IoM to DoD: Update Substance Use Guidelines

WASHINGTON – The Department of Defense needs to update its guidelines and practices in order to address the rising rates of alcohol and drug misuse and abuse among the active duty personnel, according to a report released Sept. 17 by the Institute of Medicine.

The 350-page report, mandated by Congress, recommends that the military increase its preventive efforts, adopt evidence-based programs, increase access to care, and increase its health care workforce, while providing them with appropriate training.

bowdenimages/istockphoto.com

"I can’t say I was surprised at anything," Dr. Charles P. O’Brien, chair of the committee that wrote the report, said in an interview. "Maybe what was surprising was that some of the guidelines haven’t been changed in 20 years, and I think they need to be updated right away."

In a statement, the Department of Defense (DoD) said, it appreciates the Institute’s work in assessing substance abuse programs and policies in the military health system. "We are in the process of analyzing [the] findings and recommendations, but most importantly, we want to do the right thing for the service member.

"If there are areas in need of improvement, then we will work to improve those areas. The health and well-being of our service members is paramount."

Roughly 20% of active duty personnel reported engaging in heavy drinking in 2008, compared with 15% in 1998. Binge drinking rates increased from 35% in 1998 to 47% in 2008, according to the IOM study. Meanwhile, of prescription drug use rates increased among the military personnel over the past decade, the study points out, mirroring the increase in the civilian population. Only 2% of active duty personnel reported prescription drug misuse in 2002. That rate increased to 11% in 2008.

Meanwhile, military physicians wrote nearly 3.8 million prescriptions for pain medications in 2009, almost four times as many as they prescribed in 2001, according to the IOM report.

Training of military health care professionals is among the recommendations in the report. During a press briefing announcing release of the report, Dr. O’Brien said providing training on how to recognize and deal with addiction should extend to medical schools.

The report also recommends that TRICARE, which provides health insurance to service members and their families, needs to update its substance use disorder (SUD) guidelines. The program, the IOM noted, does not include several evidence-based therapies that are currently considered standard practice, and it does not allow for long-term use of certain medications used for treatment of addiction.

"If the DoD fails to make these needed changes to the TRICARE SUD benefits in a timely manner, the committee recommends that Congress consider taking action to mandate such DoD policy changes," the authors wrote.

The report also identifies several barriers to access, including gaps in insurance coverage, stigma, lack of confidentiality, and fear of negative consequences.

The study not only recommends that branches provide optional confidential treatment, but also offer routine screening for unhealthy alcohol use; and reduce reliance on residential and inpatient care; and add capacity for outpatient care, using a chronic care model.

"Recommendations are clear and they’re doable. There’s nothing that’s impossible," said Dr. O’Brien, director of the Center for Studies of Addiction at the University of Pennsylvania, Philadelphia. "If they would follow these recommendations, we would see a big improvement."

WASHINGTON – The Department of Defense needs to update its guidelines and practices in order to address the rising rates of alcohol and drug misuse and abuse among the active duty personnel, according to a report released Sept. 17 by the Institute of Medicine.

The 350-page report, mandated by Congress, recommends that the military increase its preventive efforts, adopt evidence-based programs, increase access to care, and increase its health care workforce, while providing them with appropriate training.

bowdenimages/istockphoto.com

"I can’t say I was surprised at anything," Dr. Charles P. O’Brien, chair of the committee that wrote the report, said in an interview. "Maybe what was surprising was that some of the guidelines haven’t been changed in 20 years, and I think they need to be updated right away."

In a statement, the Department of Defense (DoD) said, it appreciates the Institute’s work in assessing substance abuse programs and policies in the military health system. "We are in the process of analyzing [the] findings and recommendations, but most importantly, we want to do the right thing for the service member.

"If there are areas in need of improvement, then we will work to improve those areas. The health and well-being of our service members is paramount."

Roughly 20% of active duty personnel reported engaging in heavy drinking in 2008, compared with 15% in 1998. Binge drinking rates increased from 35% in 1998 to 47% in 2008, according to the IOM study. Meanwhile, of prescription drug use rates increased among the military personnel over the past decade, the study points out, mirroring the increase in the civilian population. Only 2% of active duty personnel reported prescription drug misuse in 2002. That rate increased to 11% in 2008.

