Treatment for alcohol use disorders
Soundoff! - 8/8/2019
Aug. 7--Some service members may be tempted to have several drinks over the weekend, particularly in the summer when relaxing at a backyard barbecue or vacationing with family.
But binge drinking after work to help ease duty stress could be a sign of alcohol abuse.
The Substance Use Disorder Clinical Care facility at Kimbrough Ambulatory Care Center provides treatment for service members experiencing alcohol and substance use disorders.
SUDCC is a specialty area within the Multi-Disciplinary Behavorial Health Clinic at Kimbrough.
The Army's health assessment surveys from 2015 reveal that more than 90,000 Soldiers per year report potentially problematic alcohol use. However, only about 11,000 Soldiers were enrolled in formal substance abuse treatment in 2016.
Therese Boucher, clinical director of SUDCC, said there no longer is a formal diagnosis for alcoholism.
The Diagnostic and Statistical Manual 5 of Mental Disorders, published by the American Psychiatric Association, is used by mental health professionals to diagnose and treat psychiatric disorders.
In the DSM5, alcohol use disorders are now categorized as either alcohol abuse or alcohol dependence, and are diagnosed using a scale of mild to moderate and severe.
"Alcoholism is a chronic, progressive illness," Boucher said. "When we talked about it as abuse and dependence, people that were treated for abuse did not feel they had that chronic condition. They were not realistic about treatment options."
About 40 to 50 Soldiers assigned to Fort Meade are now undergoing treatment for alcohol use disorders. Service members enter treatment by referring themselves as a walk-in or by a referral from their unit commander.
Commanders usually refer service members when results on a mandatory drug test are positive or when they have been involved in an incident related to alcohol abuse, such as an arrest for DUI.
At SUDCC, service members are evaluated by mental health professionals to determine the extent of the alcohol use and whether it meets the criteria for a medical diagnosis from the DSM5. The evaluation also determines what kind of treatment is best.
After the evaluation is completed, a rehabilitation team meeting is held for the service member, the mental health counselor and the commander. Results of the evaluation are discussed, and the counselor makes recommendations for a treatment plan.
If the alcohol use does not meet the requirements for a medical diagnosis, the service member is enrolled in a two-day Alcohol and Drug Abuse Prevention Treatment workshop led by Samson Robinson, prevention coordinator at Fort Meade's Army Substance Abuse Program.
The Army instituted new guidelines in March for voluntary referrals for substance use disorders.
The directive allows Soldiers who meet specific criteria to voluntarily self-refer for alcohol-related, behavioral health treatment and health care without having to notify their commander. Or, they could be enrolled as a mandatory requirement into substance use disorder treatment, which could result in negative consequences for their active-duty service.
"This is a very dramatic change in health care," Boucher said.
However, if certain conditions are met, such as an investigation by military or civilian police, or if the Soldier's substance use affects his or her judgment or poses a clear risk to security, occupational functioning or mission readiness, then a Soldier who voluntarily self-refers will be enrolled in mandatory treatment.
When a referral comes from the command, there is a loss of confidentiality for the service member. The command is notified of every step of the treatment process, said Boucher.
There are also duty-restrictions. Service members, regardless of the severity of their condition, are non-deployable for six months after treatment ends.
"We wanted Soldiers to have the opportunity to self-refer and not have those duty restrictions," Boucher said.
Depending on the diagnosis and its severity, service members can be referred to outpatient group counseling for three to six months for a mild alcohol use disorder; six to nine months for moderate; and a residential treatment center for six to nine months for a severe alcohol use disorder.
Boucher said treatment entails lifestyle changes, psychotherapy and, in some cases, medication.
In a command referral for treatment, treatment takes at least 30 to 90 days to ensure that the service member has abstained from alcohol use before undergoing a permanent change-of-duty station.
When there is a diagnosis of mild alcohol use -- the early stages of alcoholism -- this is the best time to make lifestyle changes and avoid the chronic progression that occurs in other medical conditions such as diabetes, Boucher said.
"In the very early stages, if you make lifestyle changes, those symptoms can go into remission," Boucher explained. "If you continue those dangerous lifestyle choices, then it is likely that your condition will progress."
Boucher said there is a biological disposition for alcoholism, like many other medical conditions, and that there are lifestyle factors that must be present for it to actualize.
For example, she said, a person can have the biological factors for alcoholism and grow up in a religiously conservative family and never develop alcoholism or its unhealthy behaviors. Other people, however, who may have the biological factors and, because of their pattern of using alcohol, may develop alcoholism in its earlier stages.
Boucher said the symptoms of alcoholism are not like other medical conditions -- they are not physiological. In the early stages, a service member may experience the emotional and behavioral aspects of the condition, such as depression and low self-esteem, and problems in their workplace, relationships and finances.
Hallmark of Alcoholism
In the later stages of alcoholism, the drinker may experience hypertension, gout and liver disease.
Boucher said the hallmark of alcoholism is its unpredictability and the chaos that can erupt in one's life.
These symptoms should lead service members who are struggling with alcohol use to enter behavioral health treatment. However, said Boucher, they may be hesitant for fear of losing their security clearance.
But Boucher said entering treatment is the most appropriate step when alcohol use becomes symptomatic.
For service members who engage in high-risk behaviors that may have legal implications and are not in treatment, there is a possibility of losing their security clearance, she said.
But service members who enter treatment and are compliant with their treatment conditions and refrain from drinking are not likely to lose their clearance, although they must report their treatment to the security clearance board.
People who seek help may also be concerned about the possibility of relapse. Boucher said relapse can and does occur over the course of a lifetime.
"We don't look at substance use as a one-time occurrence that when you're finished [treatment], you're done," she said. "We look at it as a process. People may relapse over a lifetime.
"We try to anticipate that as part of the treatment plan so people don't hit bottom when they relapse. They can go back into recovery more quickly."
Boucher said although alcohol abuse is taken seriously in the military, recovery can be difficult for service members.
"One of the most challenging aspects of recovery in the military is the mixed messages that we receive," she said.
Recovery is also challenging in the civilian community, said Boucher, because drinking is so glamourized.
"[But in the military], there's so much binge drinking and it's so accepted by everyone," she said. "So when there's an incident, the administrative consequences are becoming more serious."
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