. During the Civil War, addiction to opium prescribed for pain became known as the “soldier’s disease.” Drug problems in both the military and civilian sectors have intensified throughout the 20th century as the types and formulations of substances being used have increased.

Since the 1970s, the Institute of Medicine (IOM) has been called upon numerous times to advise the government on both medical and legal solutions to the problem of substance abuse. Experts from various fields, ranging from mathematics and epidemiology to pharmacology and law, have spent many hours on about a dozen different committees struggling with this thorny problem, which affects our country on societal, economic, personal, and public health levels. While the popular substances of abuse may shift from decade to decade, the overarching problem continues. In the 21st century, prescription opioid abuse has arisen as a major area of concern while problems of alcohol, nicotine, and stimulants have persisted as well. Research has demonstrated that stress and availability are important background factors for causing the initiation and abuse of drugs. As the United States approaches the end of the longest continuous period of war in our history, the stresses faced by our military population are apparent. Our all-volunteer military has endured long periods of deployment and redeployment in highly taxing and demanding environments. Consequently, posttraumatic stress, traumatic brain injury, substance abuse, and suicide are at very high levels.

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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Press reports of substance abuse among the military stimulated congressional interest and a call for action. The Department of Defense requested that the IOM take a fresh look at the policies and programs of each of the branches of the military and evaluate the adequacy and appropriateness of their prevention, screening, diagnosis, and treatment of substance use disorders. The committee approached this task by holding public meetings to gather information from representatives of each of the military branches and TRICARE (the military’s purchased care health plan), as well as from academic researchers and interested members of the public. The committee also conducted visits to military bases and met with a variety of care providers, including those working in substance abuse specialty programs and those in primary care, behavioral health, and pain management.

The committee requested information from each branch of the military and from TRICARE Management Activity regarding program descriptions, access, utilization, and evaluation results. We also requested data on the providers in the substance abuse programs. We extend our appreciation for the exceptional cooperation from all of those who presented at our meetings, hosted our visits to military bases, and assisted with our information gathering efforts.

In addition, the committee wishes to express our appreciation to the study director, Dr. Maryjo Oster, and to the IOM staff, Ms. Emily Morden, Mr. Jon Sanders, and Dr. Rick Erdtmann.

Charles P. O’Brien, Chair

Committee on Prevention, Diagnosis, Treatment and Management of Substance Use Disorders in the U.S. Armed Forces

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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Acknowledgments

The committee thanks the Department of Defense, the individual service branches, and TRICARE Management Activity for the opportunity to review and comment upon the organization and content of their substance used disorders prevention and treatment services. We appreciate their assistance and collaboration in the review.

Many individuals assisted the committee in its work by providing useful data and presenting information at the committee’s public meetings and during its site visits. We thank the following people for their contributions: Capt. Robert DeMartino, Alfred Ozanian, Greg Woskow, Frank Lee, and Diana D. Jeffery, TRICARE Management Activity; Les McFarling, Army Center for Substance Abuse Programs; Charles Gould, U.S. Navy Bureau of Medicine and Surgery; Lt. Col. Mark S. Oordt, U.S. Air Force Medical Operations Agency; Keith Humphreys, Stanford University; Don Jansen, Congressional Research Service; Brig. Gen. Margaret Wilmoth, Office of the Assistant Secretary of Defense for Health Affairs; Col. John J. Stasinos, Department of the Army, Office of the Surgeon General; Capt. Mary Rusher, Naval Medical Center San Diego; Vladimir Nacev, Defense Centers of Excellence; Col. Charles Milliken, Walter Reed Army Institute of Research; Wilson Compton and Eve Reider, National Institute on Drug Abuse; John Veneziano, Marine Corps Consolidated Substance Abuse Counseling Center; Ted Jutson and Jerry Sinel, Navy Drug and Alcohol Counselor School; John Sparks, TRICARE Regional Office-West; Andrea Brooks Tucker, TRICARE Regional Office-South; Marie Mentor, TRICARE Regional Office-North; Frank Maguire, TriWest; Debbie Del Rosario and Gary Proctor, ValueOptions; Ian Schaffer and John Wagoner,

