The Department of Defense and Veterans Administration Medical Systems:

1. The Department of Defense and Veterans Administration Medical Systems: What Counselors Need to Know Presenter: Larry Ashley, Ed.S, LCADC, CPGC University of Nevada Las Vegas

2. NAADAC, The Association of Addiction Professionals, believes that all veterans including full-time servicemen and women, the National Guard, Reservists and their families deserve the highest quality of health care possible, including access to addiction prevention, treatment, and recovery services from highly qualified substance abuse counselors.

3. In effect since 1994, according to Department of Defense (DoD) and Department of Veterans Affairs (VA) policies, the only eligible counselors are; • Psychiatrists • Psychologists • Social Workers • Licensed Professional Mental Health Counselors • Marriage and Family Therapists • With Substance Abuse Certification

4. Until 1994, substance abuse counselors could be licensed, have a master’s degree, and provide counseling for DoD and the VA. • In 1994, the insurance went from CHAMPUS to Tricare, and at the same time, active duty military benefits for substance abuse treatment changed to, • Psychologists • Psychiatrists • Licensed Social Workers • MFT’s and LPC’s were recently added

5. When the Army released a job announcement last summer for 130 new substance abuse counselor positions needed by October 1, only eligible for hire were; • Psychiatrists • Masters level psychologists • Social Workers • Licensed Professional Mental Health Counselors • Marriage & Family Therapists

6. Current Department of Defense (DoD) and Department of Veterans Affairs (VA) policies prevent the hiring of qualified substance abuse counselors to treat current Service members under Tricare and veteran’s through the VA system.

7. With the influx of returning veterans from long periods of deployment, coupled with the broad range of psychosocial problems in which they are faced with, the need for substance abuse professionals with competency-based training is vitally important.

8. Licensed or certified substance abuse counselors posses specialized skills through competency-based training, including treating combat trauma. “Support increasing access to addiction prevention, treatment, and recovery services from highly qualified substance abuse counselors, by urging the DoD and VA to stop discriminating against substance abuse counselors in their hiring practices” ~

9. This fall, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a technical assistance packet on becoming a Tricare provider, which was posted on the website of the National Council for Community Behavioral Healthcare (and is not on SAMHSA’s website). the National Council announced it is offering a 20-hour online course to receive a “Behavioral Health Certificate” to treat veterans, for a fee of $350. But it’s not for substance abuse counselors — as per DoD and Tricare policy.

10. “This is discrimination,”~(Larry Ashley,) chairman of the veterans committee with NAADAC, the Association for Addiction Professionals (NAADAC). “We have people who have master’s and Ph.D.s who chose not to become social workers or psychologists,” ~(Larry Ashley)

11. “Why are we being discriminated against when we’re the professionals?” ~Larry Ashley Reviewing the curriculum of the Top Rated University’s in the nation it is clear that there is a lack of required addiction education for Marriage & Family Therapists, Psychiatrists, Master’s of Social Work, and Psychiatrist. These graduate degrees are currently the most hired degrees in the addictions treatment professions, including Tricare and the VA.

12. Top 10 MFT Graduate Schools in the U.S. • ONLY 3 Offer Addictions Courses • OHIO STATE UNIVERSITY • MICHIGAN STATE UNIVERSITY • PURDUE UNIVERSITY • FLORIDA STATE UNIVERSITY (substance abuse counseling) • UNIVERSITY OF MARYLAND • BRIGHAM YOUNG UNIVERSITY (addictions and violence in families) • UNIVERSITY OF GEORGIA • COLORADO STATE UNIVERSITY • TEXAS TECH UNIVERSITY (Grad Certificate in Addictive Studies; 3 classes offered: Couple and family dynamics of addiction, systems treatment of addiction, eating disorder and other process addictions.) • EAST CAROLINA UNIVERSITY

13. Top 5 MSW Graduate Schools in the U.S. University of Michigan: Drugs society & human behavior (elective) Prevention, Treatment Law and Civil Policy (elective) Washington University St. Louis: Alcohol & Substance Abuse (elective) University of Chicago*: Drugs: Culture & Context (elective) Child & Adolescent Substance Abuse (elective) Clinical Interventions in Substance Abuse (elective) Substance Abuse Prevention (elective) *ONLY 2 of these electives are required for the AODA advanced certificate as well as a field placement in a relative social service. Cont.

