1.This Act may be cited as the
Supporting Uniformed Personnel by
Providing Oversight and Relevant Treatment for Substance Use Disorders
Act
or the SUPPORT for Substance Use Disorders
Act
.
2.Congress makes the following
findings:
(1)The Armed Forces
is comprised of more than 1,400,000 members in the regular components and more
than 1,080,000 members in the Reserves. More than 1,800,000 members of the
Armed Forces have been deployed in Operation Iraqi Freedom, Operation Enduring
Freedom, and the Global War on Terrorism since 2001.
(2)Substance use
disorders are chronic diseases that can be prevented, treated, and managed
effectively. Failure to prevent or treat these conditions results in severe and
widespread consequences, including increased risk of suicide, exacerbation of
mental and physical health disorders, increased risk of domestic violence and
family discord, and increased risk of unemployment and homelessness.
(3)According to the
2005 Department of Defense Survey of Health Related Behaviors Among Active Duty
Personnel, 24 percent of the members of the Armed Forces surveyed reported
symptoms of alcohol dependence and nearly 11 percent of the members surveyed
reported use of an illicit drug. Misuse of controlled prescription drugs,
particularly narcotic painkillers, is a significant and growing problem among
members of the Armed Forces as well.
(4)Substance abuse disorders often co-occur
with other health problems. According to the 2007 Report of the Department of
Defense Task Force on Mental Health, 17 percent of soldiers from brigade combat
teams are at risk of developing clinically significant symptoms of
post-traumatic stress disorder, major depression, or anxiety after deployment,
and an even higher percentage of such soldiers, 28 percent, would experience
symptoms based upon broader screening criteria. The prevalence of
post-traumatic stress disorder within a year of combat deployment was estimated
to range from 10 to 25 percent.
(5)According to the
2007 Report of the Department of Defense Task Force on Mental Health, symptoms
of disorders such as post-traumatic stress disorder often include complex
disinhibitory behaviors such as self-medicating with alcohol, other
medications, or illicit drugs in an attempt to return to
normalcy
.
(6)According to the
2007 Report of the Department of Defense Task Force on Mental Health, of the
686,306 veterans separated from active duty between 2002 and December 2006 who
were eligible for care from the Department of Veterans Affairs, 229,015 (or 33
percent) accessed care at a Department facility. Of those veterans who accessed
such care since 2002, 83,889 (or 37 percent) were diagnosed with or were
evaluated for a mental disorder, including post-traumatic stress disorder
(39,243 or 17 percent), nondependent abuse of drugs (33,099 or 14 percent), and
depressive disorder (27,023 or 12 percent).
(7)According to the
2007 Report of the Department of Defense Task Force on Mental Health, 20
percent of married soldiers planned to separate or divorce.
(8)According to the
2007 Report of the Department of Defense Task Force on Mental Health,
relationship problems are the top risk factor for suicide. Mental disorders,
alcohol and substance use disorders, and significant stress are other
significant risk factors for suicide. The National Violent Death Reporting
System of the Centers for Disease Control and Prevention determined that, of a
group of former or current military personnel who died by suicide in 2005, 17.2
percent had an alcohol problem and 7.7 percent had a problem with other
substances. The suicide prevention action network (SPAN) reports a 20 percent
increase in suicide among members of the Armed Forces on active duty, 89
suicides in 2007 with 32 deaths under investigation, and a rise of attempted
suicides by soldiers by 6 times higher than it was at the start of Operation
Iraqi Freedom.
(9)While some commands
and facilities in the Armed Forces provide outstanding services for members of
the Armed Forces for substance use disorders, the prevention, diagnosis,
mitigation, treatment, and management of, and research on, substance use
disorders in members of the Armed Forces is inconsistent in availability,
structure, and success among the various Armed Forces.
3.Comprehensive
plan on prevention, diagnosis, mitigation, treatment, and management of
substance use disorders in members of the Armed Forces
(a)Review and
assessment of current capabilities
(1)Not later than 180 days after the date of the enactment
of this Act, the Secretary of Defense shall, in consultation with the
Secretaries of the military departments and the Secretary of Veterans Affairs,
conduct a comprehensive review of the programs and activities of the Department
of Defense for the prevention, diagnosis, mitigation, treatment, and management
of, and research on, substance use disorders in members of the Armed
Forces.
