APPROACH TO THE CHARGE
The charge presented to the committee was substantial and expansive. It involved several distinct topic areas (prevention, diagnosis, treatment, and management) and subpopulations (active duty service members, members of the National Guard and Reserves, and military dependents). Additionally, it entailed an investigation of six sets of policies and programs (DoD, Air Force, Army, Navy, Marine Corps, and TRICARE), some discrete and some overlapping.
This broad charge necessitated a comprehensive approach. The committee engaged in three types of information gathering. First, the committee held four public information gathering meetings that featured presentations by representatives from each of the military branches and TRICARE, as well as academic researchers. Second, the committee conducted five site visits to military bases. During these visits, the committee met with a variety of care providers, including SUD-specific providers as well as those in primary care, behavioral health, and pain management clinics. Third, the committee submitted to each of the military branches and TRICARE Management Activity formal requests for information and numerical data on program reach, service access and utilization, and evaluation results, along with data on the numbers and types of SUD care providers.
The committee compared all of the information thus collected with the best practices and modern standards of care in the scientific literature to assess the adequacy and appropriateness of policies and programs, access to care, and workforce standards. The committee then formulated a set of conclusions and recommendations for improvement in each of these areas, with the aim of helping DoD provide the highest-quality SUD care to military service members and their dependents.
SETTING THE STAGE
The military has a long history of use and abuse of alcohol and other drugs, often exacerbated by deployment and combat exposure. To address these issues, DoD and the individual branches developed a series of policy directives starting in the early 1970s, largely as an outgrowth of concern about substance use during the Vietnam era. Substance abuse has well-known negative health consequences and detrimental effects on military readiness, levels of performance, and discipline. Thus, current DoD policy strongly discourages alcohol abuse (i.e., binge or heavy drinking), illicit drug use, and tobacco use by members of the military. Despite these official policies, however, substance use and abuse remain a concern for the military. Many of the medical conditions that prevail in a heavily deployed force have led to frequent prescriptions for controlled substances, increasing