Alcohol and Drug Use in Military Veterans



This deck provides a general overview about alcohol and substance use disorders (SUDs) within the military. The presenters will review prevalence rates of use/misuse, clinical assessment and best treatment practices for substance use disorders.  Information will be presented on the 2013 Department of Defense (DoD) Institute of Medicine report, comparisons of alcohol and substance use in civilian and military/veteran populations, and the military cultural context in which alcohol and substance use occurs.  Commonly used brief assessment instruments for substance use disorders are described. Additionally, common co-morbidities to SUDs and the approaches to addressing them will also be discussed.  VA/DoD guidelines, practices, and programs, are reviewed to highlight effective approaches in this population.  Specific evidence-based psychological treatments for SUDs are briefly described, ranging from brief interventions that can be incorporated as part of screening for appropriate cases to continuing care approaches for individuals with more severe and chronic problems. Particular attention is given to the importance of (a) taking a stepped care approach to the treatment of SUDs, (b) viewing SUDs on a continuum of severity, (c) using a motivational interviewing style of interacting with individuals with SUDs, and (d) employing the use of some of the most highly rated evidence-based treatments for SUDs.   

Learning Objectives:

  1. Describe common trends in alcohol and drug use amongst civilian and military populations.
  2. Identify strategies for screening and assessing civilian and military clients for substance use disorders.
  3. Discuss evidence-based treatments for substance use disorders.


I.  Historical Perspective: An Introduction to SUDs in the Military
          a.   Brief history including timeline of problem recognition and the beginning of policy making and treatment programs (as outlined in the Office of the Under Secretary for Personnel and Readiness report, 2015)
                i.   DoDI 1010.1 issued in 1974 following recognition of drug problems with returning Vietnam Vets
               ii.   Sentinel event: May 1981 aircraft accident aboard the USS Nimitz costing 150 million dollars. 6 killed and cannabis was implicated in the crash bringing military drug use to the news        
          b.   Intro to Substance Use Disorders and recommendations (IOM Report, 2013)
          c.   Into to the VA/DoD Clinical Practice Guidelines for SUDs
II.  Prevalence Rates
          a.   Commonly abused substances
          b.   Prevalence Rates of use     
                i.   Civilian
               ii.   Active Duty Military
               iii.  Veterans
          c.   Military Risk Factors for SUDs
          d.   Alcohol Use in the Military  
                i.   General risk factors for heavy/binge drinking  
               ii.   Military specific risk factors for heavy/binge drinking   
              iii.   Contributing factors to alcohol use among Service members
          e.   Tobacco Use in the Military       
               i.   Prevalence rates by type of tobacco product 
              ii.   Contributing factors to tobacco use in the military   
          f.   Prescription Drug Misuse
              i.   Civilian versus Military
              ii.  Prescription drug use and misuse in the military      
             iii.  Contributing factors to opioid misuse in the military
III.   Screening/Assessment and Diagnosis of Substance Use Disorders
          a.   DSM-V Criteria for SUD diagnosis
          b.   Screening for SUDs within a Military/Veteran Context
              i.   Screening for tobacco use     
             ii.   Screening for alcohol use disorders  
            iii.   Identification of others SUDs
IV.   Co-Occurring Physical or Mental Health Conditions
         a.   Conditions
             i.   Depression/Anxiety/PTSD 
            ii.   Sleeping Problems
           iii.   TBI 
           iv.   Chronic Pain  
            v.   Suicide 
        b.   Treating SUDs and Co-morbidities
V.   Guidelines for SUD Treatments
       a.   Trends in SUDs treatment
             i.   Stepped Care: Brief Interventions for Mental Health Providersii.
            ii.   Web-Based Social Media Interventions
       b.   VA/DoD Clinical Practice Guidelinesi.
            i.   Psychotherapy
                1.  Based on locally available expertise, initiate addiction-focused psychosocial interventions with empirical support     
                2.  Addiction-focused psychosocial interventions should be coordinated with evidence-based intervention(s) for other biopsychosocial problems to address        
                3.  Intervention should be provided in the least restrictive setting necessary for safety and effectiveness identified concurrent problems     
                4.  Motivational Interviewing (MI) techniques and style should be used in SUD treatment sessions. Confrontational counseling styles should generally be avoided   
          ii.   Pharmacotherapy
VI.   Treatment and Relapse Prevention for the treatment of SUDs  
        a.   Motivational Interviewing (MI)
            i.   Not a therapy protocol, but an intervention technique 
           ii.   MI in action – video provided
        b.   EBPs for SUDs: A look at a few of the top-rated treatments for SUDs 
           i.   Motivational Enhancement Therapy (MET)
           ii.  Cognitive Behavioral Therapy (CBT)
          iii.  Behavioral Couples Therapy (BCT)
          iv.  Twelve-Step Facilitation 
        c.   Relapse Prevention  
           i.   Marlatt’s model
          ii.   Helping the service member identify high-risk situations
VII.   VA and DoD SUDs Treatment Programs
        a.   Department of Defense (DoD) SUDs Treatment Programs   
            i.   Army (ASAP)
            ii.  Navy/Marines (SARP)
           iii.  Air Force (ADAPT)
       b.  VA SUD Treatment Programs
           i.   SARRTP  
          ii.   VA endorsed Community Transitional Living options 
       c.   ASAM Criteria: Determining appropriate level of care/treatment     
       d.   DoD SUD prevention programs
VIII.   Additional Resources    


  1. Historical Perspective of Substance Use Disorders (SUDs) and Treatment in the Military
  2. Prevalence of Substance Use and Problem Use
  3. Screening/Assessment and Diagnosis of SUDs
  4. Co-Occurring Physical and Mental Health Conditions
  5. Guidelines for Treating SUDs
  6. Evidence-based practices and Relapse Prevention planning for SUDs
  7. DoD and VA programs for the treatment of SUDs
  8. DoD SUD prevention programming
  9. Additional Resources