(2)The
review conducted under paragraph (1) shall include, at a minimum, an assessment
of each of the following:
(A)The current state
and effectiveness of the programs of the Department of Defense and the military
departments relating to the prevention, diagnosis, mitigation, treatment, and
management of, and research on, substance use disorders in members of the Armed
Forces.
(B)The adequacy of the
availability of and access to care for substance use disorders in military
medical treatment facilities and under the TRICARE program.
(C)The adequacy of
oversight by the Department of programs relating to the prevention, diagnosis,
mitigation, treatment, and management of substance use disorders in members of
the Armed Forces.
(D)The adequacy and
appropriateness of current credentials and other requirements for healthcare
professionals treating members of the Armed Forces with substance use
disorders, including an assessment of the advisability of adopting uniform
credentials and requirements for such treatment for healthcare professionals
who are members of organizations such as the Association for Addiction
Professionals (NAADAC), the American Society of Addiction Medicine (ASAM), the
American Psychiatric Association (APA), and the National Board for Certified
Counselors (NBCC).
(E)The advisable
ratio of physician and non-physician care providers for substance use disorders
to members of the Armed Forces with such disorders.
(F)The adequacy and
appropriateness of protocols for the diagnosis, treatment, and management of
substance use disorders in members of the Armed Forces.
(G)The adequacy of the
availability of and access to care for substance use disorders for members of
the reserve components of the Armed Forces when compared with the availability
of and access to care for substance use disorders for members of the regular
components of the Armed Forces, including an identification of any obstacles
that are unique to the prevention, diagnosis, mitigation, treatment, and
management of substance use disorders in members of the reserve components of
the Armed Forces.
(H)The adequacy of
the prevention, diagnosis, mitigation, treatment, and management of substance
use disorders and related distress in dependent family members of members of
the Armed Forces, whether such family members suffer from their own substance
use disorder or because of the substance use disorder of a member of the Armed
Forces.
(I)Any gaps in the
current capabilities of the Department of Defense for the prevention,
diagnosis, mitigation, treatment, and management of, and research on, substance
use disorders in members of the Armed Forces.
(3)Not
later than 180 days after the date of the enactment of this Act, the Secretary
of Defense shall submit to the congressional defense committees a report
setting forth the findings and recommendations of the Secretary as a result of
the review conducted under paragraph (1). The report shall—
(A)set forth the
findings and recommendations of the Secretary regarding each element of the
review set forth in paragraph (2);
(B)set forth relevant
statistics on the frequency of substance use disorders in members of the
regular components of the Armed Forces, members of the reserve component of the
Armed Forces, and dependents of such members (including spouses and children);
and
(C)include such other
findings and recommendations on improvements to the current capabilities of the
Department of Defense for the prevention, diagnosis, mitigation, treatment, and
management of, and research on, substance use disorders in members of the Armed
Forces as the Secretary considers appropriate.
(b)Plan for
improvement and enhancement of programs
(1)Not later than 180 days after the date of the enactment
of this Act, the Secretary of Defense shall, in consultation with the
Secretaries of the military departments and the Secretary of Veterans Affairs,
submit to the congressional defense committees a comprehensive plan for the
improvement and enhancement of the programs and activities of the Department of
Defense for the prevention, diagnosis, mitigation, treatment, and management
of, and research on, substance use disorders in members of the Armed Forces and
their dependent family members.
(2)The
comprehensive plan required by paragraph (1) shall take into account the
following:
(A)The results of the
review and assessment conducted under subsection (a).
(B)Any preliminary
results of the study required by section 4.
(C)Similar
initiatives of the Secretary of Veterans Affairs to expand and improve care for
substance use disorders among veterans, including the programs and activities
conducted under title I of the Veterans’ Mental Health and Other Care
Improvements Act of 2008 (Public Law 110–387; 112 Stat. 4112).
