Counseling Services and Resources
Counseling services are available through each service:
- Army Substance Abuse Program
- Marine Corps Substance Abuse Program
- Navy Alcohol and Drug Abuse Prevention
- Air Force Alcohol and Drug Abuse Prevention and Treatment (ADAPT) Program
Overall Treatment Considerations
Department of Defense (DoD) Instruction 1010.04 Problematic Substance Use by DoD Personnel outlines procedures for problematic alcohol and drug use prevention, identification, diagnosis, and treatment for DoD military and civilian personnel. Providers within the Military Health System (MHS) should consult DoD Instruction 1010.04, other relevant-DoD policies and individual service level policies for overall guidance and procedural requirements. Further, providers should consult the evidence-based treatment recommendations in the Department of Veterans Affairs (VA)/DoD Clinical Practice Guideline for the Management of Substance Use Disorders (VA/DoD SUD CPG) along with individual patient needs and characteristics, to include patient preferences and provider competencies, when making treatment decisions.
Per VA/DoD SUD CPG, providers should offer referral for specialty substance use disorder (SUD) care for patients if they are diagnosed with a SUD that may benefit from additional evaluation of their substance use and related problems, or are willing to engage in specialty care. There are many factors that help to determine the appropriate level of care for SUD treatment, such as patient preference, patient motivation, patient willingness and available resources. There is no clear evidence to support using a standardized assessment to determine initial intensity and setting of SUD care rather than the clinical judgment of trained providers.
For patients with SUD in early recovery or following relapse, providers should promote active involvement in group mutual help programs using a systematic approach such as peer linkage, network support or 12-step facilitation. Patients in intensive outpatient or residential treatment should be offered ongoing systematic relapse prevention efforts or recovery support individualized on the basis of treatment response. Patients who do not respond to treatment or relapse should not be automatically discharged from treatment.
Treatment for Cannabis Use Disorder
For patients with cannabis use disorder, there are several psychosocial interventions recommended per the VA/DoD SUD CPG, including cognitive behavioral therapy, motivational enhancement therapy and combined cognitive behavioral therapy/motivational enhancement therapy. There is no clear evidence to support the use of pharmacotherapy in the treatment of cannabis use disorder.
Treatment for Stimulant Use Disorder
There is no clear evidence to support the use of specific pharmacotherapy for the treatment of patients with cocaine use disorder or methamphetamine use disorder. However, there are several psychosocial interventions recommended, to include cognitive behavioral therapy, recovery-focused behavioral therapy comprising general drug counseling and a community reinforcement approach (a comprehensive intervention that combines cognitive behavioral therapy, couples counseling and other recovery focused components), or contingency management in combination with one of the noted psychosocial interventions.[ Reference 1 ]