Meanwhile, military physicians wrote nearly 3.8 million prescriptions for pain medications in 2009, almost four times as many as they prescribed in 2001, according to the IOM report.

Training of military health care professionals is among the recommendations in the report. During a press briefing announcing release of the report, Dr. O’Brien said providing training on how to recognize and deal with addiction should extend to medical schools.

The report also recommends that TRICARE, which provides health insurance to service members and their families, needs to update its substance use disorder (SUD) guidelines. The program, the IOM noted, does not include several evidence-based therapies that are currently considered standard practice, and it does not allow for long-term use of certain medications used for treatment of addiction.

"If the DoD fails to make these needed changes to the TRICARE SUD benefits in a timely manner, the committee recommends that Congress consider taking action to mandate such DoD policy changes," the authors wrote.

The report also identifies several barriers to access, including gaps in insurance coverage, stigma, lack of confidentiality, and fear of negative consequences.

The study not only recommends that branches provide optional confidential treatment, but also offer routine screening for unhealthy alcohol use; and reduce reliance on residential and inpatient care; and add capacity for outpatient care, using a chronic care model.

"Recommendations are clear and they’re doable. There’s nothing that’s impossible," said Dr. O’Brien, director of the Center for Studies of Addiction at the University of Pennsylvania, Philadelphia. "If they would follow these recommendations, we would see a big improvement."

WASHINGTON – The Department of Defense needs to update its guidelines and practices in order to address the rising rates of alcohol and drug misuse and abuse among the active duty personnel, according to a report released Sept. 17 by the Institute of Medicine.

The 350-page report, mandated by Congress, recommends that the military increase its preventive efforts, adopt evidence-based programs, increase access to care, and increase its health care workforce, while providing them with appropriate training.

bowdenimages/istockphoto.com

"I can’t say I was surprised at anything," Dr. Charles P. O’Brien, chair of the committee that wrote the report, said in an interview. "Maybe what was surprising was that some of the guidelines haven’t been changed in 20 years, and I think they need to be updated right away."

In a statement, the Department of Defense (DoD) said, it appreciates the Institute’s work in assessing substance abuse programs and policies in the military health system. "We are in the process of analyzing [the] findings and recommendations, but most importantly, we want to do the right thing for the service member.

"If there are areas in need of improvement, then we will work to improve those areas. The health and well-being of our service members is paramount."

Roughly 20% of active duty personnel reported engaging in heavy drinking in 2008, compared with 15% in 1998. Binge drinking rates increased from 35% in 1998 to 47% in 2008, according to the IOM study. Meanwhile, of prescription drug use rates increased among the military personnel over the past decade, the study points out, mirroring the increase in the civilian population. Only 2% of active duty personnel reported prescription drug misuse in 2002. That rate increased to 11% in 2008.

Meanwhile, military physicians wrote nearly 3.8 million prescriptions for pain medications in 2009, almost four times as many as they prescribed in 2001, according to the IOM report.

Training of military health care professionals is among the recommendations in the report. During a press briefing announcing release of the report, Dr. O’Brien said providing training on how to recognize and deal with addiction should extend to medical schools.

The report also recommends that TRICARE, which provides health insurance to service members and their families, needs to update its substance use disorder (SUD) guidelines. The program, the IOM noted, does not include several evidence-based therapies that are currently considered standard practice, and it does not allow for long-term use of certain medications used for treatment of addiction.

"If the DoD fails to make these needed changes to the TRICARE SUD benefits in a timely manner, the committee recommends that Congress consider taking action to mandate such DoD policy changes," the authors wrote.

The report also identifies several barriers to access, including gaps in insurance coverage, stigma, lack of confidentiality, and fear of negative consequences.

The study not only recommends that branches provide optional confidential treatment, but also offer routine screening for unhealthy alcohol use; and reduce reliance on residential and inpatient care; and add capacity for outpatient care, using a chronic care model.

"Recommendations are clear and they’re doable. There’s nothing that’s impossible," said Dr. O’Brien, director of the Center for Studies of Addiction at the University of Pennsylvania, Philadelphia. "If they would follow these recommendations, we would see a big improvement."