Substance Abuse Prevention, Treatment, and Research Efforts in the Military

Substance Abuse Prevention, Treatment, and Research Efforts in the Military

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Updated August 17, 2018
Substance Abuse Prevention, Treatment, and Research Efforts
in the Military
Congress has taken an interest in understanding federal
exposure and injuries. However, the incidence rate for
efforts and identifying options to address substance abuse,
dependence or abuse among service members has declined
particularly in the context of the opioid crisis. On October
by 38% between 2012 and 2016. When adjusted for
26, 2017, President Trump declared the drug demand for,
demographics, the opioid death rate among service
and use of, opioids as a “national public health emergency”
members is significantly lower than the U.S. population at
and directed all executive agencies to “use every
2.7 per 100,000 and 10.4 per 100,000, respectively.
appropriate emergency authority to fight the opioid crisis.”
How does substance abuse impact military training
The Department of Defense (DOD) has, for many years,
and operations?
operated substance abuse programs focused on prevention,
Service members seeking substance abuse treatment or
treatment, and research of alcohol, illicit drug use, and non-
rehabilitation may require extended leave from duty. Those
medical use and abuse of prescription drugs.
with problematic substance use can be administratively
separated from the military. Administrative separations
What are the substance abuse trends in the
occur when a service member refuses to participate in, or
military?
fails to successfully complete, a rehabilitation program; or
From 2009-2016, the number of new alcohol or substance
if there is a lack of potential for continued military service.
abuse diagnoses per year has been on a declining trend for
active duty service members. According to the 2015 DOD
Extended absences or unplanned attrition can impact a
Health-Related Behaviors Survey, active duty service
unit’s mission by creating staffing and capability gaps,
members reported using or misusing the following
disrupt unit cohesion, reduce morale, or perpetuate mental
substances within the past year: illicit drugs (0.7%),
health stigma. In 2011, DOD quantified the amount of lost
prescription drugs (4.1%), and alcohol binge drinking
duty days resulting from service member illnesses and
(30%). Other than binge drinking, the prevalence of
injuries. Substance abuse ranked as the second-highest
substance abuse is lower than in the general U.S.
cause with at least 7.0 lost duty days per patient. While this
population. DOD attributes these trends to the education,
rate is lower than the U.S. civilian employer average of
prevention, and treatment programs it has developed over
14.8 days, reduced productivity and absenteeism can
the past decade.
negatively impact military training and operations.
Figure 1. Incidence Rates of Alcohol and Substance
What are the main elements of DOD’s substance
Abuse in Active Duty Service Members, 2007-2016
abuse prevention, compliance, and disciplinary
policies?
Table 1 lists selected aspects of DOD’s substance abuse
policies, which are implemented by various DOD
components and each military service. In general, they
focus on administrative and medical approaches to
prevention, screening, treatment, compliance, and
retention/separation.
Table 1. Aspects of DOD Substance Abuse Policies

Conduct substance use education and awareness activities

Implement a urinalysis drug testing program

Source: Shauna Stahlman and Alexis Oetting, “Mental Health

Conduct regular and systematic medical screening for at-
Disorders and Mental Health Problems, Active Component, U.S.
risk substance use
Armed Forces, 2007-2016,” Medical Surveillance Monthly Report, vol.

Provide evidence-based substance use disorder services to
25, no. 3 (March 2018), pg. 5.
eligible service members
Note: “Person-year” is a measure of the time at risk for a defined

Return service members to full duty following substance use
population.
disorder treatment, if feasible