(3)Comprehensive
statement of policyThe comprehensive plan required by paragraph
(1) shall include a comprehensive statement of the policy of the Department of
Defense regarding the prevention, diagnosis, mitigation, treatment, and
management of, and research on, substance use disorders in members of the Armed
Forces and their dependent family members.
(4)Availability of
services and treatmentThe comprehensive plan required by
paragraph (1) shall include mechanisms to ensure the availability to members of
the Armed Forces and their dependent family members of services and treatment
for substance use disorders, including, but not limited to, services and
treatment as follows:
(A)Screening for
substance use disorder in all settings, including primary care settings.
(B)Short-term
motivational counseling services.
(C)Marital and family
counseling.
(D)Inpatient,
intensive outpatient, or other residential care services.
(E)Private medical,
psychiatric, and professional counseling services.
(F)Relapse prevention
services.
(G)Ongoing aftercare
and outpatient counseling services.
(H)Pharmacological
treatments aimed at treating substance use disorders, including treating
cravings for drugs and alcohol.
(I)Detoxification and
stabilization services.
(J)Coordination with
groups providing peer-to-peer counseling.
(K)Such other
services as the Secretary considers appropriate.
(5)Prevention and
reduction of disordersThe comprehensive plan required by
paragraph (1) shall include mechanisms to facilitate the prevention and
reduction of substance use disorders in members of the Armed Forces through
science-based initiatives, including education programs, for members of the
Armed Forces and their families.
(6)The comprehensive plan required by paragraph (1)
shall include each of the following:
(A)Instructions on the prevention, diagnosis, mitigation,
treatment, and management of substance use disorders in members of the Armed
Forces, including the abuse of alcohol, illicit drugs, and nonmedical use and
abuse of prescription drugs (including addiction to prescription drugs that is
an unintended consequence of otherwise required and medically appropriate pain
treatment).
(B)Instructions on—
(i)appropriate
training of healthcare professionals in the prevention, screening, diagnosis,
mitigation, treatment, and management of substance use disorders in members of
the Armed Forces;
(ii)appropriate
staffing levels for healthcare professionals at military medical treatment
facilities for the prevention, screening, diagnosis, mitigation, treatment, and
management of substance use disorders in members of the Armed Forces;
and
(iii)such uniform
training and credentialing requirements for physician and non-physician
healthcare professionals in the prevention, screening, diagnosis, mitigation,
treatment, and management of substance use disorders in members of the Armed
Forces as the Secretary considers appropriate.
(C)Instructions on the availability of services for
substance use disorders to military dependents (including services for
dependents suffering from their own substance use disorder and dependents
suffering because of the substance use disorder of a member of the Armed
Forces), including instructions on making such services available to such
dependents to the maximum extent practicable.
(D)Instructions on the dissemination of materials
regarding substance abuse prevention, including, at a minimum, materials on the
following:
(i)The
dangers of alcohol abuse.
(ii)The risks of self-medication, and the
potential co-occurrence of drug use or abuse with illnesses such as
post-traumatic stress disorder.
(iii)The risks
associated with abuse of prescription medications and the signs of inadvertent
addiction to prescription medications that may occur as a consequence of
otherwise prescribed treatment plans, as well as the need to properly secure
and dispose of such substances to safeguard such substances from third parties
such as children.
(iv)The
risks of substance abuse faced by military dependents due to the stresses of
having a spouse or parent deployed, as well as other factors relating to
substance abuse that are unique to military families.
(v)Strategies for
prevention of drug and alcohol abuse among children of military families, and
suggestions for military parents on how to intervene and find help for a child
with a substance use disorder.
(E)Differentiation
of disciplinary action and treatmentInstructions on the
separation of disciplinary actions from prevention and treatment of substance
use disorders in members of the Armed Forces.
(F)Instructions
on confidentiality for members of the Armed Forces in seeking or receiving
services or treatment for substance use disorders.
(G)Participation of
chain of commandInstructions on appropriate consultation,
reference to, and involvement of the chain of command of members of the Armed
Forces in matters relating to the diagnosis, treatment, and management of
substance use disorders in such members.
