By David VergunSeptember 29, 2016
WASHINGTON (Army News Service) -- On Saturday, Oct. 1, the Army Medical Command will take the lead for overseeing the clinical component of the Army Substance Abuse Program, or ASAP.
However, non-clinical aspects of ASAP will continue to fall under Army Installation Command, or IMCOM, which currently also oversees the clinical component, according to Lt. Col. Christopher Ivany, Army director of Psychological Health and chief of the Behavioral Health Division, Office of the Army Surgeon General.
Non-clinical, he said, includes such things as drug testing and deterrence and prevention awareness programs. Clinical includes such things as treatment and various types of therapies.
"It's a big transition for the Army and an opportunity to improve care for Soldiers and families," Ivany said.
WHY THE CHANGE?
Last year, the secretary of the Army made the decision to move the clinical component back to Army Medical Command, where it had previously resided six years ago, Ivany said.
The secretary's intent was to integrate that substance use disorder care closer with the behavioral health and medical care already being provided to Soldiers. "That's the general direction that the whole country has been moving, in terms of how to best take care of patients who have substance use disorders," he said.
It's widely recognized that many people who have substance use disorder also have a mental health condition, he continued. And, "unless the treatment of those two things is integrated and coordinated, then you have less of a chance of being successful in the treatment outcome of helping the person improve their mental health condition as well as their substance use disorder."
In recent years, a growing understanding of the biological basis of substance use disorders and has informed different new treatment methods that are showing promise, he said.
For instance, medication-assisted therapies are the choice for people with certain substance-use disorders. These medicines help the patients reduce their urges or cravings
It is within the primary care setting that substance use disorders first show up in the form of physical issues caused by the substance, Ivany said. So it's important that primary care providers are trained to screen for those kinds of conditions and know what to do when they encounter patients with those conditions.
Within the mental treatment world, which the Army calls "behavioral health," there is a role for treatment with medication as well as a role focused on psychotherapy, he said.
"So all those elements of care can be integrated more easily when they're under [Army] Medical Command," he concluded.
TREATMENT CLOSER TO SOLDIERS
With the changes taking place across the Army on Oct. 1, those seeking help will have more avenues of care and greater access to care.
Behavioral health providers are currently embedded in small clinics in areas on post where the combat brigade Soldiers are located. Over the last several years that the embedding of providers occurred, the number of Soldiers seeking help with mental health issues has roughly doubled.
Ivany credited that increase with a greater availability of behavioral health providers closer to where Soldiers are on post and not centralized in the big hospitals. Now, substance use counselors will be among those behavioral health providers at those small clinics.
"The hope is that there will be even greater utilization of those clinical providers, so treatments can be offered earlier in the course of the illness of the substance disorder before it gets to the point that the Soldier has a DUI or comes up hot on a urine drug test administered to a unit," he said.
Ivany encouraged Soldiers to seek help. "The earlier we can offer the treatment, the better off it is for a Soldier for their career, for their livelihood, for their health and for the readiness of the Army, because we think we'll be able to intervene before these adverse events occur."
Soon after the secretary made the decision to move the clinical side over to MEDCOM, pilots were conducted with the changeover at Schofield Barracks, Hawaii; Joint Base Lewis-McChord, Washington; Fort Riley, Kansas; and Fort Stewart, Georgia, Ivany said.
For the past several months, MEDCOM has been working on how that integration can best proceed, beginning Oct. 1. Many of the lessons learned from the pilots will guide the process for the other installations.
The response from physicians to patients during the pilots has been positive, according to Ivany.
"The medical staff in general are very happy to have the substance-use disorder counterparts coming over to working in much closer proximity to them," he said. "So they can communicate easier to be able to take better care of their patients."
In the past, such communication required coordinating with someone in a building that could be a few miles across post. Now, that coordination will, in some cases, be with someone located right down the hall.
"That's much easier, that's much safer and we think will lead to better treatment outcomes," Ivany said.