The primary objective of the Army Center for Substance Abuse Programs (ACSAP) is to promote readiness, health and wellness through the prevention and treatment of substance misuse and abuse. The ACSAP Program is designed to identify risk factors and help individuals avoid hazardous substance use before it causes significant damage to their health and career.

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The ACSAP Program offers: Comprehensive evaluation of substance use covers demographic, family, social, behavioral, psychological, spiritual and medical factors. Standardized questionnaires are combined with a clinical interview to identify risk factors and to make recommendations for treatment or prevention services.

Alcohol Brief Counseling: Alcohol Brief Counseling includes an individualized consultation to provide feedback from the assessment and develop a personalized change plan. Education is provided on DoD substance use policy. Alcohol brief counseling may also include modules on values clarification, anxiety or anger management, assertive communication, healthy thinking, sleep enhancement, and relaxation.

Substance abuse treatment services (group/individual): Individual and group treatment services are provided to individuals who are addressing substance abuse or dependency issues. Referrals to higher levels of substance abuse treatment, such as intensive outpatient treatment or inpatient treatment, will also be provided when needed.

Other resources include: Initial civilian employee assessment for work-related misconduct that is related to substance use, as well as referrals for treatment, education and prevention classes. Family programs, including individual and group counseling sessions. Civilian supervisor training, first duty station and key-personnel briefings.

Alcohol Misuse.

The Army policy recognizes that alcohol misuse negatively affects public behavior, duty performance, and/or physical and mental health. The Army provides comprehensive clinical assistance to eligible beneficiaries seeking help for an alcohol problem.

Illicit Drug Use. The Army does not tolerate the illegal or improper use of drugs by Army personnel. Such use: Is a serious breach of discipline. Is incompatible with service in the Army. Automatically places the member's continued service in jeopardy. Can lead to criminal prosecution resulting in a punitive discharge or administrative actions, including separation or discharge under other than honorable conditions.

ACSAP Program Overview.

The primary objectives of the ACSAP Program are to promote readiness, health, and wellness through the prevention and treatment of substance misuse and abuse, to minimize the negative consequences of substance misuse and abuse to the individual, family, and organization, to provide comprehensive education and treatment to individuals who experience problems attributed to substance misuse or abuse, to restore function and return identified substance abusers to unrestricted duty status or to assist them in their transition to civilian life, as appropriate.

These objectives are met through four levels of activities: Universal (Primary) Prevention and Education: This includes population-based outreach, education, prevention programs, screening, and consultation. Community based prevention and education efforts will be delivered by ACSAP staff through coordinated efforts with other community agencies.

Selective (Targeted) Prevention: This involves global screenings for alcohol misuse, as well as initiatives to prevent future alcohol misuse, prescription drug misuse, or drug use with individuals who are identified as high risk or are suspected of substance misuse. Selective prevention includes screening, assessment, education, brief preventive counseling, and tailored feedback in specific individuals or groups identified as moderate to high risk.

Indicated Prevention: This is indicated for those who are engaging in risky drinking but have not yet developed problems associated with their drinking. Individuals in this group can be identified through screening in primary care or other appropriate setting. The majority of these individuals are best served through motivational interviewing and brief advice. This focuses on those who are already in the early stages of alcohol and substance use.

Treatment and Continuing Care (Aftercare): Provide evidence-based substance use disorder treatment for individuals who are abusing or are dependent on alcohol or drugs that follows the clinical practice guidelines. The primary aim should be restoring function, improving quality of life, and returning members to productive and unrestricted duty, or to assist them in their transition to civilian life, as appropriate.

Use of Evidence-Based Services.

ACSAP Program will provide evidence-based substance use disorder services that adhere to this instruction, clinical practice guidelines, as well as other DoD/Veterans Affairs sanctioned task force and/or accredited professional organizations specializing in the treatment of substance use disorders.

Substance misuse prevention efforts are geared toward enhancing individual and unit resiliency, both of which can be compromised by hazardous alcohol use and SUDs. Prevention strategies must be comprehensively structured to educate and inform the overall population as well as specifically target higher risk populations.

In collaboration with other Integrated Delivery System members, the ACSAP staff works to develop and implement prevention programs geared towards increasing organizational and individual awareness of SUD issues, including misuse and abuse of prescription medications, illegal and illicit drug abuse, trends, and threat to mission readiness.

Patient Assessment.

Treatment or prevention counseling for all patients should be based on thorough assessment (e.g. Substance Use Assessment Tool, clinical interview, and collection of collateral data as appropriate), determination of risk, and should be tailored for the individual.

Evaluation for specialty treatment requires a thorough biopsychosocial assessment that adheres to evidence based clinical practice guidelines from VA/DoD. The initial assessment in ACSAP is the Substance Use Assessment Tool Intake/Assessment. Information from the Substance Use Assessment Tool intake is utilized to make treatment recommendations.

When treating ACSAP patients, providers and technicians must do a complete review of the individual's medical history, including a thorough medication reconciliation. This can help providers uncover potential poly-substance abuse disorders, identify drug-seeking behaviors, and target therapy appropriately. Throughout treatment, providers should periodically monitor any changes in the patient's medical diagnoses or medication regimen in order to identify unrecognized prescription medication abuse.

Detoxification.

Patients being referred for inpatient treatment will be assessed to determine the level of detoxification services required. When medically indicated, patient detoxification will be managed on an outpatient basis prior to inpatient or residential treatment. Patients assessed as requiring medically managed detoxification (inpatient) will be entered into an appropriate medical facility. All patients must have 72 hours of monitored abstinence (inpatient or outpatient) prior to departure from detoxification.

Continuity of Care in Treatment.

ACSAP Program staff will communicate with the inpatient treatment facility to ensure continuity of care. Inpatient treatment may begin immediately, if the history, physical examination, and other documentation indicate that the patient can safely begin treatment. If, however, the patient experiences symptoms of apparent withdrawal, he or she will be re-assessed and a detoxification protocol initiated.

Considerations following Treatment Completion.

At a minimum, a relapse prevention plan will be created (or reviewed if created prior to discharge) and agreed upon. Suicide risk will also be assessed at this visit and a follow-up visit will be scheduled. Patients discharged from inpatient residential will be monitored over a sufficient period of time.

Patients returning from an IOP, residential/inpatient treatment facility will have a meeting within 14 calendar days of return to assess the patient's progress during inpatient or residential treatment and design a continuing care (aftercare) plan.

Decisions regarding continuing care (aftercare) services will be based on a current assessment of status and will include establishment of a continuing care treatment plan identifying specific goals, interventions, and means to assess interventions.

Use of pharmacological treatments, such as Naltraxone, Disulfiram, Acamprosate, etc., will be strictly monitored by the psychiatrist or physician who has prescribed the medication. The ACSAP Program staff will communicate with all providers to ensure continuity of treatment.

Long-Term Inpatient/Residential Substance Use Treatment. Whenever possible and appropriate, military inpatient or residential substance use treatment facilities will be used for service members for long-term treatment.

Continuing Care (Aftercare) Program.

Upon completion of the treatment section of the ACSAP Program (e.g. Outpatient, IOP, Inpatient, etc.), the member will begin a period of continuing care (aftercare).

All patients who completed treatment will participate in continuing care (aftercare) as part of the ACSAP Program. Continuing care (aftercare) does not begin until all goals of the treatment plan are met. Once these goals are met, the patient is moved into continuing care (aftercare).

Continuing Care (Aftercare) requirements.

Patient's progress will be monitored by the ACSAP staff at least every 30 days while the patient is in continuing care (aftercare). The goal of continuing care is to ensure any new goals are addressed, the patient does not need to be returned to treatment, and a relapse prevention plan is implemented and proceeding smoothly.

The with a drug history undergo monthly random drug testing for one year following their most recent discharge from a treatment program.

Program Completion.

Program Completion. Patients will not be considered to have successfully completed the ACSAP Program until the patient has completed treatment and continuing care (aftercare). The Army determines, based on VA/DoD Clinical Practice Guidelines for Management of Substance Use Disorders, current DSM criteria and ASAM PPC, patient's progress towards agreed upon goals and/or issues as stated in the treatment and continuing care (aftercare) plans, when the patient no longer requires program resources.

The Army determines, based on VA/DoD Clinical Practice Guidelines for Management of Substance Use Disorders, current DSM criteria and ASAM PPC, patient's progress towards agreed upon goals and/or issues as stated in the treatment and continuing care (aftercare) plans, when the patient no longer requires program resources.