similarly finds that SUD treatment is in some cases not being counted in the MDR database from which PHRAMS calculates estimates for staffing. PHRAMS therefore requires modification before it can be applied to estimate staffing needs for alcohol and drug counselors (DoD, 2011).

The PHRAMS analysis, however, includes interesting data related to alcohol and drug use treatment needs. During fiscal year (FY) 2010, 10.4 percent of the psychological health encounters in the MDR database were related to “psychotic and nonpsychotic substance use,” with a mean of 3.5 encounters among individuals with a substance use encounter (Harris and Marr, 2011). PHRAMS assumes that each substance use patient should receive a mean of 9 encounters. The PHRAMS database (FY 2003 through FY 2010) shows increasing use of psychological health services over the 8-year span and variations by service branch (Harris and Marr, 2011). Based on the trend of increasing encounters and adjusting for underutilization and changes in demographics, PHRAMS estimates an increasing need for services related to SUDs. It should be kept in mind, however, that the PHRAMS FTE estimate reflects only services reported in the MDR database.

The committee’s charge included offering recommendations on evidence-based methods for estimating staffing needs to address SUDs. The PHRAMS software appears to include the key variables required for estimating staffing needs, including the ratio of physician and nonphysician health care providers. The underestimated need for counselors to treat SUDs, however, suggests that the parameters for making estimates need substantial modification and that the data used to generate the staffing estimates for SUD treatment may be incomplete. Refinement and complete data are required if PHRAMS is to be used to estimate staffing needs for substance use encounters.

Finding 8-5: All of the branches appear to have shortages of SUD counselors.

The branches all reported shortages of counselors in their SUD programs. The Army was actively recruiting licensed practitioners to staff ASAPs while the committee met. The Navy had unfilled authorized positions. The Air Force and Marine Corps reported minimal staffing levels in their programs as well. It is apparent that the branches have pressing needs for additional qualified counselors to staff their SUD programs.

In both civilian and military programs, recruitment and retention of practitioners skilled in addressing SUDs is an ongoing challenge because the positions have low prestige, offer low salaries, and tend to attract entry-level practitioners. The low prestige reflects the lack of professional training and licensure. Credentialed counselors who are not licensed often are



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