Despite a well-documented increase in the abuse of alcohol and prescription medications among military personnel over the past decade, the Defense Department's strategies for screening, treating and preventing those problems remains behind the times, a major new report finds.
“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,†said Charles P. O'Brien, chairman of the panel that wrote the report and the director of the Center for Studies of Addiction at the University of Pennsylvania.
The report by the Institute of Medicine, a bran ch of the National Academy of Sciences, asserts that heavy drinking “is an accepted custom†within the military that needs to be regulated more carefully, recommending routine screening for excessive alcohol use.
About 20 percent of active-duty military personnel reported heavy drinking in 2008, the latest year for which data were available, and reports of binge drinking increased to 47 percent in 2008, from 35 percent in 1998, according to the report.
The report noted that while rates of illicit and prescription drug abuse are relatively low, the rate of medication misuse - particularly of opioid pain killers - has risen sharply: 11 percent of active-duty personnel reported misusing prescription drugs in 2008, up from 2 percent in 2002.
Such prescription-drug abuse is rising faster within the military than among civilians, and is perhaps more common than the use of illegal drugs like cocaine or marijuana. Yet the military's drug-testing regimen, creat ed in the post-Vietnam era, continues to focus on certain illegal drugs that may not be the main problem anymore, the 14-member panel concluded.
The panel, while commending the Pentagon for taking steps in recent years both to curb prescription drug abuse and expand availability of substance abuse programs, asserts the military needs to do more to reduce the stigma attached to seeking substance abuse treatment.
Among other things, the report recommends that prevention and treatment programs be integrated more into primary care, a step it says would encourage more people to seek care. The report also says that the armed services could do more to maintain confidentiality of service members who request care for substance abuse disorders.
“While services are available through military treatment facilities for active duty service members, the number of patients treated is below epidemiological expectations,†the report says. “Barriers to care apparently in hibit use of these services. These barriers include the structure and location of the services, a reliance on residential care, and stigma that inhibits help-seeking behavior early on.â€
On the treatment side, the panel recommended that the military health system reduce its reliance on residential and inpatient care programs and instead focus on expanding outpatient programs. Such outpatient programs are better suited for dealing with the long-term nature of substances abuse treatment, the authors said.
Dr. Richard A. Friedman, a professor of clinical psychiatry at Weill Cornell Medical College, who has studied prescription drug use in the military, said the panel's recommendations are “full of common sense†and, given the uptick in prescription drug and alcohol abuse, not particularly controversial.
The problem, he said, will be finding money to implement its recommendations, which might require hiring additional personnel.
“It isn't as if the military doesn't know the right thing to do,†Dr. Friedman said. “It is that they are so understaffed and underfinanced.â€
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