Due to serious reports of rising rates of alcohol and prescription drug abuse in the military, the Institute of Medicine (IOM) was asked by the Department of Defense (DoD) to analyze policies related to screening, prevention, diagnosis, and treatment of substance use disorders (SUDs) for active duty services members of all branches of the military, i.e., the Air Force, Army, Marine Corps, Navy, members of the National Guard and Reserve, and their military families. The IOM report, entitled “Substance Use Disorders in the U.S. Armed Forces,” was released on September 17, 2012.
History of Alcohol and Substance Abuse
The U.S. military has a long history of alcohol and drug abuse. According to the IOM report, in 1998, 15 percent of active duty members admitted to heaving drinking and 35 percent to binge drinking. As of 2008, those figures had increased substantially, with 20 percent admitting to heavy drinking and 47 percent to binge drinking. The IOM further reports that military doctors “wrote nearly 3.8 million prescriptions for pain medication in 2009, more than quadruple the number of such prescriptions written in 2001.”
A Public Health Crisis
The IOM analysis concludes that “alcohol and other drug use in the armed forces remain unacceptably high, constitute a public health crisis, and both are detrimental to force readiness and psychological fitness.” The IOM believes that these facts must be acknowledged at the highest level of the military leadership and must be addressed through a variety of strategies, including limiting access to alcohol and drugs. Additional structural recommendations by IOM include:
- a routine check by prescribers of local prescription drug monitoring programs before dispensing;
- training health care professionals to recognize patterns of prescription drug use and medication-seeking behaviors;
- routine screening for unhealthy alcohol use and mechanisms to support interventions; and
- placing interventions within the context of primary care.
Environmental changes recommended by IOM include reducing the number of outlets that sell alcohol, restricting their hours of operation, and reducing the type and amount of alcohol available.
Use of Evidence-Based Practices
The IOM report recommends that DoD fully implement its evidence-based guideline, entitled “VA[Veterans Affairs]/DoD Clinical Practice Guideline for Management of Substance Abuse Disorders,” which has already been developed by DoD. Implementation of this guideline, according to IOM, would help facilitate their recommendations regarding routine screening and effective treatment.
Expanding TRICARE Benefits
The IOM concedes that the military health care system presently provides SUD treatment directly and through TRICARE insurance. TRICARE, however, does not cover intensive outpatient services, office-based outpatient services, and certain evidence-based pharmacological therapies which are standard SUD components of care. The IOM, therefore, recommends that TRICARE SUD benefits be expanded to include care in intensive outpatient and office-based settings, which would increase access to care. IOM further recommends that should the DoD fail to timely implement these TRICARE SUD changes, that Congress should consider legislation mandating these changes to DoD.