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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Healthnet Federal Services; John M. Morrow, Substance Abuse and Mental Health Services Administration; Abigail Gewirtz, University of Minnesota; Ron Astor, University of Southern California; Barbara Cohoon, National Military Family Association; Lisa Najavits, Harvard University; Anthony Hassan, University of Southern California; Eugene Moore, Cdr. Joseph B. Lawrence, Josh Devine, and Libby Hearin, TRICARE Pharmacy Operations; Isabel Jacobson, Naval Health Research Center; Lt. Gen. David Fridovich, United States Special Operations Command; Lt. Col. Kevin Galloway, Army Pain Management Task Force; Col. Chester Buckenmaier, Walter Reed Army Medical Center; Anthony H. Dekker, Ben Krepps, and Jennifer Weaver, Fort Belvoir Community Hospital; Chideha Ohuoha, Doryan Dixon, Jorge Grandella, and Susan Jessup, Dewitt Army Hospital, Ft. Belvoir; Bob Huebner, National Institute on Alcohol Abuse and Alcoholism; Col. Charles Engel, Department of Defense Deployment Health Clinical Center; Harold Holder, Prevention Research Center of the Pacific Institute for Research & Evaluation; Daniel Kivlahan, Office of Mental Health Services, Veterans Health Administration; 1Lt. Julianna Petrone, SSgt. Cecilia Cardenas, Paul Ahlberg, SrA. Stephanie Tipton, Kim Perez, Eva Shinka, Myron Horn, and Maj. David Cordry, Keesler Air Force Base; Capt. Mary K. Rusher, Joanne Rigoloso, Capt. Warren Peter Klam, Tara Leverett, Valerie Sudduth, Nelson Ferrer, Richard Arriaga, Steven Sovich, and Steven Hanling, Naval Medical Center, San Diego; LTC Sharette Gray, Nicolette Dennis, MAJ Agius, and April Arrington, Carl R. Darnall Army Medical Center, Fort Hood; Dan Harris, CNA; and Caryn Blitz, U.S. Department of Health and Human Services.

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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5-1     Best-Practice Domains and Recommendations of the National Institutes of Health’s Behavior Change Consortium

5-2     A Delivery System Approach Based on the Center for Substance Abuse Treatment’s (CSAT’s) Treatment Improvement Protocol No. 47

6-1     Military Programs Mentioning Dependents

7-1     Utilization of Alcohol and Drug Abuse Prevention and Treatment (ADAPT) Services by Active Duty Air Force Personnel

7-2     Army Active Duty Initial Referrals to the Army Substance Abuse Program (ASAP)

7-3     Utilization of Substance Abuse and Rehabilitation Program (SARP) Treatment by Active Duty Navy and Marine Corps Members

7-4     Numbers of Active Duty Marines Receiving Substance Abuse Counseling Center (SACC) Screening and Completing Treatment

7-5     Numbers of Dependent Beneficiaries Receiving SUD Care in Military Treatment Facilities by TRICARE Region (FY 2010)

7-6     Number of Active Duty Service Members (ADSMs) and Active Duty Family Members (ADFMs) Who Accessed Care at Military Treatment Facilities for an SUD Diagnosis by Type of Service (FY 2010)

7-7     Substance Use Disorders of Operation Iraqi Freedom (OIF)/Operation Enduring Freedom (OEF)/Operation New Dawn (OND) Veterans in Department of Veterans Affairs Programs, 2002-2012

7-8     Number of Operation Iraqi Freedom (OIF)/Operation Enduring Freedom (OEF)/Operation New Dawn (OND) Veterans Treated in Department of Veterans Affairs Programs for an SUD Diagnosis

7-9     Average Number of Beneficiaries by TRICARE Region for Fiscal Year 2010

7-10   Number and Rate per 1,000 Beneficiaries Utilizing the Purchased Care Sector for SUD Care, by TRICARE Region (FY 2010)

7-11   Medications for Addiction Treatment Given to Active Duty Service Members and Active Duty Family Member Adult Dependent Beneficiaries (aged 18 and over), All Systems of Care (FY 2010)

7-12   Number of Beneficiaries Receiving SUD Care by Type of Purchased Care Facility, North Region (FY 2010)

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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7-13   Number of Beneficiaries Receiving SUD Care by Type of Purchased Care Facility, West Region (FY 2010)

7-14   Number of Beneficiaries Receiving SUD Care by Type of Purchased Care Facility, South Region (FY 2010)

7-15   Number of Beneficiaries with Claims in Purchased Care Settings, by Type of SUD Care (FY 2010)

8-1     Alcohol and Drug Abuse Prevention and Treatment (ADAPT) Workforce

8-2     Army Substance Abuse Program (ASAP) Prevention Workforce

8-3     Army Substance Abuse Program (ASAP) Clinical Workforce as of December 2011

8-4     Substance Abuse Rehabilitation Program (SARP) Workforce

8-5     Substance Abuse Counseling Center (SACC) Workforce

I-1     Ratings of Policy-Relevant Strategies and Interventions

Figures

2-1a   Active duty component members with and without children

2-1b   Reserve component members with and without children

2-2a   Active duty component family status

2-2b   Reserve component family status

2-3   Substance use trends for active duty military personnel, past 30 days, 1980-2008

