Military Behavioral Health Care: Alcohol and Drug Abuse Prevention

and TreatmentFamily Advocacy Program

Alan Ogle, Maj, USAF, BSC

Military Psychology PSY4990

University of West Florida, Spring 09

Disclaimer: information in this briefing was compiled from multiple sources in the US military medical services. Many have been modified or shortened to fit the educational purpose, format and training time available. Views expressed are those of the author and do not reflect the official policy or position of the United States Air Force, Department of Defense, or the U.S. Government.

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Behavioral Health Services

Mental Health Clinic

ADAPT Family Advocacy Program

BHOP SNIAC DDR

Psychotherapy: individual, marital, family, group

Consultation in med clinic

Family relocation clearances

Drug testing program

Suicide Prevention Program

Command consultant on substance issues

Family Advocacy Committee, CRB, HRVRT, CSMRT

Outreach/Prevention/Educational briefings – e.g. stress management, suicide prevention, alcohol use vs misuse, family violence prevention, parenting skills, drug education/prevention

Integrated Delivery Services Team (IDS) – i.e. collaboration of all base helping agencies

Consultant to Community Action Information Board (CAIB)

Installation Traumatic Stress Response Team leadership (TSRT)

Behavioral Health Services

Alcohol and Drug Abuse Prevention and Treatment (ADAPT)

Family Advocacy Program

ALCOHOL AND DRUG ABUSE PREVENTION AND TREATMENT

(ADAPT Program )

Promote readiness, health and wellness through prevention and treatment of substance abuse

Minimize negative consequences of substance abuse to individual, family, and organization

Provide education and treatment for individuals with substance abuse problems

Return patients to unrestricted duty status or assist them in transition to civilian life

5.0

10.0

15.0

20.0

25.0

30.0

Rat

e (%

)

DoD 20.8 24.1 23.0 17.2 15.5 17.4 15.4 18.1

AF 14.3 17.7 16.5 14.5 10.6 10.4 11.7 12.3

1980 1982 1985 1988 1992 1995 1998 2002

DoD/Air Force Heavy Alcohol Use* Trend2002 DoD Survey of Health Related Behaviors Among Military Personnel

* > 5 drinks on the same occasion at least once a week in the past 30 days

Significant increase from 1998

Unadjusted Binge Drinking Rates by Service, 2002 – 2005

DoD Survey of Health Related Behaviors

*Significant difference between 2002 and 2005 at .05 level. Civilian estimate for 1-4 years past High School reported from Monitoring the Future, past 2 weeks, 2004.

Binge Drinking = 5 or more drinks on a single occasion at least once in the past 30 days

Substance Misuse:A Clear and Present Danger

AF average of ~ 5300 Alcohol Related Incidents/Year (e.g. DUI/DWI & underage drinking)

Alcohol misuse is involved in: 33% of suicides 57% sexual assaults 28.5% domestic violence cases 20-25% PMV accidents

“Alcoholism” should not be the sole focus!

Substance misuse directly impacts mission effectiveness… PREVENTION + DETECTION + TREATMENT = SUCCESS

90th Space Wing’sDeveloping a Responsible Drinking Culture Campaign

90th SPACE WING90th SPACE WINGResponsible Drinking Culture CampaignResponsible Drinking Culture Campaign

90 SW MISSION90 SW MISSION

America’s ICBM Team Deterring Violence America’s ICBM Team Deterring Violence Across the Spectrum of Conflict With Across the Spectrum of Conflict With Professional People and Safe, Secure, Professional People and Safe, Secure,

Ready MissilesReady Missiles

No RiskNo Risk Low Risk DrinkingLow Risk Drinking

Problem Drinking/ARIsProblem Drinking/ARIs Illegal/UnderageIllegal/Underage Binge DrinkingBinge Drinking

Alcohol AbuseAlcohol Abuse Alcohol DependenceAlcohol Dependence

LOW RISK

MODERATE

RISK

HIGH RISK

&

ILLNESS

NO RISK

90th SPACE WING90th SPACE WINGResponsible Drinking Culture CampaignResponsible Drinking Culture Campaign

R & D: Levels of Drinking BehaviorR & D: Levels of Drinking Behavior

Where is FE Warren on this scale?

