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Military Behavioral Health Care: Alcohol and Drug Abuse Prevention and Treatment Family Advocacy Program. Alan Ogle, Maj, USAF, BSC Military Psychology PSY4990 University of West Florida, Spring 09.

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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.


Behavioral health services
Behavioral Health Services 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.

  • 3


Behavioral health services1
Behavioral Health Services 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.

Alcohol and Drug Abuse Prevention and Treatment (ADAPT)

Family Advocacy Program


Alcohol and drug abuse prevention and treatment adapt 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


  • Significant increase from 1998

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


Unadjusted binge drinking rates by service 2002 2005 dod survey of health related behaviors
Unadjusted Program )Binge DrinkingRates by Service, 2002 – 2005DoD Survey of Health Related Behaviors

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

  • *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.


Substance misuse a clear and present danger
Substance Misuse: Program )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 Program )

Responsible Drinking Culture Campaign

90 SW MISSION

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


NO RISK Program )

LOWRISK

MODERATE

RISK

HIGH RISK

&

ILLNESS

90th SPACE WING

Responsible Drinking Culture Campaign

R & D: Levels of Drinking Behavior

  • No Risk

  • Low Risk Drinking

  • Problem Drinking/ARIs

    • Illegal/Underage

    • Binge Drinking

  • Alcohol Abuse

  • Alcohol Dependence

Where is FE Warren on this scale?


Wing goal create a responsible alcohol culture that promotes healthy low risk drinking behavior
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


Alcohol prevention
Alcohol Prevention promotes healthy, low-risk drinking behavior

BASE

LEVEL

COMMUNITY

LEVEL

  • Awareness

  • Education

  • Prevention

  • Intervention

  • Alternatives

  • Collaboration

  • Responsible Alcohol Service

  • Disciplinary Control Board

INDIVIDUAL LEVEL

  • Education

  • Discipline

  • Pre-Screening

  • Treatment

LEADERSHIP

  • CULTURE

  • OF

  • RESPONSIBILITY


Individual level
Individual Level promotes healthy, low-risk drinking behavior

  • 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
    ADAPT SERVICES: promotes healthy, low-risk drinking behaviorEVALUATION 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


    Components of abc
    Components of ABC promotes healthy, low-risk drinking behavior

    • 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


    Component 2 c2 follow up
    Component 2 (C2): Follow-up promotes healthy, low-risk drinking behavior

    • 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 treatment

          They are designed to be targeted (secondary) prevention, education and reassessment


    Substance use disorders
    Substance Use Disorders: promotes healthy, low-risk drinking behavior

    • 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
    ADAPT Services: Treatment promotes healthy, low-risk drinking behavior

    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
    Base Level: Stating a Norm promotes healthy, low-risk drinking behavior

    • 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 WING promotes healthy, low-risk drinking behavior

    Responsible 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 limit

    BAC


    90th SPACE WING promotes healthy, low-risk drinking behavior

    Responsible 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

    BAC


    Public awareness campaign
    Public Awareness Campaign promotes healthy, low-risk drinking behavior


    Beer man campaign
    “Beer Man” Campaign promotes healthy, low-risk drinking behavior


    There s more to life campaign
    “There’s More To Life” Campaign promotes healthy, low-risk drinking behavior


    It s about drinking responsibly campaign
    “It’s About Drinking Responsibly” Campaign promotes healthy, low-risk drinking behavior


    It s about drinking responsibly campaign1
    “It’s About Drinking Responsibly” Campaign promotes healthy, low-risk drinking behavior


    Base level
    Base Level promotes healthy, low-risk drinking behavior

    • 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
    Community Level promotes healthy, low-risk drinking behavior

    • 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
    0-0-1-3 Results 2004 to 2005 promotes healthy, low-risk drinking behavior

    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%

     93%

     64%


    Additional
    Additional promotes healthy, low-risk drinking behavior

    • “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 Prevention, Response promotes healthy, low-risk drinking behavior

    and Intervention


    Dod and air force policy
    DoD and Air Force Policy promotes healthy, low-risk drinking behavior

    • 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
    Family Advocacy Program promotes healthy, low-risk drinking behavior

    • 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
    FAP Services promotes healthy, low-risk drinking behavior


    Important key points intervention
    Important Key Points: Intervention promotes healthy, low-risk drinking behavior

    • 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
    FAP Intervention promotes healthy, low-risk drinking behavior

    • 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
    Dynamics of Domestic Abuse promotes healthy, low-risk drinking behavior

    • 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
    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 incidents1
    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 incidents2
    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
    Ensuring Victim Safety Range of Incidents

    • 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
    Resource Links Range of Incidents

    • 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
    CONCLUSION Range of Incidents


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