2-4   Use of selected categories of illicit drugs, past 30 days, DoD branches, 2002, 2005, and 2008

2-5a   Standardized comparisons of active duty component personnel and civilians, heavy alcohol use and past 30-day smoking, by age group, 2008

2-5b   Standardized comparisons of active duty component personnel and civilians, past 30-day illicit drug use, by age group, 2008

2-6   Prevalence of alcohol-related disorders among the active duty component (rates per 100,000)

2-7   Prevalence of drug-related disorders among the active duty component (rates per 100,000)

2-8   Prevalence of alcohol- and other drug-related disorders among the reserve component (rates per 100,000)

2-9   Prevalence of alcohol- and other drug-related disorders among dependents

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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2-10   Incidence rates of acute and chronic alcohol-related inpatient and outpatient cases, active duty component, U.S. military, 2001-2010

2-11   Alcohol use problems and interventions

3-1   Defense Enrollment Eligibility Reporting System (DEERS)

3-2   TRICARE organization of services

3-3   The uniformed services

3-4   Terminology related to the uniformed services health care system

7-1   Number of Army Substance Abuse Program (ASAP) treatment enrollments by substance of abuse for fiscal year 2010

H-1   Components of health care delivery systems

Boxes

3-1     TRICARE Patient Priority System

4-1     ACO Accreditation Standards

4-2     Dimensions of American Society of Addiction Medicine’s (ASAM’s) Patient Placement Criteria

4-3     National Quality Forum’s Voluntary Consensus Standards for the Treatment of Substance Use Conditions

6-1     Policies and Directives Related to Substance Use Disorders

6-2     Army Substance Abuse Program (ASAP) Prevention and Treatment Capabilities

6-3     Military Studies of the National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism

7-1     A Soldier’s Untreated Substance Abuse

7-2     DoD-Wide Programs to Increase Access to Behavioral Health Care Services and Encourage Help Seeking

7-3     Access Standards of the Veterans Health Administration for SUD Care

7-4     TRICARE Policies Governing Access to SUD Care

8-1     12 Core Functions of Substance Abuse Counselors

8-2     Psychological Health Risk-Adjusted Model for Staffing (PHRAMS) Diagnosis and Risk Groups

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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Acronyms and Abbreviations

AA Alcoholics Anonymous
ABAM American Board of Addiction Medicine
ABC Alcohol Brief Counseling
ACO Accountable Care Organization
ACSAP Army Center for Substance Abuse Programs
ADAMS Alcohol and Drug Abuse Management Seminar
ADAPT Alcohol and Drug Abuse Prevention and Treatment
ADC alcohol and drug counselor
ADCO alcohol and drug control officers
ADFM active duty family member
ADMITS Alcohol and Drug Management Information Tracking System
ADSM active duty service member
ADT active duty training
AFI Air Force Instruction
AFIP Armed Forces Institute of Pathology
ALARACT All Army Activities
APA American Psychiatric Association
AR Army regulation
ARI alcohol-related incident
ARM Alcohol-Related Misconduct
ASAC Adolescent Substance Abuse Counseling
ASAM American Society of Addiction Medicine
ASAP Army Substance Abuse Program
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AUD alcohol use disorder
AUDIT Alcohol Use Disorders Identification Test

BAM Brief Addiction Monitor
BASIC Building Alcohol Skills Intervention Curriculum
BHIVES Buprenorphine and HIV Care Evaluation and Support
BHOP Behavioral Health Optimization Program
BUMED Bureau of Medicine and Surgery

CARF Commission on Accreditation of Rehabilitation Facilities
CATEP Confidential Alcohol Treatment and Education Pilot
CBT cognitive-behavioral therapy
CDC Centers for Disease Control and Prevention
CD-MART Controlled Drug Management Analysis and Reporting Tool
CEOA comprehensive effects of alcohol
CFR Code of Federal Regulations
CHCBP Continued Health Care Benefit Program
CM contingency management
CO commanding officer
COBRA Consolidated Omnibus Budget Reconciliation Act
CoRC Culture of Responsible Choices
CPG Clinical Practice Guideline
CSAP Center for Substance Abuse Prevention
CSAT Center for Substance Abuse Treatment
CSF Comprehensive Solider Fitness

DAPA Drug and Alcohol Program Advisor
DCoE Defense Centers of Excellence
DDCAT Dual Diagnosis Capability in Addiction Treatment
DEA Drug Enforcement Agency
DEERS Defense Enrollment Eligibility Reporting System
DEFY Drug Education for Youth
DoD Department of Defense
DODD Department of Defense Direction
DODI Department of Defense Instruction
DOJ Department of Justice
DOT Department of Transportation
DRI drug-related incident
DSM Diagnostic and Statistical Manual
DUI driving under the influence
DWI driving while intoxicated