14. University of Washington Seattle: Understanding addiction (elective) Social Work practices of chemical dependent adults (elective) Co-occuring disorder mental illness and addiction (elective) Columbia University: Alcoholism and other chemical dependency (elective) Field of Practice contemporary social issue Talks about social issues of addiction in course work

15. Top 5 Graduate Schools Psychology Program Stanford University Only references a possible correlation in the Affective Psychology program by using the term “Reward Processing” University of Berkley California Nothing specific to addiction Harvard University Only references a possible correlation in the Graduate program of Psychology by using the term “Reward & Motivation” University of Michigan Drugs of Abuse Yale University Nothing specific to addiction

16. “Anybody that has killed somebody or seen somebody killed is changed” ~Larry Ashley • Combat Trauma • & • Trauma & Addiction “The multiple deployments have made this even harder on the vets, because of the “yo-yo” effect, your body is back home, but your brain is still there.” ~Larry Ashley

17. Post traumatic stress disorder (PTSD) has been linked to suicides and other problems in veterans. • But the argument is that alcohol is the main cause of suicide not PTSD, with prescription drug abuse being overprescribed to service members. • “There’s a huge issue of overprescribing of prescription drugs and over diagnosing of PTSD.” ~Michael R. Hurst

18. 25% of the troops in Iran or Afghanistan are on medications for sleep, anxiety, or depression. • “They come home with these prescriptions, I’ve never seen this before in a war situation.” ~Larry Ashley • Veterans may turn to illicit drugs and alcohol for the same problems. • “If you numb out, you don’t feel, you are self-medicating.” • ~Larry Ashley

19. The total number of patients in the U.S. Department of Veterans Affairs (VA) health care system with a substance use disorder was 485,092 in fiscal year 2002.5 Veterans with substance use disorders accounted for approximately 12 percent of VA patients and about 25 percent of total VA expenditures, or $4.2 billion.

20. Alcohol • Drugs • &Gambling

21. The Veterans Administration Health Services Research & Development funded a study to determine the prevalence of problem and pathological gambling addiction within the U.S. military, and their findings were disturbing. Here are a few items that stood out: (http://www.citizenlink.com/2011/05/26/military-gambling-addiction-twice-as-high/)

22. One in 10 veterans has a problem or pathological gambling addiction (2 percent pathological addictions and 8 percent problem addictions to gambling) • Unemployment seemed to play a major role in whether the veteran had gambling addictions, and married veterans were more likely to have gambling addictions (not what psychologists and researchers expected to see, very unusual) • Veterans have about twice the rate of problem / pathological gambling addictions compared to the general, non-military population.

23. Both male and female veterans have almost identical problem and pathological gambling addiction rates (again, this is unusual – not what psychologists and researchers expected to see) • Veterans with post-traumatic stress disorder, depression and anxiety tend to have more gambling addiction problems • Younger veterans (20s) were more likely to be diagnosed as pathological gamblers (from previous data, most veterans with pathological gambling addictions are 35 and older, so this change in age for addiction was unexpected)

24. Rachel Volberg, a medical sociologist who runs Gemini Resources, which measures gambling rates around the world. She stated: "We met a great deal of defensiveness, both in Washington and on base," she said. "Everyone was very concerned that those revenues might go away.“ "Only the chaplains took this really seriously. They told us that one out of three people who come to them for counseling have a problem with gambling, but can't tell anyone because they will be dishonorably discharged.” (http://www.nytimes.com/2005/10/19/business/19slots.html?pagewanted=all)

25. While there are plentiful opportunities for veterans and enlisted personnel to gamble in the United States and overseas, many members of the military do not have access to treatment for gambling problems and may face disciplinary action after seeking help. (Veterans and Problem Gambling: A review of Literature, Emshoff, 2010).

26. Hidden Addiction unaddressed by the Military: “Compulsive gambling is a serious psychiatric disorder, as exhibited by the extraordinary high rates of suicide and the high incidence of severe depression, alcohol abuse and crime associated with sufferers of this illness….. Because compulsive gambling has an immediate association with financial matters, its effect on readiness and the overall mental health of service members has been largely overlooked and ignored.” ~House Armed Services Committee

27. Intervention and Treatments Options: Exist but are not currently available to meet the needs both overseas and stateside for active military, retired military and their families.

28. Inpatient Treatment Outpatient Treatment Group Support Response to intervention and treatment is effective with in treating those struggling with addiction. However there is not enough treatment options in the military personnel and their families.

29. Having the skills and training to assess individuals for diagnosis for all mental illness and addiction is essential to designing a treatment plan and effectively helping someone in treatment. Military personnel have different needs in treatment programs due to traumatic experiences in combat. These events require treatment from individuals trained in addressing their problems.