(H)Instructions on gender specific requirements in the
prevention, diagnosis, mitigation, treatment, and management of substance use
disorders in members of the Armed Forces, including gender specific care and
treatment requirements.
(I)Coordination
with other healthcare initiativesInstructions on the integration
of efforts on the prevention, diagnosis, mitigation, treatment, and management
of substance use disorders in members of the Armed Forces with efforts to
address co-occurring health care disorders (including post-traumatic stress
disorder and depression) and suicide prevention.
(7)In addition to the matters specified in paragraph (3),
the comprehensive plan required by paragraph (1) shall include the
following:
(A)The designation by the Assistant Secretary of Defense for
Health Affairs of a lead agent to coordinate implementation of the plan.
(B)Milestones and schedules for the achievement of the
goals of the plan, including goals relating to the following:
(i)Enhanced education
of members of the Armed Forces regarding substance use disorders.
(ii)Enhanced and
improved identification and diagnosis of substance use disorders in members of
the Armed Forces.
(iii)Enhanced and
improved access of members of the Armed Forces to services and treatment for
and management of substance use disorders.
(iv)Appropriate
staffing of military medical treatment facilities and other facilities for the
treatment of substance use disorders in members of the Armed Forces.
(C)The incorporation of evidence-based best practices
utilized in current military and civilian approaches to the prevention,
diagnosis, mitigation, treatment, and management of substance use
disorders.
(D)The incorporation of applicable results of available
studies, research, and academic reviews on the prevention, diagnosis,
mitigation, treatment, and management of substance use disorders.
(8)Update in light
of independent studyUpon the completion of the study required by
section 4, the Secretary of Defense shall—
(A)in consultation
with the Secretaries of the military departments and the Secretary of the
Department of Veterans Affairs, make such modifications and improvements to the
comprehensive plan required by paragraph (1) as the Secretary of Defense
considers appropriate in light of the findings and recommendations of the
study; and
(B)submit to the
congressional defense committees a report setting forth the comprehensive plan
as modified and improved under subparagraph (A).
4.Independent
report on substance use disorders in members of the Armed Forces
(a)The Secretary of Defense shall provide for a study on
substance use disorders in members of the Armed Forces to be conducted by the
Institute of Medicine of the National Academies of Sciences or such other
independent entity as the Secretary shall select for purposes of the
study.
(b)The
study required by subsection (a) shall include a review and assessment of the
following:
(1)The current state
and effectiveness of the programs of the Department of Defense and the military
departments relating to the prevention, diagnosis, mitigation, treatment, and
management of, and research on, substance use disorders in members of the Armed
Forces.
(2)The adequacy of
the availability of and access to care for substance use disorders in military
medical treatment facilities and under the TRICARE program.
(3)The adequacy of
the oversight by the Department of Defense of programs related to the
prevention, diagnosis, mitigation, treatment, and management of substance use
disorders in members of the Armed Forces.
(4)The adequacy and
appropriateness of current credentials and other requirements for physician and
non-physician healthcare professionals treating members of the Armed Forces
with substance use disorders.
(5)The advisable
ratio of physician and non-physician care providers for substance use disorders
to members of the Armed Forces with such disorders.
(6)The adequacy and
appropriateness of protocols for the diagnosis, treatment, and management of
substance use disorders in members of the Armed Forces.
(7)The adequacy of the
availability of and access to care for substance use disorders for members of
the reserve components of the Armed Forces when compared with the availability
of and access to care for substance use disorders for members of the regular
components of the Armed Forces.
(8)The adequacy of
the prevention, diagnosis, mitigation, treatment, and management of substance
use disorders in dependent family members of members of the Armed Forces,
whether such family members suffer from their own substance use disorder or
because of the substance use disorder of a member of the Armed Forces.
(9)The need for and
appropriate provision of confidentiality for members of the Armed Forces who
seek services or treatment for a substance use disorder.
(10)Such other
matters as the Secretary considers appropriate for purposes of the
study.
