DESCRIPTION:
This presentation will provide a general overview about alcohol and substance use disorders (SUDs) within the military population. Presenters will review prevalence rates of use/misuse of substances, clinical assessment and best treatment practices for SUDs. Information presented will be based upon recommendations as informed by the 2015 VA/DoD Clinical Practice Guidelines for the Treatment of SUDs with Service members and Veterans and the current literature informing SUD treatment. Commonly used brief assessment instruments for substance use disorders are introduced and use described. Prevalence rates and treatment are discussed within the context of consideration for mentally and physically co-occurring disorders.
VA/DoD guidelines for the treatment of SUDs (2015), practices, and programs, are reviewed to highlight effective approaches in support of recovery for military service members. 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 and relapse prevention planning for individuals with more severe and chronic problems. Particular attention will be given to the importance of (a) taking a stepped care approach to the treatment of SUDs while providing treatment in the least restrictive environment possible, (b) viewing SUDs on a continuum of severity, and (c) employing the use of some of the most empirically supported evidence-based treatments for SUDs. Case examples provide an opportunity for audience members to discuss the clinical application of knowledge about SUDs for specific situations that they may encounter in working with SMs.
LEARNING OBJECTIVES:
- Characterize common trends in alcohol and drug use among military versus civilian populations.
- Recommend strategies for screening and assessing military clients for substance use disorders.
- Prioritize evidence-based treatments for substance use disorders.
OUTLINE:
I. Substance Use in the Military
a. Commonly used/abused substances
b. Prevalence Rates of potentially problematic use
i. Active Duty Military
ii. Veterans
c. Military Risk Factors for SUDs
d. Alcohol Use in the Military
i. Military specific risk factors for heavy/binge drinking
ii. General risk factors for heavy/binge drinking
iii. Contributing factors to alcohol use among Service members
e. Tobacco Use in the Military
i. Contributing factors/risk factors to tobacco use in the military
f. Prescription Drug Misuse
i. Prescription drug use and misuse in the military
ii. Contributing factors to opioid misuse in the military
II. Assessment/Screening 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 alcohol use disorders
ii. Identification of others SUDs in Military service members
iii. When to refer to Specialty Care
c. Case Example #1: NG soldier “Marc”
III. 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
c. Case Example #2: Army Airborne “Robert”
IV. Guidelines for SUD Treatments
a. Trends in SUDs treatment
i. Stepped Care: Brief Interventions for Mental Health Providers
ii. SBIRT (Screening, Brief Intervention, Referral to Treatment)
iii. Brief Interventions explained
b. VA/DoD Clinical Practice Guidelines
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
V. Evidence-Based Treatments for SUDs
a. Motivational Enhancement Therapy (MET)
b. Cognitive Behavioral Therapy (CBT)
c. Behavioral Couples Therapy for Alcohol Use Disorders/AUD (BCT)
d. 12-Step Facilitation Therapy (TST)
e. Medication Assisted Treatment for Opioid Use Disorders/OUD (MAT)
f. Aftercare and managing relapses (not an EBT, but suggested follow-up)
VI. 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 SUDs Treatment Programs
i. SARRTP
ii. VA endorsed Community Transitional Living options
VII. Additional Resource