Stuttgart ASAP’s evidence-based programs cutting edge

The Institute of Medicine published a report on the current level of substance use and misuse among active duty service members and their dependents, labeling the situation as a public health crisis.

Forty-seven percent of active duty military are binge drinkers (defined as having five or more drinks at one time), and prescriptions for pain medicine have more than quadrupled from 2001 to 2009, resulting in increased opioid dependence, according to the report.

The report’s major critiques for the military’s current prevention programs include antiquated programs not grounded in scientific evidence, a lack of integration between service branches and within the health care system, and the neglect of family members.

A part of me shook my head in disgusted agreement, and the other part of me never felt more proud of the cutting-edge, evidence-based programming already adopted by the U.S. Army Garrison Stuttgart’s Army Substance Abuse Program.
Since 2011, the mandatory ASAP briefs have changed focus from educational briefings on high-risk behaviors to open discussions on the importance of changing the culture around alcohol, adjusting the “social norms” of drinking in the military, and adopting evidence-based practices — all major themes highlighted in the report.

In July 2011, Stuttgart Warrior Pride Challenge was created based on research performed on college campuses that found a correlation between providing alcohol-free activities and reduced negative incidents, such as arrests and vandalism. The IOM report highlighted best practices along the continuum of care from prevention to treatment.

According to the report, evidence-based prevention programs often include skills important for the military, including “avoiding high-risk situations, and identifying and bonding with individuals who provide social support and a nonuse (alcohol/drug free) norm.”

These approaches are all major elements of SWPC, a program that uses alcohol-free options to promote healthy habits, foster wellness, build social ties, and reduce alcohol use and related problems among our most at risk service members: E1-E7 and O1-O2, and their spouses.

This initiative has been driven by a junior enlisted advisory council. So far, SWPC programming has included a late-night Call of Duty tournament, four obstacle course challenges (co-hosted with Special Forces), Saturday morning paintball, snowboarding trips, ropes course excursions, skydiving and paragliding.

The ASAP staff participates in these activities alongside our service members, creating relationships formed outside of a clinical or educational setting.
Moreover, SWPC events provide opportunities for building social ties among participants, ASAP staffers and among organizations. This increased social interaction can encourage help-seeking behaviors and is associated with a reduced likelihood of suicidal behaviors.

The increased focus on social interaction is well-founded. “Psychology Today” recently reported on Julianne Holt-Lunstad of Brigham Young University, whose research examined 148 studies and found that, “People with active social lives were 50 percent less likely to die of any cause than their nonsocial counterpart. Low levels of social interaction have the same effect as smoking 15 cigarettes a day, and worse effects than being obese or not exercising.”

The IOM report also stated that addressing this public health crisis “will undoubtedly require changes to military culture.” A theme throughout the report is that heavy drinking in the military is tolerated as long as it does not result in a negative incident.

Stuttgart has been an advocate for changing culture by addressing the importance of leading by example, and setting a nonuse norm for troops, to prevent heavy drinking. This nonuse norm stressed in the IOM report has been integrated into ASAP briefings, Unit Prevention Leader trainings and the SWPC.

ASAP education now stresses that heavy drinking is more than 50 percent greater among service members who believe that their supervisors drink, versus those who did not know or believed that their supervisor did not drink (based upon the 2008 Department of Defense Survey of Health-Related Behaviors Among Active Duty Military Personnel health survey.)

Moreover, heavy alcohol use not only hurts us physically, but those service members who drink heavily experience serious consequences three to five times more than any other group of drinkers (light, moderate, or moderate/heavy drinkers).

Correcting social norms is another priority in our programming and is accomplished through biweekly news spots, newsletters, ASAP briefings and modeling healthy behavior.

More than 1,000 troops have now participated in SWPC alcohol-free activities, and SWPC-sponsored activities consistently sell out.  Participation in these events communicates unspoken messages that are much more potent than anything one might say about the hazards of substance abuse. They clearly demonstrate that having fun doesn’t have to involve alcohol … helping to establish a new norm. Recently one participant told us that this was the first time in 12 years that he had fun without alcohol.

Substance abuse and alcohol misuse is a threat to the readiness and health of anyone who might be impacted by the harmful substance use by others, and is associated with increased suicide, depression, alcohol dependence, loss of productivity, drunken driving incidents and being overlooked for promotions.
The Stuttgart ASAP has adopted many evidence-based practices; however, as emphasized in the IOM report, “The most effective universal, population-based environmental prevention strategies increase the price of, and reduce access to, alcohol and other drugs.”

The garrison commander has begun to address this by eliminating wine tastings at the Patch Shoppette, but further action is still needed. Addressing this military public health crisis hinges on changing our attitudes and culture about acceptable alcohol and drug use in the military.

At one time, our society tolerated smoking in the workplace, restaurants and even hospitals. Increased taxation on cigarettes, restrictions on where smoking is permitted, and most importantly, changes in social norms about smoking, have resulted in major reductions in smoking initiation and tobacco use.

Alcohol misuse and substance use are an underappreciated cause of death, disability, productivity loss, and negative social and economic effects on individuals, families, communities and our military. In our culture “we work hard, and we play hard.” In light of this public health crisis, isn’t it time we redefine playing as something other than partying?

For more information on USAG Stuttgart’s Warrior Pride Challenge, call 431-2530/civ. 07031-15-2530.