Where is FE Warren on this scale?

Wing Goal: Create a responsible alcohol culture that promotes healthy, low-risk

drinking behavior

• 50% reduction in DUIs

• Reduce high-risk drinking and associated problem behaviors

• Increase awareness and prevalence of low-risk vs. high-risk drinking

INDIVIDUAL LEVELINDIVIDUAL LEVEL

• Pre-Screening

• Treatment

• Education

• Discipline

BASE BASE LEVELLEVEL

• Awareness

• Education

• Prevention

• Intervention

• Alternatives

COMMUNITYCOMMUNITYLEVELLEVEL

• Collaboration

• Responsible Alcohol Service

• Disciplinary Control Board

Alcohol Prevention

LEADERSHIPCULTURE

OF RESPONSIBILITY

Individual Level

IDENTIFY high risk individuals (~30-40%, NIAAA, 2002) Screening for those w/ alcohol misuse or substance disorder Self-referral Mandatory evaluation for all Alcohol Related Misconduct

EDUCATION/BRIEF INTERVENTION

TREATMENT

DISCIPLINE w/ swift, public response to criminal behavior may include summary courts or public NJP

ADAPT SERVICES: EVALUATION AND

EDUCATION All Referrals Receive:

Initial diagnostic evaluations 6-hour Substance Abuse Awareness Seminar Alcohol Brief Counseling, pilot testing at 15 bases

Education Topics- Military and civilian standards -Hazards of binge drinking- Individual responsibilities -Family Dynamics of substance abuse- Legal/administrative consequences -DUI/DWI education - Facts and statistics about alcohol -Drug abuse education- Physical and psychological effects -Values clarification- Impact on self, others, and community -Healthy stress management- Biopsychosocial Model of addiction -Decision-making, goal setting skills

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Components of ABC

SUAT Intake

ABC Component 1 (C1): Brief consultation and feedback session

Includes completion of: Alcohol Education Module Change Plan Additional education modules

ABC Component 2 (C2): Follow-up(s) (1-2 based on risk level)

ABC Component 3 (C3): Final follow-up/case close Can be done in conjunction with one of the follow-up visits in C2

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Component 2 (C2): Follow-up

Minimum of One follow-up Low to Moderate Intensity of Intervention

All of the following: AUDIT score 14 and below No history of prior Alcohol Related Misconducts (ARM) Quantity of intake for ARM was 3 standard drinks or less for women

and 4 or less for men Minimum of Two follow-ups

Higher Intensity of Intervention Any one or more of the following: AUDIT score above 14 A history of ARM-eligible behavior (e.g. drinking and driving) Quantity of intake for ARI was 4 or more for women and 5 or more for

men.

The focus of these appointments is NOT treatmentThey are designed to be targeted (secondary) prevention, education and

reassessment

Substance Use Disorders:

305.00 Alcohol Abuse (31% college students) Recurrent, significant adverse consequences related to

repeated alcohol use Not addicted to alcohol

303.90 Alcohol Dependence (15% general population, lifetime rate) Clinically significant impairment Continued use despite serious negative consequence Tolerance With or Without Physiological Dependence

ADAPT Services: Treatment

Patients with substance use disorder receive treatment

Alcohol Abuse / Alcohol Dependence Treatment options: Outpatient, Intensive Outpatient,

Partial or Full Hospitalization Programs as clinically indicated

Family and unit involvement Duration ~4 - 24 months Successful completion of treatment is condition for

continued employment “Treatment failure” AF rate = ~2%

Base Level: Stating a Norm

Why 0-0-1-3 “0-0”: Just restates the law “1”: Liver can only process

1 drink / hour “3”: Targets binge drinking

Binging is most dangerous form of abuse 10X increase in negative consequences Most research starts binging threshold at 4 drinks

Slogan easily remembered Affects behavior at overt, subconscious and peer levels

KEEP BAC < .05

90th SPACE WING90th SPACE WINGResponsible Drinking Culture CampaignResponsible Drinking Culture Campaign

