Military Personnel, Veterans and Their Families: How Substance Abuse Research is Effecting Positive Change

A Congressional Briefing Sponsored by The Friends OF NIDA
In Conjunction with the Congressional Addiction, Treatment and Recovery Caucus
and the Congressional Caucus on Prescription Drug Abuse

Monday, March 11, 2013

The Government Relations Office of the American Psychological Association’s Science Directorate coordinated a congressional briefing on March 11 on behalf of the Friends of the National Institute on Drug Abuse (NIDA) coalition, highlighting recent research relevant to military personnel, veterans and their families and efforts to address substance abuse issues in the military community. The briefing was the 18th in the coalition’s Charles R. Schuster Educational Briefing Series on Capitol Hill, designed to educate policy makers about current initiatives and advancements in science funded by NIDA. Cosponsored by the Congressional Addiction, Treatment and Recovery Caucus, the Congressional Caucus on Prescription Drug Abuse and 23 member organizations of the Friends of NIDA, the briefing was attended by over 100 congressional staff, federal agency staff and members of the science advocacy community.

Michael E. Kilpatrick, MD, deputy director for force health protection and readiness programs at the Department of Defense (DOD), opened the briefing with remarks about the invisible wounds of war. Having served as a physician for the U.S. Navy for 25 years, Kilpatrick spoke about the tremendous stressors of war. He then outlined research-based methods that are being developed at DOD to curb substance abuse among service members, veterans and their families, and current programs such as resilience training used by the Army and Marine Corps. Kilpatrick noted than an annual health assessment conducted by the Army revealed a high rate of self-reported problems with alcohol.

Next, Wilson M. Compton, MD, MPE, director of the division of epidemiology services and prevention research at NIDA, delivered a presentation on the institute’s current research portfolio on war stressors and substance use. Compton discussed stressors of the Iraq and Afghanistan wars and the disincentives to seek treatment for substance use disorders in the military, including possibility of discharge, reduced confidentiality of medical records, potential career consequences and stigma related to treatment. Data on the prevalence of substance abuse in the military populations show a higher rate of prescription drug abuse and alcohol use among service members than in the civilian population. Compton also presented on the relationship of alcohol misuse and PTSD, on research that suggests how traumatic brain injury may contribute to vulnerability for substance use disorders, and on the problem of opioid addiction after exposure to opiate medications for the treatment of chronic pain.

Following Compton’s presentation were two research presentations by NIDA funded scientists, APA members Abigail Gewirtz, PhD, associate professor at the University of Minnesota’s Department of Family Social Science and Institute of Child Development and Kathleen M. Carroll, PhD, Albert E. Kent Professor of Psychiatry at the Yale University School of Medicine. Gewirtz presented an evaluation of After Deployment, Adaptive Parenting Tools (ADAPT), a web-enhanced parenting program for military families. ADAPT is designed to extend the reach of the Parent Management Training Oregon (PMTO) program, found to be effective in improving children’s adjustment and reducing substance use in other populations. Data on the effectiveness of the 14-week long, web-enhanced, group-based program for troops returning from deployment, who have at least one child aged 5-12 years, showed that at eight-month follow-up, people who received the ADAPT intervention displayed lower levels of poor discipline, better couple adjustment, increased mindfulness and stronger parenting self-efficacy than those who did not receive the ADAPT intervention.

Carroll presented findings from substance abuse treatment studies showing that effective substance use intervention reduces co-occurring problems and their costs. Behavioral therapies, including motivational interviewing, contingency management, cognitive behavior and behavioral therapies for couples and families have been found effective across types of substance abuse, including smoking and abuse of alcohol, opioids, cocaine and marijuana. Carroll presented an integrative model of PTSD and substance use disorders treatment that addresses the issues simultaneously, focusing on connections between the two. Carroll emphasized the importance of bridging the gap between evidence-based therapies and VA practice, particularly the training of a large workforce, barriers to adopting novel therapies in large systems and the use of technology to make science based therapies more available. Her presentation included preliminary data on the effectiveness of Computer Based Training for Cognitive Behavioral Therapy (CBT 4 CBT) with veterans.

Kilpatrick and Compton discussed a 2012 presidential executive order requiring DOD, VA and the Department of Health and Human Services to work together to expand suicide prevention strategies and take steps to meet the current and future demand for mental health and substance abuse treatment services for veterans, service members and their families. The executive order followed a 2012 Institute of Medicine (IOM) report, Substance Use Disorders in the U.S. Armed Forces, that recommended increased emphasis on efforts to prevent substance use disorders; development of strategies for identifying, adopting, implementing and disseminating evidence-based programs and best practices for substance abuse care; increasing access to care and strengthening the substance use disorders workforce.

In January of this year, NIDA announced a joint research initiative with DOD, the National Institute on Alcohol Abuse and Alcoholism and the National Center for Complementary and Alternative Medicine, titled “Prevention and Health Promotion Interventions to Prevent Alcohol and Other Drug Abuse and Associated Physical and Psychological Health Problems in U.S. Military Personnel, Veterans and their Families.” The funding announcement includes two mechanisms of support, an R01 and an R34. Compton also noted standing funding opportunity announcements that NIDA has issued in conjunction with other NIH institutes, for research on children in military families and for research on prevention and health promotion interventions.

Pictures from the briefing: