About 1 in 10 veterans seeking treatment at a Veterans Administration facility meet the criteria for substance use disorder, a higher rate than the civilian population. In some cases, this substance use problem begins during their service. The stress of training, deployment, returning after deployment and military culture can lead to substance misuse. Additionally, active-duty members with multiple deployments and combat experiences are at greater risk of facing both substance use and trauma-related conditions together.
Unique circumstances in the military may also prevent active members from seeking treatment. Barriers to treatment may include:
- Stigma
- Fear of disciplinary action and career derailment
- Lack of confidentiality within the military.
Confidentiality laws differ for active-duty military personnel compared to the civilian population. When an active-duty servicemember seeks help for a mental health condition or substance use, their commanding officers must be informed. However, if they seek basic counseling or substance use education without posing harm to themselves, others or missions, command notification may not be necessary.
Although this lack of confidentiality may seem intrusive and discourage servicemembers from seeking treatment, it’s essential for commanders to assess fitness for duty. Yet, seeking treatment doesn’t necessarily lead to severe disciplinary action. In fact, a commander’s involvement in treatment can support positive outcomes.
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Reasons for Substance Abuse Intervention in the Military
Policy dictates that active-duty personnel participate in urinalysis testing to prevent and identify drug use in the military. While most testing is random, commanding officers can order testing if they suspect illegal drug use. Failure to comply can result in disciplinary action. If the servicemember fails the test, they’re usually referred to an assessment to determine the severity of the addiction. After an assessment, medical professionals can make treatment recommendations.
Commanders may also refer a servicemember for an assessment if they have a substance-related incident with the police. This could be something like disorderly conduct or a DUI charge. Servicemembers may also seek help voluntarily to treat a substance use disorder. Depending on the situation, this may or may not result in disciplinary action.
Confidentiality Protections for Servicemembers
Servicemembers seeking counseling for issues who don’t pose risks to themselves or others may gain confidentiality protections. Common complaints in therapy may include:
- Grief
- Relationship problems
- Difficulties adjusting to military life
- Mild symptoms of depression and anxiety
- Struggles with managing stressors
Circumstances Requiring Commander Notification
Voluntarily requesting information regarding substance use may be done confidentially. However, some instances require commander notification about mental and behavioral health. Along with displaying a risk of harm to the mission, themselves and others, some scenarios include:
- Inpatient care: When a servicemember is referred to an inpatient care facility for mental health concerns or substance use disorders, the supervising officers must be informed. The commander needs to be aware to offer unit and logistical support during and after the inpatient program.
- Addiction treatment program: Military personnel must inform their commanding officers if they join a substance treatment program. This applies to both inpatient and outpatient-based programs at any level of care. The commanding officer needs this information to assess operational risks. They may also need to plan for any necessary aftercare services.
- Acute mental health conditions: Servicemembers must disclose acute symptoms of a serious mental health condition to their command. Such conditions may significantly affect a person’s functioning or pose a risk of a medical emergency. Examples include bipolar disorder, psychotic episodes and major depressive disorder.
- Specialized personnel: All military members must be able to perform general duties. However, some roles require even higher standards of physical, mental, and emotional readiness. If the personnel holds one of these specialized roles, any mental health treatment must be disclosed to command.
Confidentiality Regulations for Military Personnel
Disclosing mental health and substance use treatment to commanding officers falls under the Military Command Exception. This stipulation is included in the Health Insurance Portability and Accountability Act (HIPAA). For civilians, HIPAA typically ensures confidentiality. However, these confidentiality exceptions for the military serve a logical purpose.
The military must consider its servicemembers’ medical and mental health status in a military context. The command must know a servicemember’s mental or behavioral health status to make informed decisions. This ensures both personnel safety and the ability to assess mission capabilities. However, the military’s lack of confidentiality shouldn’t discourage active-duty personnel from seeking treatment.
Benefits of Commander Involvement in Substance Use Treatment
There are several benefits of commanding officers’ being involved in a servicemember’s treatment.
- If a commander intervenes early enough, they can prevent the addiction from progressing and causing other issues.
- Supervising officers can work with clinicians to track progress, ensure accountability and plan aftercare. In turn, this helps promote positive treatment outcomes for the individual.
- Commanders can also offer support to help you follow through on treatment and maintain recovery.
Although it might not be ideal for command to know about your mental health and substance use treatment, delaying treatment will only do more harm than good for both you and your unit.
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