Base Level: “Why the 1 and the 3?” 0.03% 1 drink/hr: relaxed, feeling of exhilaration 0.06% 1-2 drinks/hr: feeling of warmth &

relaxation, decrease of fine motor skills 0.09% 2-3 drinks/hr: slow reaction time, poor

muscle control, slurred speech, wobbly 0.12% 2-4 drinks/hr: clouded judgment,

lessened inhibitions & self-restraint,

impaired reasoning, well over legal limitBACBAC

90th SPACE WING90th SPACE WINGResponsible Drinking Culture CampaignResponsible Drinking Culture Campaign

Base Level: “Why the 1 and the 3?” 0.15% 3-5 drinks/hr: blurred vision, speech

unclear, unsteady walking, impaired

coordination, possible blackout 0.18% 5-8 drinks/hr: behavior is totally

impaired, trouble staying awake, numb 0.30% 8-13 drinks/hr: stupor or deep sleep 0.40% 11-15 drinks/hr: coma, probable death 0.50% 14-18 drinks/hr: death

BACBAC

Public Awareness Campaign

“Beer Man” Campaign

“There’s More To Life” Campaign

“It’s About Drinking Responsibly” Campaign

“It’s About Drinking Responsibly” Campaign

Base Level

Anonymous Arrive Alive Taxi (#1 Need) Alternative activities

This generation does not RSVP, waits until 2130 or later to go out, doesn’t like what CCs like

Dorm Escape (Chapel run) Make a Difference (MAD) Crew

Private chartered organization Events for airmen, by airmen

Recreation activities after 2100

– Hip-Hop Hoops / Aquatics

– 24 / 7 B-ball– Club dances– Late Friday / Saturday

movies– Outdoor paintball– Outdoor Recreation

Programmer

Community Level

Partner with off-base agencies and coalitions Wyoming Governor’s Council on Impaired Driving Enforcing Underage Drinking Laws (EUDL) Council

Base Commander’s letter to area alcohol retailers

• Cheyenne, Laramie, Ft Collins and Greeley Armed Forces Disciplinary Control Board

Notified 4 establishments of unlawful actions jeopardizing safety of base personnel

Responses corrected management deficiencies

Police Ride-Alongs “Shoulder-tap” Stings

0-0-1-3 Results 2004 to 2005

•Savings in:•Lives / Accidents / Violence /Injuries•Crimes•70% reduction in Article-15•Ready for Duty rates = 38 additional Airmen•Commander/Enlisted Leaders time on discipline/manning/problems

•Improved:•Community focus•Chapel attendance•Services

68%68%

64%64%

93%93%

Additional

“0-0-1-3” Featured nationally--USA Today, CNN, conferences

AF Culture of Responsible Choices (CoRC) http://www.afcrossroads.com/websites/corc.cfm

2006 EUDL $3.6M grants to other bases and surrounding communities, e.g. http://www.usa0013.com/ Additional funding available http://ojjdp.ncjrs.org/

Other Programs: “That Guy” http://www.thatguy.com/

Domestic Abuse Domestic Abuse Prevention, ResponsePrevention, Response

and Interventionand Intervention

DoD and Air Force Policy

Deputy Secretary of Defense Memorandum, Domestic Violence, November 19, 2001

SECAF/CSAF Memorandum, Victim Support, April 1, 2004

DoD Directive 1315.7 (Personnel Assignments) DoD Instruction 1342.24 (Transitional Compensation) DoDD 6400.1 (Department of Defense FAP Directive) DoDD 1030.1 (Victim Witness Assistance Program) AFI 40-301 (Air Force Family Advocacy Program

Instruction) AFI 51- 201 (Administration of Military Justice)

Family Advocacy Program

OPR for the prevention and treatment of domestic violence Works to reduce the number and severity of family maltreatment

incidents Prevent where possible…treat where needed Promotes alliance between leadership, agencies and

community to: Facilitate an atmosphere of nonviolence in work and home Encourage member and family asset and skill development Foster personal, family and community capacity, resilience and

sustainability Enhance victim safety by providing information on victim resources Build member and family strengths that support mission readiness

