By Stephen Spotswood
WASHINGTON — If Navy leadership has anything to do with it, the misleading stereotype of the drunken sailor or hard-drinking Marine will fade into the past.
Though Navy officials note that their alcohol-abuse problems are no greater than the general population and might be less, the Marines began twice-yearly mandatory breathalyzers for personnel on Jan. 1, with the Navy set to begin regular alcohol screening shortly thereafter.
The move is intended as a way of preventing alcohol-related problems, medical and otherwise, before they happen.
Stronger emphasis on identifying Marines and sailors who might be at risk of problems involving alcohol in the future is part of the 21st Century Sailor and Marine initiative announced last spring. The initiative emphasizes responsible use of alcohol and a zero-tolerance drug policy.
The mandatory breathalyzers also come on the heels of an Institute of Medicine (IoM) report released in September that showed alcohol consumption in the military rising substantially during the past decade.
In 1998, 15% of active duty servicemembers reported heavy drinking. That rose to 20% in 2008. In 1998, 35% reported binge drinking — a number that rose to 47% in 2008. An Alcohol Use Disorders Identification Test (AUDIT) conducted using alcohol-use data from 2008 showed 24.6% of active duty servicemembers had scores in the hazardous category, 4.2% had scores in the harmful category, and 4.5% had scores high enough to suggest possible alcohol dependence.
The IoM report noted, “Routine screening for unhealthy alcohol use and mechanisms to support brief interventions would permit healthcare professionals to point out the risk of excessive alcohol consumptions.”
This is exactly how the Navy envisions its early-intervention screening — education of servicemembers and a prevention of future problems, explained Charles Gould, program manager of the Navy’s Substance Abuse and Rehabilitation Program (SARP). “The Navy’s emphasis is to keep people out of trouble before they have an incident.”
The Navy currently screens about 10,000 sailors annually. That number could increase substantially when the mandatory breathalyzers go into effect. Depending upon what the screening indicates and at the discretion of physicians, Navy personnel are recommended for varying levels of treatment.
The first is the “Impact” program — a 20-hour program focused primarily on education the first time a patient enters it.
“We basically focus on education about alcohol usage,” explained Gould. “We’ve incorporated a lot from living and balance programs — exercises making people aware of how alcohol affects their body and mind.”A Year Without Alcohol Incident
If a servicemember sent to the Impact program goes one year after treatment with no alcohol-related incident, the intervention is considered a success.
For those needing more-intensive interventions, the Navy has numerous outpatient programs available, providing anywhere from 56 to 128 hours of treatment. What that treatment includes depends greatly on physician recommendations. If necessary, a sailor can be admitted for residential inpatient treatment — a five-week course of treatment and detoxification.
In the case of alcohol and substance abuse, it is the weeks and months after a patient leaves treatment that can be the most difficult and the most important for assuring long-term success. This is where the Navy’s programs excel, Gould said.
“The Navy is the only military program that has an after-care program for a year. We’ve even expanded it to include phone-based and Web-based programs,” he said.
Because of the mobile nature of the military, the Navy wanted to make sure its personnel had access to after-care treatment anywhere in the world.
“They have access to a huge amount of resources,” Gould said. “They have a coach who will respond to an email from them. They have access to all our resource libraries.”
They will also be able to set up their own support group, usually consisting of colleagues with whom they went through treatment, so they feel comfortable.
Counselors are military members who have received specialized training in outreach, screening, assessment, and treatment of alcohol and substance abuse. The 11-week training program for counselors at the Surface Warfare Medical Institute in San Diego offers Navy and international civilian certifications and focuses on honing group-therapy skills, one-on-one counseling and recognizing mental-health issues that might arise. Personnel who have completed it are in high demand once they leave the military.
“We have a great reputation for training counselors,” Gould said. “Once they choose to get out of the Navy, they get snatched up by civilian [treatment] programs.”
While the Navy has a lot of backstops in place to support sailors with alcohol problems, they usually only get one incident that results in a treatment referral. The second incident results in the Navy beginning an administrative discharge.
The Navy will continue to provide services throughout the discharge process, however, and will make an effort to place that servicemember, once they are discharged, into treatment somewhere else — VA or a civilian treatment center, for example.
“While that administrative discharge is ongoing, these treatment and counseling services are still being offered,” Gould said. “We’re going to help you get to where you need to be. Our first priority is the safety and well-being of our servicemembers.”
Although the focus of the general public might be on the increased use of breathalyzers, Navy health officials said they believe the Navy — and the military in general—does not have a bigger problem than the civilian sector. They just track and address it better.
“We don’t have any larger a problem in the military, and it’s probably smaller than the rest of society. We’re a microcosm of the bigger picture,” explained Shoshona Pilip-Florea of Navy public affairs. “Because our mission is so critical and lives are at stake, we get out ahead of these issues before they become a problem. We nip them in the bud before there’s an alcohol incident. And our success rate [at treatment] is twice that of our civilian counterparts.”
Part of the reason for that success is that the military provides a much more regulated structure than anything in the civilian sector. Another is the sheer number of people around that are looking out for that servicemember, she said.
“Once you have an alcohol-related incident, or if you self-refer, at that point your command is aware of the issue,” Pilip-Florea said. “Your shipmates are looking out for you. And you’re aware of that. There’s an impact of everyone around you looking out for you. Outside the service, that isn’t necessarily the case.”
The process for tracking the DoD’s most serious adverse medical events is “fragmented, impeding the Defense Health Agency’s (DHA) ability to ensure that it has received complete information,” according to a new review.
With a long history of point of care testing at both of its predecessor organizations, the Walter Reed National Military Medical Center (WRNMMC) laboratory services staff were keenly aware of the advantages of using portable testing devices to obtain rapid patient assessments.