Alan Ogle, Maj, USAF, BSC Military Psychology PSY4990 University of West Florida, Spring 09

1. 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

2. 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.

3. Behavioral Health Services • 3

4. Behavioral Health Services Alcohol and Drug Abuse Prevention and Treatment (ADAPT) Family Advocacy Program

5. 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

6. DoD/Air Force Heavy Alcohol Use* Trend • 2002 DoD Survey of Health Related Behaviors Among Military Personnel • Significant increase from 1998 • * > 5 drinks on the same occasion at least once a week in the past 30 days

7. Unadjusted 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.

8. 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

9. 90th Space Wing’s • Developing a Responsible • Drinking Culture Campaign

10. 90th SPACE WING 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

11. NO RISK 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?

12. 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

13. Alcohol Prevention 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

14. 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

15. 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

16. 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

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

18. 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

19. 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%

20. 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

21. 90th SPACE WING 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

22. 90th SPACE WING 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

23. Public Awareness Campaign

24. “Beer Man” Campaign

25. “There’s More To Life” Campaign

26. “It’s About Drinking Responsibly” Campaign

27. “It’s About Drinking Responsibly” Campaign

28. 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

29. 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

30. 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%  93%  64%

31. 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/

32. Domestic Abuse Prevention, Response and Intervention

33. 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)

34. 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

35. FAP Services

36. 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…

37. 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

38. 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.

39. 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.

40. 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)

41. 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.

42. 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

43. 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

44. CONCLUSION