Services provided through Outreach Prevention Program; New Parent Support Program; Treatment Intervention

FAP Services

Important Key Points: Intervention

Domestic violence is a crime Domestic abuse violates the privacy, dignity and safety

of the victim and children Response to domestic abuse incidents must be timely,

thorough and appropriate; safety is the first priority There is zero tolerance of family abuse Active duty offenders impede mission readiness and

violate the spirit and intent of Air Force core values Commanders are responsible for the safety and welfare

of active duty and their family members Commanders can contribute to prevention of family

violence…

FAP Intervention

Education—leaders, medical staff, schools, law enforcement, child care providers

Mandated referral for suspected maltreatment Evaluation & Intervention

Protection Orders HRVRT / CSMRT

Coordination with JA, OSI, law enforcement, and other agencies

Treatment and follow up

Dynamics of Domestic Abuse

Domestic Abuse Domestic violence or a pattern of behavior resulting in

emotional/psychological abuse, economic control, and/or interference with personal liberty that is directed toward a person of the opposite sex who is: (a) A current or former spouse; (b) A person with whom the abuser shares a child in common; or (c) A current or former intimate partner with whom the abuser shares or has shared a common domicile.

Domestic Violence

An offense under the United States Code, the Uniform Code of Military Justice, or State law that involves the use, attempted use, or threatened use of force or violence against a person of the opposite sex, or a violation of a lawful order issues for the protection of a person of the opposite sex who is (a) A current or former spouse; (b) A person with whom the abuser shares a child in common; or (c) A current or former intimate partner with whom the abuser shares or has shared a common domicile.

Dynamics of Domestic Abuse: Types of Domestic Abuse and Range of Incidents

Partner Physical Abuse Includes but not limited to scratching, pushing, shoving, throwing,

grabbing, biting ,choking, shaking, slapping, hitting, restraining, use of weapons/objects, burning, punching, poking, and hair pulling

Partner Sexual Abuse The use of physical force to compel the spouse to engage in a sex act

against his/her will, whether or not the act is completed; the use of a physically or emotionally aggressive act to coerce a sex act (attempted or completed)

Note: Though many of the following concepts are not legal definitions, they do generally describe conduct constituting actionable behavior.

Dynamics of Domestic Abuse: Types of Domestic Abuse and Range of Incidents

Partner Neglect Deprivation, more than inconsequential physical injury, or

reasonable potential for more than inconsequential injury resulting from capable spouse’s acts or omissions toward a spouse who is incapable of self care due to substantial limitations in

(a) physical (including, but not limited to quadriplegia)

(b) psychological/Intellectual (including but not limited to vegetative depression, very low IQ, psychosis)

(c) Cultural (including, but not limited to inability to communicate, inability to manage activities of rudimentary daily living due to foreign culture)

Dynamics of Domestic Abuse: Types of Domestic Abuse and Range of Incidents

Partner Emotional Abuse Berating, disparaging, degrading, humiliating, interrogating,

restricting ability to come and go freely, obstructing access to assistance, threatening, harming pets, people or property, stalking, making victim think he/she is crazy, isolating victim, facilitating victim’s more than inconsequential fear, psychological distress and stress related somatic symptoms that significantly interfere with normal functioning.

Ensuring Victim Safety

Civilian and Military Protective Orders and instruction on issuance

Immigration provisions of the Violence Against Women Act (VAWA)

Lautenberg Amendment to the Gun Control Act of 1968

Armed Forces Domestic Security Act Considerations in Victim Safety

Resource Links

Air Force Leaders Guide to Managing Personnel in Distress Navy Leaders Guide to Managing Personnel in Distress Marine Leaders Guide to Managing Personnel in Distress Deployment Health Center Substance Abuse page Military Onesource Military Homefront Air Force Culture of Responsible Choices 0-0-1-3 implementation at Malmstrom AFB/Great Falls, MT http://www.thatguy.com/ Development of 0-0-1-3 video DoD Family Advocacy Program

CONCLUSION