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Wednesday, September 19, 2012

Institute of Medicine Report on Substance Use Disorders Among United States Armed Forces, and Recommendations to Move Forward


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. 
CPDDBLOG welcomes CPDD member's thoughts on these issues.