Two weeks before a high-powered presidential election is probably not the best time to release a major report – if you want anybody to notice it. But the Institute of Medicine, part of the National Academies, just came out with a critically important report on substance abuse in the military, calling the situation a “crisis” that reduces military readiness. And the report shows that the Defense Department’s response is inadequate and outdated.
Could federal lawmakers on the various Armed Forces committees take time out from campaigning to read it?
Entitled “Substance Use Disorders in the U.S. Armed Forces,” the report says that in the Iraq-Afghanistan war era, with longer deployments and greater exposure to combat, military personnel are drinking more and drinking more heavily. At the same time, prescription drug abuse, especially painkillers, is escalating, partly because of increasing prescriptions for chronic pain to cope with the rising number of injuries during a decade of continuous war.
“Military physicians wrote nearly 3.8 million prescriptions for pain medication in 2009, more than quadruple the number of such prescriptions written in 2001 — IOM report“
The report, which says the DoD needs to change the entire way it delivers substance use disorder treatment, was funded by the DoD itself. Today, the military relies almost entirely on inpatient treatment; the report recommends employing outpatient treatment because it costs less, is often equally effective and allows people to continue working and living their lives while undergoing treatment. Outpatient treatment has become the mainstay for most civilian health systems.
The report also recommends confidentiality so that more service members will seek help.
That would represent a big change in the military environment, but it’s necessary. Other recommendations include:
- Enforce regulations on underage drinking, reduce the number of alcohol outlets on military bases and limit hours of alcohol sales
- Improve tracking and reduce access to controlled medications like painkillers
- Institute effective evidence-based treatment and increase use of technology for prevention, screening, diagnosis and treatment
- Introduce screening for alcohol abuse in all military healthcare
- Increase standards of professional training for treatment personnel
- Use medication-assisted treatment for substance use disorders
- Integrate substance use disorder treatment with other health care
- Launch joint effort with VA to raise public profile of treatment and fight stigma
- Improve data collection on substance abuse in the military
In other words, the military needs to join the 21st century when it comes to substance use disorder treatment. But so do most healthcare systems in America.