(c)Not
later than one year after the date of the enactment of this Act, the entity
conducting the study required by subsection (a) shall submit to the Secretary
of Defense and the congressional defense committees a report on the results of
the study. The report shall set forth the findings and recommendations of the
entity as a result of the study.
5.Center of
Excellence in the Prevention, Diagnosis, Mitigation, Treatment, and Management
of Substance Use Disorders
(a)The Secretary of Defense shall establish within the
Department of Defense a Center of Excellence in the Prevention, Diagnosis,
Mitigation, Treatment, and Management of Substance Use Disorders.
(b)The
Secretary of Defense shall ensure that the Center collaborates to the maximum
extent practicable with the Department of Veterans Affairs, institutions of
higher education, and other appropriate public and private entities (including
international entities) to carry out the responsibilities specified in
subsection (c).
(c)The
Center shall have responsibilities as follows:
(1)To implement the
comprehensive plan of the Department of Defense for the prevention, diagnosis,
mitigation, treatment, and management of substance use disorders under section
3, including the performance of research on gender and ethnic group-specific
health needs related to substance use disorders.
(2)To provide for the
development, testing, and dissemination within the Department of evidence-based
best practices for the prevention, diagnosis, mitigation, treatment, and
management of substance use disorders.
(3)To provide
guidance for healthcare professionals and support service staff of the health
system of the Department in providing quality health care for members of the
Armed Forces with substance use disorders, and their dependents, when possible,
who are suffering from the effects of substance use disorders.
(4)To
provide guidance for healthcare professionals and support service staff to make
members of the Armed Forces receiving prescription pain medications aware of
the potential for abuse of or addiction to such substances, and to provide such
members education on ways of properly securing such substances and disposing of
such substances when no longer needed.
(5)To recommend
uniform credentials and other requirements for healthcare professionals and
support service staff who provide care and support for members of the Armed
Forces and their dependents who suffer from substance use disorders.
(6)To establish,
implement, and oversee a uniform and comprehensive program to train physician
and non-physician healthcare professionals and support staff in the Department
in the screening, intervention, treatment, and management of substance use
disorders.
(7)To
coordinate research, data collection, and data dissemination on the prevention,
diagnosis, mitigation, treatment, and management of substance use disorders,
and to maintain a database of information for that purpose.
(8)To facilitate
advancements in the study of the short-term and long-term physical and
psychological effects of substance use disorders.
(9)To
disseminate evidence-based best practices within the military medical treatment
facilities for training healthcare professionals and support staff with respect
to substance use disorders.
(10)To conduct basic
science and translational research on substance use disorders in members of the
Armed Forces for the purposes of understanding the etiology of substance use
disorders and developing preventive interventions and new treatments.
(11)To develop
programs and outreach strategies for families of members of the Armed Forces
with substance use disorders to address and to mitigate the impact of substance
use disorders on such family members and to support the recovery of such
members from substance use disorders.
(12)To conduct
research on the health needs of families of members of the Armed Forces with
substance use disorders and develop protocols to address any needs identified
through such research.
(13)To disseminate
information to families of members of the Armed Forces regarding ways to help
prevent alcohol and drug abuse among their children, as well as educational
materials to address how situations unique to military families, such as having
a parent deployed, can increase stress levels and put a child at increased risk
of abusing drugs or alcohol.
(14)To develop and
oversee a long-term plan to increase the number of healthcare professionals and
support personnel within the Department in order to facilitate the meeting by
the Department of the needs of members of the Armed Forces with substance use
disorders while they remain on active duty and until their transition to care
and treatment from the Department of Veterans Affairs.
(15)To develop and
deploy an education and awareness training initiative designed to reduce the
negative stigma associated with substance use disorders and treatment.
(16)Such other
responsibilities as the Secretary shall specify.
6.Congressional
defense committees definedIn
this Act, the term congressional defense committees means—
(1)the Committee on
Armed Services and the Committee on Appropriations of the Senate; and
(2)the Committee on
Armed Services and the Committee on Appropriations of the House of
Representatives.