Separate all service members who knowingly misuse drugs
DOD recently reported that opioid medications are
prescribed at a higher rate for service members than the
Sources: Department of Defense Instruction 1010.01, “Military
general U.S. population. This higher prescription rate may
Personnel Drug Abuse Testing Program,” 2018. Department of
be attributable to deployment-related effects such as combat
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Substance Abuse Prevention, Treatment, and Research Efforts in the Military
Defense Instruction 1010.04, “Problematic Substance Use by DOD
Projects Agency, overseas contingency operations, or other
Personnel,” 2014.
military research agencies) are not reflected in this account.
Prevention Efforts
DOD Efforts to Address the “Opioid Crisis”
DOD mandates that substance abuse education be provided
DOD has taken certain steps to address opioid abuse and
to all service members. Each military service operates a
dependence:
substance abuse prevention program that provides a wide
range of education and training services targeted to
 Integration of behavioral health consultants in primary
individual service members, health care providers, and unit
care
commanders. Prevention efforts also include the
anonymous Drug Take Back program at every military
 Implementation of a comprehensive pain management
treatment facility (MTF), active health surveillance for at-
model focusing on non-pharmacologic treatment
risk service members, and annual screenings for
problematic substance use behaviors.
 Adjustment of TRICARE policy to cover opioid
replacement treatment of substance use disorders
Treatment Options
Service members may receive treatment for substance use
 Distribution of opioid-reversal kits (including
disorders at certain MTFs or through TRICARE, an
naloxone) to first responders at all military installations
insurance-like program that contracts civilian health care
providers. Only medically necessary and evidence-based
 Data-sharing with state Prescription Drug Monitoring
therapies and interventions are covered by TRICARE.
Programs (retail or mail-order only)
These may include inpatient services, intensive outpatient
programs, detoxification, medication assisted treatment,
In addition to these efforts, the President’s Commission on
mental health services, office-based opioid treatment,
Combating Drug Addiction and the Opioid Crisis report of
partial hospitalization programs, and residential programs.
2017 outlines several recommendations for DOD to
consider, such as developing model policies that ensure
Substance abuse evaluation and treatment can be self-
informed patient consent, conducting a comprehensive
initiated, or referred by a supervisor, co-worker, or family
review of research programs, and establishing strategic
member. To dispel stigma when service members
research goals.
voluntarily access mental health care and substance abuse
treatment, MTF health care providers notify the member’s
Relevant Statutes, Regulations, and Policies
supervisor only under a limited set of circumstances (e.g.,
self-harm, harm to others, harm to mission, designated
Title 10, U.S. Code, Chapter 55 – Medical and Dental Care
personnel, inpatient admission/discharge, command-
Title 32, U.S. Code of Federal Regulations, Part 199 – Civilian
directed evaluation, or other special circumstances).
Health and Medical Program of the Uniformed Services
Department of Defense Instruction 1010.04 – Problematic
Medical Research Efforts
Substance Use by DOD Personnel
Historically, DOD has conducted medical research on the
clinical aspects of substance abuse, its impact on military
readiness, and its co-morbidity with post-traumatic stress
CRS Products
disorder or traumatic brain injury. For FY2018, Congress
CRS Report R44987, The Opioid Epidemic and Federal Efforts to
has appropriated $2 billion within the Defense Health
Address It: Frequently Asked Questions, by Lisa N. Sacco and Erin
Program (DHP) account for medical research, development
Bagalman
and evaluation programs and activities. Of that amount, $4
CRS In Focus IF10219, Opioid Treatment Programs and Related
million is designated for alcohol and substance abuse
Federal Regulations, by Johnathan H. Duff
disorder research through the Congressionally Directed
CRS In Focus IF10530, Defense Primer: Military Health System, by
Medical Research Program. Other research efforts under
Bryce H. P. Mendez
this account include identification and development of:
 New medications to improve treatment outcomes for
Other Resources
alcohol and substance use disorders in conjunction with
Defense Health Agency, Interim Report to Congress on Preventing
traumatic brain injury and post-traumatic stress
the Diversion of Opioid Medications, 2017.
disorder;
Defense Health Agency, Report on Prescription Opioid Abuse and

Effects on Readiness, 2017.

Assessment, prevention, and treatment, and compliance
tools to mitigate substance abuse; and
Institute of Medicine, Substance Use Disorders in the U.S. Armed
Forces, 2013.
 Epidemiological studies to identify the nature of the
substance abuse problem, including unique

contributing and protective factors.
Bryce H. P. Mendez, Analyst in Defense Health Care
Substance abuse research activities conducted outside of the
Policy
Defense Health Program (e.g., Defense Advanced Research
IF10951
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Substance Abuse Prevention, Treatment, and Research Efforts in the Military

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