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DoD Follows National Guidelines to Help Substance Abusers

By Douglas J. Gillert
American Forces Press Service

WASHINGTON, Sept. 23, 1999 – As much as possible, DoD follows nationally established health care guidelines for treating substance abusers.

What is substance abuse and who are abusers in DoD depends on the substance and the abuser, even in the health care arena where a patient is a patient and sickness is sickness. For instance, service members come under strict, zero-tolerance regulations for illicit drug use, but DoD's approach is more lenient toward alcohol. Retirees and family members eligible for DoD health care benefits aren't necessarily subject to the same regulations.

Drug abuse among service members isn't tolerated but it's also not a large problem because of screening programs and a general consensus among commanders and troops that drug use is incompatible with military service. Respondents to a tri-annual worldwide health behavior survey last year indicated less than 2 percent of active duty service members use illicit drugs.

Alcohol abuse is a different story, and health officials are specifically concerned about binge drinking among the youngest enlisted members.

DoD has joined other government and business organizations nationwide in recognizing September as National Alcohol and Drug Addiction Recovery Month. The theme of this year's observance, "Addiction Treatment: Investing in People for Business Success," coincides with DoD downsizing and the need to retain a skilled work force, said John Mazzuchi, deputy assistant secretary of defense for health affairs clinical and program policy.

"Human resources are precious. If you have somebody who is in trouble with substance abuse -- for active duty military, alcohol abuse -- it is well worth getting that person treatment," Mazzuchi said. "Alcoholism responds well to treatment, especially if there's a good support system. We've had outstanding success in our programs. We have recovering alcoholics, people who have gone through our programs, who have gone on to be successful, including physicians, pilots and soldiers in all the branches of service."

DoD follows the guidelines of the American Society of Addiction Medicine to treat substance abusers. Depending on the level of abuse or addiction, treatment may be provided in a controlled, inpatient facility or through intensive outpatient programs.

Although DoD and Uniform Code of Military Justice are unequivocal concerning drug abuse by service members, they send a cloudier message about alcohol abuse, Mazzuchi said.

"Yes, alcohol is a legal substance, but I think it's a mistake to treat it as less serious than we do other substances," he said. "It's only legal if you're of legal drinking age, and in most states, that's 21. Yet, our recent survey shows that about 19 percent of our youngest uniformed personnel drink excessively.

"That has, in the past, not caused the department to be quite as concerned as about illicit substances. I think we need to be concerned. We have to be careful how we address it, but we must address it."

Following the lead of college fraternities, which are beginning to take binge drinking seriously, DoD health care leaders met recently with the Research Society on Alcoholism and the National Institute on Alcohol Abuse and Alcoholism. Mazzuchi hopes the NIAAA will bid on upcoming contracts to help DoD develop effective strategies to deal with teen-age drinking.

The overriding concern of DoD health care providers is to restore abusers and addicts to good health. That includes alcohol abusers among the active duty population and drug or alcohol abusers among family members and retirees. Mental health programs in all the services are now available through TRICARE- provided treatment programs. DoD civilians also can get help through most plans under the Federal Employees Health Benefits Program.

If abusers don't identify themselves for treatment, then family members, friends or co-workers may have to intervene, Mazzuchi said.

"The problems don't get better by themselves," he said. "The smartest thing to do is first seek assistance from a mental health professional and then set up an intervention. There are ways of doing interventions successfully that trained people know how to do."

Mazzuchi said workplaces may be the last place substance abuse is recognized. Nationally, 70 percent of drug abusers and 80 percent of alcohol abusers hold down good jobs, he said. A corollary is that supervisors can use the threat of job loss as an incentive to get a person into treatment, he said.

"Make it a condition of employment to seek help," he said. "You have a better chance of helping somebody who has a job that he or she wants to hang on to.

"Anyone who thinks they have a loved one or work associate who may be abusing alcohol or drugs should get guidance from a mental health counselor on what to do next," Mazzuchi said. "There's hope, but there's not much hope by ignoring it."

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