After USA TODAY reveals problems, Army revises drug, alcohol abuse program

Source: USA Today

Gregg Zoroya

October 20, 2015

The Army is placing medical officials in charge of substance abuse treatment for soldiers in the wake of a USA TODAY investigation that uncovered poor treatment and a spike in suicides among those suffering addiction.

Army Secretary John McHugh decided to shift oversight of the program back to the Army Medical Command to improve the counseling soldiers receive, an Army deputy assistant secretary, Anthony Stamilio, said in an interview. About 20,000 soldiers are screened each year for drug and alcohol abuse.

Problems began surfacing after the Army decided in 2010 to place the program under the Army’s Installation Management Command, which operates garrisons and lacks medical expertise.

That move led to a sharp decline in the quality of care. Half of the Army’s treatment clinics fell below professional standards, veteran personnel left en masse and clinics hired unqualified directors and counselors, according to senior Army clinical staff members and records obtained by USA TODAY.

Stamilio defended the program, saying that under Installation Command management the “program is running well,” current counselors are fully credentialed, and rates of soldiers successfully completing treatment and staying sober are high.

The USA TODAY report in March said that since 2010, about 90 soldiers had committed suicide within three months of receiving substance-abuse treatment and at least 31 suicides followed documented cases of substandard care, according to tabulations by clinical staff, though they did not specifically blame the deaths on poor treatment.

Current and former clinic staff members told USA TODAY that about half of the 7,000 soldiers screened for alcohol or drug problems last year and turned away with a clean bill of health should have been enrolled and counseled for substance abuse.

The USA TODAY reports prompted McHugh and then-Army chief of staff Gen. Ray Odierno to order an inspector general investigation of the program. The Army has not released those results, but McHugh later ordered the program back to medical supervision over a phased-in period to be completed by next October.

“They’re finally going to bring some reasonable and responsible action to help soldiers,” said Dr. Patrick Lillard, a psychiatrist and former clinical director of the Army’s largest in-patient substance abuse program at Fort Gordon, Ga.

“It means that the direction of the substance abuse treatment program will be back in the province of medical people rather than command, so that decisions will be made by medical people” said Lillard, a vocal critic of the earlier change in management. “The people in command do not understand the nature of the (substance abuse) disease and the complications that occur.”

The latest move was well-received by medical experts. David Rosenbloom, professor of public health at Boston University said “if they’re putting it under medical control they’re probably going in the right direction.”

Wanda Kuehr, a psychologist and former director of clinical services for the Army substance-abuse program who also had been critical of its management, cautioned that “safeguards must ensure that (treatment) clinicians continue to be licensed, trained and certified in substance abuse rehabilitation. If not, soldiers’ treatment is not likely to be optimal. In fact, it may well put the soldiers at risk.”

The Army plans call for placing substance-abuse counselors within mental health clinics now “embedded” with combat brigades to make care more accessible and reduce the stigma associated with seeking help. Currently, drug and alcohol counselors work in separate clinics on each Army base.

“What we have found is that our soldiers are more willing to go into an embedded behavioral health facility to be seen,” said Maj. Gen. Jimmie Keenan, deputy commander for operation under the Medical Command.

“Their mental health care and their substance-abuse treatment can be delivered in the same location and the people providing that care can make sure it’s coordinated and risk is managed even better than it is now,” said Army Lt. Col. Chris Ivany, Army director of behavioral health.

Lillard said that non-medical leaders often fail to recognize alcoholism or drug abuse as an illness that may be related to post-traumatic stress disorder (PTSD) or mild traumatic brain injury (TBI) stemming from combat. The result: soldiers are sometimes denied necessary treatment or expelled from the Army for behavior linked to PTSD or TBI.

In one case documented by USA TODAY in August, Spc. Stephen Akins, a veteran of several tours to Iraq and Afghanistan who returned home with PTSD and TBI was kicked out of the Army with a general discharge for abusing drugs and alcohol despite pleas by his then-Army psychiatrist, Lillard, that Akin needed a medical discharge.

A two-star general determined that Akins’ substance abuse had nothing to do with his brain injury or emotional problems. Akins committed suicide in July in the basement of his mother’s home outside Atlanta.

Another USA TODAY report revealed that in 2011, an alcoholic soldier was denied hospitalization by Army commanders who overruled a medical opinion. The soldier later murdered a sheriff’s deputy while in a drunken state and then killed himself outside Fort Gordon, Ga., in an event that rocked the local community of Augusta, Ga.