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
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.
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
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
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
• 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.
• 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.
• 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”
~
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.
“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)
“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.
Top 10 MFT Graduate Schools in the U.S.
ONLY 3 Offer Addictions Courses
•
•
•
•
•
•
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•
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
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.
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
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
“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
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
• 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
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.
• Alcohol
• Drugs
• &Gambling
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/)
•
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.
• 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)
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)
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).
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
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.
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.
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.