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MONDAY, Sept. 17 (HealthDay News) -- Alcohol and drug abuse remain major problems in the U.S. military and further measures are needed to improve the prevention and treatment of these disorders among service members and their families, a new report from the Institute of Medicine says.
According to the report released Monday, which was requested by members of Congress, outdated approaches to preventing and treating substance abuse, barriers to care and other issues are impeding the U.S. Defense Department's ability to curb the problem.
Among the findings: Heavy drinking was reported by about 20 percent of active-duty military personnel in 2008, the latest year for which statistics are available; binge drinking rose from 35 percent in 1998 to 47 percent in 2008; and the number of active-duty personnel who said they misused prescription drugs rose from 2 percent in 2002 to 11 percent in 2008.
"We commend the steps that the Department of Defense and individual service branches have recently taken to improve prevention and care for substance use disorders, but the armed forces face many ongoing challenges," report committee chairman Charles O'Brien, professor and vice chair in the department of psychiatry, and director of the Center for Studies of Addiction at the University of Pennsylvania, said in a news release from the National Academy of Sciences.
"Better care for service members and their families is hampered by inadequate prevention strategies, staffing shortages, lack of coverage for services that are proved to work, and stigma associated with these disorders. This report recommends solutions to address each of these concerns," O'Brien said.
The authors of the report advise the U.S. Department of Defense to take the lead in ensuring that all branches of the military take substance use seriously and implement consistent, proven methods for prevention, screening and treatment.
Although the Defense Department already has a Clinical Practice Guideline for Management of Substance Use Disorders, which the authors of the report say is an excellent resource, it is not consistently followed, they noted.
In addition, TRICARE -- which provides health insurance to military members and their families -- does not cover several proven substance abuse treatments that are now standard practice. The coverage only provides treatment in specialized rehabilitation facilities, and doesn't cover long-term use of certain medications currently used for the treatment of addiction, according to the IOM report.
The report suggested that TRICARE's benefits should be changed to cover medications and treatments offered by health-care providers in office-based outpatient settings, which will allow patients to receive ongoing care that could help them avoid substance abuse relapses.
Among the other recommendations in the report:
- Better enforcement of regulations on underage drinking among members of the armed forces, plus a reduction in access to alcohol on bases, such as limiting the number of places to buy alcohol and fewer hours of operation.
- Military personnel should be screened by primary care providers for excessive alcohol consumption and should be offered brief counseling when screening identifies risky drinking behavior.
- The stigma associated with seeking substance abuse treatment could be reduced by making screening and intervention services part of primary care.
- Military health care personnel should be trained to recognize patterns of substance abuse and misuse, and need clear guidelines for referring patients to specialists such as pain management and mental health experts.
Because post-traumatic stress disorder, depression and suicidal thoughts often go hand-in-hand with drug and alcohol misuse, greater access to screening and treatment of substance abuse disorders could improve detection and care for these related conditions, the report authors added.
-- Robert Preidt
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