The Department of Defense and Veterans Administration Medical Systems:

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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
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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.
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• 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

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• Until 1994, substance abuse counselors could be
  licensed, have a masters 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
• MFTs and LPCs were recently added

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• 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

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• 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 veterans through the VA system.

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• 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.

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• 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
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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 SAMHSAs 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 its not for substance abuse
counselors as per DoD and Tricare policy.
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This is discrimination,(Larry Ashley,)
chairman of the veterans committee with NAADAC,
the Association for Addiction Professionals
(NAADAC). We have people who have masters
and Ph.D.s who chose not to become social workers
or psychologists, (Larry Ashley)
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Why are we being discriminated against when
were the professionals? Larry Ashley
Reviewing the curriculum of the Top Rated
Universitys in the nation it is clear that there
is a lack of required addiction education for
Marriage Family Therapists, Psychiatrists,
Masters of Social Work, and Psychiatrist. These
graduate degrees are currently the most hired
degrees in the addictions treatment professions,
including Tricare and the VA.
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• 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

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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.
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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
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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
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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
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• 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.
• Theres a huge issue of overprescribing of
  prescription drugs and over diagnosing of PTSD.
  Michael R. Hurst

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• 25 of the troops in Iran or Afghanistan are on
  medications for sleep, anxiety, or depression.
• They come home with these prescriptions, Ive
  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 dont feel, you are
  self-medicating.
• Larry Ashley

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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.
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• Alcohol
• Drugs
• Gambling

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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/milita
ry-gambling-addiction-twice-as-high/)
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• 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.

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• 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)

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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/bu
siness/19slots.html?pagewantedall)
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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).
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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
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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.
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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.
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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.

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