In response to a recent story detailing serious quality-control problems at Army substance abuse treatment centers, U.S. Army leadership is taking decisive action. Secretary John McHugh and Chief of Staff Ray Odierno have ordered the Army Inspector General’s office to open an investigation into this developing scandal, giving it free and open access to records and personnel at 54 Army-funded addiction treatment facilities in the United States, Europe and Southeast Asia. More than half of the outpatient substance abuse treatment and rehabilitation centers providing services to U.S. soldiers recently failed to pass inspection, according to a recent USA Today report. A series of internal reviews found serious problems at these facilities, and even among those that were not red-flagged, only five were given superior grades. Chronic substandard care from poorly trained addiction “specialists” was the rule rather than the exception at most of these clinics. In addition, more than 7,000 soldiers referred for substance abuse treatment were turned away in 2014, in part because of understaffing and in part because administrators failed to heed the recommendations of senior clinicians (many of whom later resigned their positions in disgust). The USA Today reporter who broke this story relied on documentation provided by a handful of whistleblowers. The most prominent of these truth-tellers was Dr. Wanda Kuehr, the recently retired chief of clinical services for the Army Substance Abuse Program. Dr. Kuehr accused her superiors of trying to sweep the program’s problems under the rug, and it does appear that Army officials were initially reluctant to follow up on the internal reviews that exposed the depth of the problem—or were at least slow to respond.
Healthcare Sacrificed as Pennies Are Pinched
Insiders say the trouble started in 2010, when Army officials transferred administrative control of its substance abuse treatment program from the U.S. Army Medical Command (MEDCOM) to the Installation Management Command (IMCOM), an umbrella organization responsible for general Army base management. This move was supposed to increase coordination and efficiency, but did just the opposite. As a result of this change, supervision of addiction services was delegated to career bureaucrats who lacked medical knowledge and expertise. Trained counselors, addiction specialists and healthcare administrators left in droves when they found their judgments being second-guessed by people more concerned with cutting costs than providing quality medical services. IMCOM responded to these defections by hiring on the cheap, and soon the Army’s substance abuse rehabilitation centers were staffed by ill-prepared counselors incapable of providing effective addiction treatment services. Poor standards also infected the evaluation departments at these clinics—according to critics, more than half the soldiers rejected for treatment in 2014 met the standards for addiction. Since 2010, more than 90 soldiers committed suicide within three months of completing treatment for a drug or alcohol problem, so even when services have been offered, they have often proven ineffective. Back in 2012, a report from the National Academy of Sciences warned Army officials of a looming drug and alcohol abuse crisis. But instead of meeting the challenge by hiring more personnel, Army leaders tried to make the problem disappear through bureaucratic sleight-of-hand. They apparently believed handing their substance abuse treatment program over to less-qualified and less-experienced administrators was somehow going to make a positive impact. Not surprisingly, it didn’t. During the upcoming Inspector General investigation, each of the Army’s 54 substance abuse clinics will be thoroughly evaluated over a 90-day period. Because the inquiry was announced publicly, there will be no element of surprise involved, however, raising fears that administrators will have time to cover their tracks before government investigators arrive.
Will the Army Act, or Is it All an Act?
Soldiers are being diagnosed with PTSD at astronomical levels, and tens of thousands are suffering the effects of brain trauma, serious injury, chronic pain and financial hardship resulting from years of deployment in the field. To cope with their problems, many of these individuals self-medicate with drugs and alcohol. Addiction to narcotic painkillers is also running wild among this vulnerable group. In 2014, 20,000 soldiers received treatment for a drug or alcohol addiction, which doesn’t include the 3,000 to 4,000 more who needed help but were turned away. The crisis the Army was warned about three years ago is unfolding rapidly, and unfortunately the actions taken to address the problem have only made the situation worse.