Magazine article Clinical Psychiatry News

IoM to DoD: Update Substance Use Guidelines and Practices

Magazine article Clinical Psychiatry News

IoM to DoD: Update Substance Use Guidelines and Practices

Article excerpt


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 by the Institute of Medicine.

The IoM called the alcohol and drug use rates in the armed forces unacceptably high, constituting "a public health crisis," and said "both are detrimental to force readiness and psychological fitness."

The 350-page report, mandated by Congress, recommended that the military increase its preventive efforts, such as limiting access to certain medications and alcohol; adopt evidence-based programs; increase access to care; and increase its health care workforce, while providing them with appropriate training. "I can't say I was surprised at any of the findings," 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 appreciated 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, prescription drug use rates have 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. 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.

To curb the rising rates, the authors recommended some structural changes, such as requiring medication prescribers to routinely check local prescription drug monitoring programs and look for medication seeking behavior.

"Routine screening for unhealthy alcohol use and mechanisms to support brief interventions would permit health care professionals to point out the risk of excessive alcohol consumption. …

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