Substance use disorders in the U.S. Armed Forces

415 Pages·2013·2.97 MB·English

by  Morden

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
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ate balance.
This study was supported by the U.S. Department of Defense through an inter-
agency agreement with the U.S. Department of Health and Human Services under
Contract No. HHSP23337030T. Any opinions, findings, conclusions, or recom-
mendations 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.
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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, CA
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
v
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
vi
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 confiden-
tial 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.)
vii
viii REVIEWERS
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, Uni-
versity 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.
Preface
Substance abuse has long been an issue of concern for the U.S. popula-
tion and for its military in particular. Dating as far back as the Revo-
lutionary 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 mili-
tary 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 solu-
tions to the problem of substance abuse. Experts from various fields, rang-
ing 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 con-
cern 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.
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x PREFACE
Press reports of substance abuse among the military stimulated congres-
sional 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 pro-
viders, 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 meet-
ings, 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