A comprehensive report on
substance use disorders in the United States Armed Forces was just published by
the Institute of Medicine (IOM). The report, commissioned by the Department of
Defense, summarizes current issues and advances 12 recommendations for
improving prevention, screening and diagnosis, and treatment of armed forces
personnel with substance use disorders.
The IOM Committee that produced the report included several CPDD members and
was Chaired by Dr. Charles O’Brien, CPDD Charter Fellow and winner of the CPDD Nathan
B. Eddy and Mentorship Awards.
Substance use disorders are
a significant and growing problem within the Armed Forces, and rank very high
among mental disorders in terms of the numbers of hospitalizations and
ambulatory visits (encounters) and lost days (bed days) experienced by Armed Forces personnel (Figure, data from the IOM Report, Table 2-5).
The report made a number of
key recommendations including that access to treatment services should be
better coordinated and standardized across service branches and reserve forces,
and extended to provide a continuum of care on an outpatient basis in primary
care settings. This change is very
much needed because the current system relies too heavily on residential and inpatient
care, which not only are more costly and stigmatized, but also tend to be less
accessible to many if not most who need care.
The report advised that
emphasis be placed on routine screening and brief intervention, to identify and
treat individuals at increased risk for developing substance use disorders. The report also noted that the Armed Forces standard of care, including some of its treatment policies and substance
use treatment personnel training, is behind the times and behind what is
available to the general public, and needs to be updated. For example, agonist substitution
medications for opioid abuse and dependence (e.g., methadone or buprenorphine)
are not allowed per current treatment policy, despite the fact that agonist
substitution therapy has been shown to be extremely effective.
The report also recommended reformulating
the treatment personnel structure by creating multidisciplinary treatment teams
with diverse expertise including up to date clinical treatment training. Such teams would be better able to
provide a continuum of treatment for substance use disorders and comorbid
substance use/mental health disorders.
The report also suggested that technology be developed to offer prevention,
screening, diagnosis and treatment to service members in need based in remote
locations, who do not have access to treatment personnel.
The report including its 12
recommendations, executive summary, and 10 appendices, is available for free
download here.
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