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EAP Employee Assistance Program
EBP evidence-based practices
ECF executive cognitive function
EUDL Enforcing Underage Drinking Laws

FEHBP Federal Employees Health Benefits Program
FOCUS Families OverComing Under Stress
FTE full-time equivalent
FY fiscal year

GAO Government Accountability Office
GAT Global Assessment Tool
GBL gamma butyrolactone
GHB gamma-hydroxybutyric acid

HRB Health Research Board
HRSA Health Resources and Services Administration

IC&RC International Certification and Reciprocity Consortium
ICD International Classification of Diseases
IDS integrated delivery system
IDT Inactive Duty Training
IHI Institute of HealthCare Improvement
IMCOM Installation Management Command
IntNSA The International Nurses Society on Addictions
IOM Institute of Medicine
IOP intensive outpatient

JCAHO Joint Commission on Accreditation of Healthcare Organizations

LCSW Licensed Clinical Social Worker
LIP Licensed Independent Practitioner
LMFT Licensed Marriage and Family Counselor
LOD line of duty
LPC Licensed Professional Counselor
LSD lysergic acid diethylamide

MAAC Marine Alcohol Awareness Course
MCO Marine Corps Order
MDMA 3,4-methylenedioxy-N-methylamphetamine
MDR M2 Data Repository
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MEDCOM Medical Command
MET motivational enhancement therapy
MHAT Mental Health Advisory Team
MHS Military Health System
MORE My Ongoing Recovery Experience
MOU Memorandum of Understanding
MTF military treatment facility

NCQA National Committee for Quality Assurance
NDAAC Navy Drug and Alcohol Advisory Council
NDACS Navy Drug and Alcohol Counselor School
NIAAA National Institute on Alcohol Abuse and Alcoholism
NIDA National Institute on Drug Abuse
NOAA National Oceanic and Atmospheric Administration
NORTH STAR New Orientation to Reduce Threats to Health from Secretive Problems That Affect Readiness
NQF National Quality Forum
NRC National Research Council
NREPP National Registry of Evidence-Based Programs and Practices

OEF Operation Enduring Freedom
OIF Operation Iraqi Freedom
OND Operation New Dawn
ONDCP Office of National Drug Control Policy

PC prevention coordinator
PCM primary care manager
PCP phencyclidine
PDHA Post-Deployment Health Assessment
PDHRA Post-Deployment Health Reassessment
PDMP Prescription Drug Monitoring Program
PEC Pharmacoeconomic Center
PFL Prime for Life
PHA Periodic Health Assessment
PHRAMS Psychological Health Risk-Adjusted Model for Staffing
PMART Prescription Medication Analysis Reporting Tool
POC Pharmacy Operations Center
POS point of service
PREVENT Personal Responsibility and Values Education and Training
PTSD posttraumatic stress disorder

Suggested Citation:"Front Matter." Institute of Medicine. 2013. Substance Use Disorders in the U.S. Armed Forces. Washington, DC: The National Academies Press. doi: 10.17226/13441.
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RE Resiliency Element
ROSC recovery-oriented systems of care
RT resiliency training
RTCQ Readiness to Change Questionnaire

SACC Substance Abuse Counseling Center
SACO Substance Abuse Control Officer
SAIC Science Applications International Corporation
SAMHSA Substance Abuse and Mental Health Services Administration
SAODAP Special Action Office for Drug Abuse Prevention
SAPST Substance Abuse Prevention Specialist Training
SARP Substance Abuse Rehabilitation Program
SBIRT screening, brief intervention, and referral to treatment
SECNAVINST Secretary of the Navy Instruction
SIP Short Index of Problems
SM service member
STD sexually transmitted disease
SUAT Substance Use Assessment Tool
SUD substance use disorder
SUDRF Substance Use Disorder Rehabilitation Facility

TAMP Transitional Assistance Management Program
TAP Technical Assistance Publication
TBI traumatic brain injury
TDP TRICARE Dental Plan
TMA TRICARE Management Activity
TPR TRICARE Prime Remote
TRS TRICARE Reserve Select
TSF twelve-step facilitation

UPL Unit Prevention Leader
URI unit risk inventory
USAF U.S. Air Force
USMC U.S. Marine Corps

VA Department of Veterans Affairs
VET veterans
VHA Veterans Health Administration

WHO World Health Organization
WTB Warrior Transition Brigade
WTU Warrior Transition Units
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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.

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